bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective Observational Study of an Eye-tracking Device for Under 12 Months of Age Infants; the Feasibility of Gazefinder
Authors: Takahashi Tomoo , Tsukamoto Kazuki , Matsumura Misaki , Takigawa Ryo , Sakai Yasuo , Maniwa Sokichi , Murphy Lynne , Taketani Takeshi , Fukushima Shuntaro
Published: January 2021

Eye-tracking to evaluate gaze patterns has developed as an assessment tool for children with Autism Spectrum Disorder (ASD). Gazefinder is one of Eye-tracking devices and few studies have investigated whether it can measure the gaze data of infants under 12 months of age. We conducted a prospective observational study from April 2019 to March 2020 in a periodic health checkup in Ohchi County, Shimane, Japan. Participants included infants between 4 and 11 months of age who were not suspected the presence of developmental problems. Ninety-three participants’ datapoints were analyzed. The mean age was 6.5 months and mean developmental quotient was 88%. The mean fixation time percentage of all sequences was 81.0% (standard deviation; 4.4), and there was no significant difference in each age group. Infants in all groups showed a significantly higher predilection for eyes than for mouths. There was a positive association of age with human gaze and a negative association with geometric gaze. Moreover, we confirmed that joint attention skills were enhanced in accordance with their growth process. The eye-tracking data were almost corresponding to previous studies’ data of infant with typical development and Gazefinder could be applied to infants starting at 4 months of age.
Risk Factors Associated With Scabies Infestation Among Schoolchildren in a Low Socio-Economic Area in Southeast of Iran
Authors: Sanei-Dehkordi Alireza , Soleimani-Ahmadi Moussa , Zare Mehdi , Jaberhashemi Seyed Aghil
Published: January 2021

Background: Scabies is a neglected tropical disease caused by the mite Sarcoptes scabiei that burrows under the skin. It is a major health problem in tropical areas, largely affecting children. Scabies is common and highly contagious and in schoolchildren spreads quite rapidly, due to overcrowding and close contact within the schools. This study aimed to determine the risk factors associated with scabies infestation among schoolchildren in Bashagard County, one of the low socio-economic areas in southeast of Iran.Methods: To conduct this community-based cross-sectional study, four primary schools were randomly selected in the Bashagard County. In each school all of the students were selected and examined for scabies. Clinical examination and sociodemographic profile of students were assessed using a pre-tested structured questionnaire. Data were analyzed using SPSS.21 software.Results: Out of 480 studied schoolchildren, there were 15 cases of scabies with a prevalence of 3.1%. The frequency of infestation in males was 1.6% and it was 4.7% in females. Independent factors associated with a high risk of scabies infestation in unadjusted analysis were being student of grade 5-6 (OR =13.12, 95% CI 2.92-58.89, p= 0.0001), being older than 10 years (OR =36.07, 95% CI 7.96-163.28, p= 0.0001), low educational level of father (OR =4.37, 95% CI 0.97-19.59, p= 0.036), low educational level of mother (OR =4.14, 95% CI 1.92-18.57, p=0.045), father’s joblessness (OR =14.77, 95% CI 4.97-43.89, p=0.0001), employment of mother (OR =5.28, 95% CI 1.38-20.16, p=0.007), large family size (OR =3.34, 95% CI 1.05-10.64, p=0.031), use of shared articles (OR =33.37, 95% CI 10.82-102.90, p= 0.0001), and absence of bathroom in the house (OR =11.77, 95% CI 2.16-63.94, p= 0.0001). Conclusion: Results of this study confirm that scabies is still one of the most important health problem in the Primary schools of the Bashagard County. Low socioeconomic status and personal hygiene of the schoolchildren were the most important factors significantly influencing the prevalence of scabies. Improvement of socioeconomic conditions and implementation of appropriate educational programs and active surveillance system to quickly detect and treat scabies cases is necessary to reduce the prevalence of scabies in schoolchildren in this area.
Identification of a Novel Genomic Region Associated With Resistance to Fusarium Head Blight in Chinese Winter Wheat
Authors: Zhao Yunzhe , Zhao Xinying , Ji Mengqi , Fang Wenqi , Guo Hong , Guo Xin , Chen Guangfeng , Tian Jichun , Deng Zhiying
Published: January 2021

The authors have requested that this preprint be removed from Research Square.
Chitosan Nanoparticles Attenuate Intestinal Damage and Inflammatory Responses in LPS-challenged Weaned Piglets via Inhibition of the NF-κB Pathway
Authors: Xu Yinglei , Ge Pu , Li Qing , Mao Huiling , Yang Caimei
Published: January 2021

Background Chitosan nanoparticles (CNP), an extensively administered oral drug carrier, were found to have anti-inflammatory properties. In this study, the effects of CNP on lipopolysaccharide (LPS)-induced intestinal damage in weaned piglets and the related mechanisms were investigated. A total of 24 piglets (21 ± 2 days, Duroc × Landrace × Yorkshire, initial mass: 8.58±0.59kg) were randomly assigned into four groups: control, LPS, CNP, and CNP+LPS. The control and LPS groups were fed a corn-soybean meal-based control diet, whereas the CNP and CNP+LPS groups were fed a control diet supplemented with 400 mg/kg CNP. After 28 days of feeding, the LPS and CNP+LPS groups were injected with LPS at 100μg/kg, meanwhile the control and CNP groups were injected with equal volumes of sterile saline solution. After 4 hours from the LPS challenge, all pigs were sacrificed for analysis.Results: CNP ameliorated the structural and developmental damages to the small intestine caused by LPS treatment. LPS induced invasion of neutrophils into the intestinal mucosa of the jejunum (P < 0.01), which resulted in marked increased secretion of marks of inflammation (p<0.01) compared with the control group. Whereas, CNP administration obviously inhibited LPS induced neutrophils invasion (P<0.01) and marks of inflammation, such as interleukin-8(p<0.05), intercellular adhesion molecule-1(p<0.05), and interferon-γ(p=0.7694), secretion in jejunum mucosa compared with LPS group. Moreover, CNP was shown to reduce cytoplasmic IκB-α degradation accompanied by reduced nuclear NF-κB p65 levels in LPS-inflamed piglets. Conclusion: CNP attenuates intestinal damage and inflammatory responses in LPS-challenged weaned piglets by impairing the NF-κB signaling pathway. These findings provide a theoretical basis for the application of CNP as a functional feed additive in piglets.
Super heavy particle production in high energy heavy ion collision
Authors: Alexey Kurepin
Published: January 2021

The estimate based on the parton model is made on the rate of production of Super Heavy Particle ( SHP ) in subthreshold collision of heavy ions at LHC. For the one-month run of lead-lead collision the yield of 16 TeV particle is of the order of 70 per year.
No-Touch Harvesting in Off-Pump Coronary Artery Bypass Grafting With Sequential Saphenous Vein Grafting: A Single-Centre Prospective Randomized Controlled Trial
Authors: Hou Xuejian , Zhang Kui , Liu Taoshuai , Li Yang , Zhao Yang , Song Bangrong , Huang Zhuhui , Xu Shijun , Zheng Jubing , Dong Ran
Published: January 2021

Background: The main graft material for coronary artery bypass grafting (CABG) is the combination of the internal mammary artery and great saphenous vein. The patency rate of vein grafts is considered not ideal; more studies support that the no-touch (NT) procedure can improve the patency rate of vein grafts. However, it is not clear that the NT technology is used in the sequential saphenous vein grafting during off-pump coronary artery bypass surgery. This study explored whether the NT technique is as safe and effective as the conventional technique in off-pump coronary artery bypass surgery using sequential vein grafts.Methods: This was a prospective single-centre randomized controlled clinical trial. A total of 200 patients undergoing off-pump coronary artery bypass grafting in the sequential saphenous graft were randomly assigned to two groups: the no-touch (NT) and conventional (CON) groups. Perioperative and postoperative data were collected during the hospital stay. The occlusion of sequential grafts was measured by cardiac computed tomography angiography (CCTA) 3 months post CABG. Leg wound complications were followed up. The mean diameter of sequential grafts for the first 100 patients was measured using CCTA 3 months after the operation.Results: The primary endpoint was that there was no difference in occlusion of sequential venous grafts between the two groups (NT: 9/180 (4.4%), CON: 5/194 (1.5%), p=0.22). Similarly, there were no differences in composite clinical events (NT: 2/91 (2.2%), CON: 1/96 (1.0%), p=0.96). There was no difference in leg wound complications between the two groups (NT: 8/91 (8.8%), CON: 4/96 (4.2%), p=0.20). However, there was a significant difference in the average diameter of sequential grafts between the two groups (NT: (2.98±0.42), CON: (3.26±0.51), p=0.005).Conclusions: The early clinical results suggest that the NT technique is as safe and effective as the conventional technique in sequential grafting in off-pump coronary artery bypass surgery. The sequential graft early expansion in the NT technique is not as pronounced as that in the conventional technique, which may have a long-term protective effect on the grafts.Trial Registration: Registered 1 November 2018, ClinicalTrials.gov NCT03729531, http://www.clinicaltrials.gov
Impact of Perioperative Use of Parecoxib on Chronic Postsurgical Pain in Elderly Patients Undergoing Hepatectomy: A Prospective Randomized Controlled Study
Authors: Ge Xiaodong , Pan Yan , Jin Danfeng , Wang Ying , Ge Shengjin
Published: January 2021

Background Chronic postsurgical pain (CPSP) in elderly patients negatively impacts recovery, quality of life, and physical functioning. This study aimed to test parecoxib's superiority versus placebo in combination with epidural anesthesia in preventing chronic post-hepatectomy pain in elderly patients.Methods One hundred and five elderly patients undergoing hepatectomy were randomized to the parecoxib group or placebo group combined with epidural anesthesia. The primary outcome was the proportion of patients with CPSP at postoperative three months. The secondary outcomes included the Short-Form McGill Pain Questionnaire score in CPSP-positive responders, acute pain intensity, postoperative analgesic demand, inflammatory markers change, and postoperative complications within 28 days. Results The parecoxib group provided a non-significant absolute 9.1% reduction in the rate of CPSP compared with the placebo group (35.3% vs. 44.4%, P=0.34). The average chronic pain verbal analog scale in the parecoxib group was lower than that in the placebo group (median (IQR) 2(1, 2) vs. 3 (2, 3), P=0.04). Significantly less moderate-to-severe acute pain at rest (4.3% vs. 17.3%, P=0.04) and with coughing (32.6% vs. 73.1%, P<0.001), less patient-controlled epidural analgesia (PCEA) consumption ( 197.4±43.6mL vs. 219.2±42.4mL, P=0.01) and less rescue analgesia (median (IQR) 0 (0, 0) vs. 1 (0, 2), P<0.001) were observed in parecoxib group. Furthermore, there was no between-group difference in inflammatory markers (P>0.05) and postoperative complications (11.8% vs.14.8%, P=0.65).Conclusions Parecoxib reduced the prevalence of CPSP in elderly patients undergoing hepatectomy under epidural analgesia from 44.4% to 35.3% with no statistical significance. Meanwhile, significantly alleviated CPSP intensity and improved acute pain management were observed.Trial Registration This study was retrospectively registered in the Chinese Clinical Trial Registry (URL: http://www.chictr.org.cn/edit.aspx?pid=56961&htm=4) on August 3, 2020 (ChiCTR-2000035198).
WITHDRAWN: Functional Analysis of Calmodulin Binding Protein 60s in Disease Resistance Responses in Rice (Oryza Sativa L.)
Authors: Kumari Diksha , Prasad Bishun Deo , Nirala R. B. P. , Sahni Sangita
Published: January 2021

BackgroundOccurrence and prevention of diseases have a big impact on sustainability of staple food crop like rice. The crosstalk between phytohormones and secondary messengers in host cell during infestation of pathogens play a pivotal role in defence responses. Apart from SA and JA, the role of brassinosteroids (BR) in defence responses in plants is unprecedented. The calcium signatures observed during early infection process modulates the expression of calmodulin and other Ca2+ binding protein followed by their interactions with calmodulin binding protein (CBP), which are pivotal in elucidating defence responses in plant. Numerous CBPs have been identified, which modulated stress responses with the help of CBD and other functional domain. Interestingly, Arabidopsis CBP60 (AtCBP60) family protein, SARD1, was involved in defense responses via SAR. However, no rice CBP60 (OsCBP60) has been identified in relation to pathogen infection yet. ResultsIn present investigation, 15 OsCBP60 genes were identified using BLASTP searchers using AtCBP60s as bait sequences. Expression studies showed that 3 OsCBP60s (OsCBP60_5, OsCBP60_10, and OsCBP60_15) genes were upregulated consistently in all the time point studied in rice seedlings treated with fungal (Magnaporthe oryzae) and bacterial (Xanthomonas oryzae) pathogens. Differential expression of OsCBP60s genes were observed in salicylic acid (SA), epi-brassinosteroid (EBR) and jasmonic acid (JA) treated rice seedlings. Taken together, OsCBP60_5 was found to be upregulated in both pathogens and two phytohormones (SA and EBR) treatment. ConclusionsThe differential expression of OsCBP60s genes under phytohormones and pathogens treatment suggests that these genes might be important targets for increasing biotic stress responses in rice.
The Role of Sex and Gender in the Selection of Alzheimer Patients for Clinical Trial Pre-screening
Authors: Rosende-Roca Maitee , Abdelnour Carla , Esteban Ester , Tartari Juan Pablo , ALARCON EMILIO , Martinez-Atienza Juliana , González-Pérez Antonio , Lafuente Asunción , Buendia Mar , Pancho Ana , Aguilera Nuria , Ibarria Marta , Diego Susana , Jofresa Sara , Hernández Isabel , López Rogelio , Gurruchaga Miren Jone , Tárraga Lluís , Marquié Marta , Valero Sergi , Ruiz Agustín , Boada Mercè
Published: January 2021

Background: Alzheimer disease (AD) is a progressive neurodegenerative disorder affecting the elderly with a prevalence of 7.1% in women and 3.3% in men aged 55 or older. Sex-related patterns have been reported in prognosis, biomarker status and risk factors. Despite this, the interaction of sex has received limited attention, with AD trials persistently recruiting lower numbers of women than the population distribution and a lack of information on the sex-disaggregated effects of anti-dementia therapies. This is the first study aiming to identify the role of sex in the selection for screening in AD clinical trials.Methods: This cross-sectional study provides a comprehensive analysis of screening eligibility according to a set of pre-selection criteria currently applied at Fundació ACE memory clinic for a more efficient trial screening process. A cohort of 6,667 women and 2,926 men diagnosed with AD dementia (55%) or mild cognitive impairment (45%) was analyzed. We also assessed the frequencies of men and women effectively screened for trial enrolment over a period of 10 years.Results: Women showed a significantly lower chance of being eligible for screening than men (OR=1.26; p<0.01). This imbalance was confirmed by a lower frequency of women screened for enrolment compared to the study population (63.0% vs 69.5%). Education was revealed as the key criterion contributing to this unbalance, with men showing over twice the chance of being screened compared with women (OR=2.25, p<0.01). Education-based differences were greater in earlier born patients, but the gap narrowed and achieved balance with increasing year of birth. Comorbidity was the most limiting criterion with sex differences in frequencies and significant discrimination against the selection of men (OR=0.86, p<0.01).Conclusions: The large number of low-educated elderly women with AD demands for a sex-focused approach in clinical research. New assessment tools insensitive to education level should be develop to enable a proportional representation of women. Although this gender education gap is mostly inexistent in developed countries, economic or cultural factors may lead to different scenarios in other regions. Overlooking the impact of sex may lead to a handicap in AD research with a direct adverse impact on women’s health.
Routine Health Information Use for Decision-making and Associated Factors among Managers Working at Public Hospitals in North Shewa Zone of Oromia Regional State, Ethiopia: A Mixed-Method Study
Authors: Tulu Gemechu , Demie Takele Gezahegn , Teshome Tesfalem
Published: January 2021

Background: Routine health information systems (RHIS) are vital for the acquisition of data for health sector planning, monitoring, and evaluation, patient management, health education, resource allocation, disease prioritization, and decision-making. Routine health information use for decision-making is low in Ethiopia. Thus, the study aimed to assess level of routine health information use and its associated factors among managers working at public hospitals in North Shewa, Ethiopia.Methods: A facility-based cross-sectional study design with both quantitative and qualitative data collection methods was conducted from May to June 2020. A total of 102 randomly selected managers working in public hospitals in North Shewa were included in the quantitative study while six in-depth interviews were performed for the qualitative method. Quantitative data were collected using a structured self-administered questionnaire and interview guide by trained data collectors, cleaned, coded, and entered into Epi-info version 7.1 software and transferred into SPSS version 23 software for Window for further statistical analysis. Both bivariable and multivariable logistic regression analyses were performed. In the multiple logistic regression analysis, a less than 0.05 P-value was considered statistically significant. The odds ratio along with a 95% confidence interval (CI) were estimated to measure the strength of the association. Thematic analysis was done for key informant interview data.Result: In this study, the level of routine health information use for decision-making was 71.6% (95% CI: 61.8%, 79.4%). According to the multivariable logistic regression analysis, training on health information system (AOR = 0.28, 95% CI: 0.08-0.98) and supportive supervision (AOR = 0.27, 95% CI: 0.09-0.78) were found significantly associated with the use of routine health information for decision-making. Moreover, the lack of staff motivation and computer and data analysis skills were the major reasons for not using routine health information.Conclusions: Three-fourth of the managers working at public hospitals used routine health information for decision-making. Training on health information system and supportive supervision were factors associated with the use of routine health information. Therefore, training of managers and the provision of supportive supervision were highly recommended to improve the use of routine health information managers for decision-making at public health institutions.
Development and Characterization of Nb3Sn/Al2O3 Superconducting Multilayers for High-performance Radio-Frequency Applications
Authors: Sundahl Chris , Makita Junki , Welander Paul , Su Yi-Feng , Kametani Fumitake , Xie Lin , Zhang Huimin , Gurevich Alex , Eom Chang-Beom , Li Lian
Published: January 2021

Superconducting radio-frequency (SRF) resonator cavities provide extremely high quality factors > 1010 at 1-2 GHz and 2K in large linear accelerators of high-energy particles. The maximum accelerating field of SRF cavities is limited by penetration of vortices into the superconductor. Present state-of-the-art Nb cavities can withstand up to 50 MV/m accelerating gradients and magnetic fields of 200-240 mT which destroy the low-dissipative Meissner state. Achieving higher accelerating gradients requires superconductors with higher thermodynamic critical fields, of which Nb3Sn has emerged as a leading material for the next generation accelerators. To overcome the problem of low vortex penetration field in Nb3Sn, it has been proposed to coat Nb cavities with thin film Nb3Sn multilayers with dielectric interlayers. Here, we report the growth and multi-technique characterization of stoichiometric Nb3Sn/Al2O3 multilayers with good superconducting and RF properties. We developed an adsorption-controlled growth process by co-sputtering Nb and Sn at high temperatures with a high overpressure of Sn. The cross-sectional scanning electron transmission microscope images show no interdiffusion between Al2O3 and Nb3Sn. Low-field RF measurements suggest that our multilayers have quality factor comparable with cavity-grade Nb at 4.2 K. These results provide a materials platform for the development and optimization of high-performance SIS multilayers which could overcome the intrinsic limits of the Nb cavity technology.
Secondary Analysis on Malaria RDTs in WHO Product Testing from Round 5 to 8 on False Negative Results in Testing Sample
Authors: Xu Biao , Tu Bo , Chu Fang , Jalloh Mohamed , Mu Jinsong , Zheng Junjie , Chen Weiwei
Published: January 2021

Background

with the widespread use of malaria rapid diagnostic tests (RDTs) in clinical practice, they also show their own challenges. Compared with most of the attention focusing on false positive results in WHO product testing, the same important false negative results attract insufficient focus.

Method

data of 129 malaria RDTs in the summary of WHO rounds 5 to 8 product testing was secondary analyzed in 5 aspects including low parasite density, improper RDTs storage, operation and interpretation, P. falciparum (Pf) with pfhrp2/3 genes deletion, inter-lot variation.

Results

First, the percentage of tests that achieved a panel detection score (PDS) < 80% at a low parasite density was 20-25% for Pf, and substantially higher for P. vivax (Pv). Second, Some Pv- and Pf- detecting products showed an increasing deterioration with increase of storage temperature. Third, approximately 20-27% products’ performances were unsatisfied in blood safety and instruction quality; and 30-35% test bands of the RDTs for Pf were barely visible, and the ones for Pv returned a higher proportion of weak band intensity. Fourth, different Lots of each test products may produce inconsistent results. Fifth, many malaria RDTs obtained a low PDS (< 50%) and a high false negative rate (> 50%) when testing Pf with deletion of pfhrp2/3 gene.

Conclusion

the malaria RDTs currently widely used were overestimated and could cause false negative results in practice. The clinicians should be aware of these shortcomings in order to draw more accurate diagnosis and treatment.
Factors Affecting Addiction Severity Index (ASI) among Clients Enrolled in Methadone Maintenance Treatment (MMT) Program in Myanmar
Authors: Tun Sun , Balasingam Vicknasingam , Singh Darshan Singh
Published: January 2021

Background: Opioid substitution with methadone maintenance treatment (MMT) is shown to reduce illicit opioid use and renew social-functioning. Understanding factors that undermine clients’ social-functioning during MMT treatment is vital for improving treatment compliance and quality of life. Method: A total of 210 respondents who were presently enrolled in formal MMT program in Myanmar were recruited from five cities through stratified random sampling for this cross-sectional study. The Addiction Severity Index (ASI) was used to objectively assess respondents social-functioning in the last 30 days. Higher ASI scores denotes poorer social-functioning. Result: Respondents total ASI scores in the respective domains were; employment (47.4%), alcohol (44.4%), drug use (7.2%), legal (49.2%) and social-family relationship (10.7%). Those reported to have never injected drugs in the last 30 days had lower ASI scores than those who reported injection drug use (p=0.026). After identifying the differences in ASI total scores, we found there are significant associations in the clients’ Hepatitis C status, age category, frequency of heroin injection, quality of life score, marital status, current leisure status with family/friend, current history of injection in the last 30 days, income status, satisfaction with current marital status, as well as reported drug and alcohol use (p<0.05). Stepwise binary logistic regression showed alcohol and higher frequency of heroin injection is associated with higher ASI scores. Meanwhile, older age respondents, those who had leisure time with family, and satisfied with current marital status had lower ASI scores (p<0.05). Conclusion: Our results indicate that those enrolled in MMT program in Myanmar faced many challenges in their daily social-functioning. Treatment providers must take heed of these apparent impediment to ensure clients chequered social-functioning do not undermine their treatment compliance. Trial registration: NA
Influence of dietary and lifestyle factors on blood pressure control among adult hypertensive patients under care in Uganda
Authors: Nakalega Patience Annet , Mugenyi Levicatus , Nuwabaine Lilian , Amperiize Mathius , Tabusibwa Barbara Kirunda
Published: January 2021

Background Hypertension is an important worldwide public-health challenge because of its high prevalence and for being a risk factor for cerebrovascular, cardiovascular and chronic renal disease. Despite these risk factors, blood pressure control among hypertensive patients is still poor. Objectives To assess dietary and lifestyle factors associated with uncontrolled blood pressure control among a series of Ugandan hypertensive patients under care at a Kiruddu hospital.Methods A cross sectional study involving 271 adult hypertensive patients attending general outpatient hypertensive clinic were enrolled. We collected data on dietary and lifestyle factors, social demographics, BMI, comorbidities, and adherence to hypertensive medication. Dietary factors were based on recommended DASH diet including nine food items salt; grains; fruits; vegetables; nut/seeds, and legumes; dairy; meat; fat; and sweets. Questionnaires on alcohol intake, smoking status and level of physical activity were also administered. An average of the previous two Blood pressure readings were recorded while weight and height were measured for each subject at enrolment. Factors associated with uncontrolled blood pressure (>140/90mmHg) were assessed using a multivariate logistic regression model.Results The mean age of study participants was 57 years (SD ± 0.76 years), with female dominance (77.9%). Among the study participants, 121 (44.7%) had uncontrolled BP. Dietary factors that remained significantly associated with uncontrolled blood pressure with adjusted OR (95%CI) included consumption of raw salt: 4.18 (1.32-13.24) and inadequate fruit consumption (less than 7days/week): 2.18 (1.26-3.75) while clinical factors included being overweight: 2.51 (1.27-4.95) and poor adherence to antihypertensive medications prescribed: 1.82 (1.03-3.21).Conclusion The proportion of hypertensive patients with uncontrolled BP was high (44.7%). Consumption of raw salt, inadequate fruit consumption being overweight and poor adherence to antihypertensive medication were significantly associated with uncontrolled BP. From these findings, many of the factors that impact on the control of blood pressure are fortunately modifiable.
Transmission frequency of covid-19 through pre-symptomatic and asymptomatic patients in AJK: A report of 201 cases
Authors: Mahmood Majid , Ilyas Noor-ul-ain , Khan Muhammad , Hasrat Muhammad
Published: January 2021

Background: Corona virus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, declared as “once-in-a-century” pandemic, has affected about entire human population. Till now, the most promising control strategy is to block the transmission which will never be effective without completely knowing the transmission patterns.Methods: This was a retrospective case to case study aiming to estimate and calculate the transmission rate of COVID-19 through pre-symptomatic and asymptomatic patients. Contact history of included positive cases during the period of 24 hours before appearance of symptoms and infection confirmation for symptomatic and asymptomatic cases respectively was traced for disease transmission. Results: Overall, a total of 201 cases had contacted with 7168 people in last 24 hours with an average of 35.66 contacts per patient ranging from a minimum of 4 to maximum of 87 contacts (Meetings). Out of 7168 meeting persons, the infection was traced in 64 (0.89%) persons. For 155 symptomatic patients, a total of 5611 contacting persons were traced before appearance of symptoms (pre-symptomatic) in last 24 hours with an average of 36.20 meetings per patient. The infection was transmitted in 63 (1.12%) people and remaining 5548 (98.88%) were remained uninfected. Out of the 63 transmissions, 62 (98.4%) were traced within last 6 hours before the onset of symptoms while only 1 was traced from 6-12 hours before symptoms. A total of 1557 persons were traced having meeting/contacts with asymptomatic cases in last 24 hours before their infection confirmation. Out of these 1557 persons, only 1 was found to be infected and the infection rate was calculated to be 0.06%. Conclusion: The study concludes that the risk of pre-symptomatic transmission of infection is low (1.12%) and it becomes very rare in contacts made longer than 6 hours before onset of symptoms. The infection transmission is traced as long as about 9 hours before the appearance of clear symptoms in the patients but the incidence was as low as about 0.02% of the total contacts in that period. Transmission frequency by asymptomatic patients is also rare (0.06%) in the studied population.
Elevated Liver Enzymes and Incident Type Two Diabetes Mellitus Risk in Yemeni Patients     
Authors: Dahman Lotfi S. Bin , Barahman Omer M. , Humam Mariam A. , Musiaan Nabil S. , Daakik Ahmed M.
Published: January 2021

Liver disease is a major cause of morbidity and mortality in patients with type two diabetes mellitus (T2DM). This case-control study was aimed to assess the association between liver enzymes and incident T2D in Yemeni patients. The present study comprising 142 T2D patients and 142 healthy control subjects were recruited from the diabetic outpatient clinic of Ibn-Sina hospital in Mukalla during the period from 1st January to 30th May 2020. Serum fasting blood glucose (FBG), total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) were analyzed using the Cobas Integra Plus 400 autoanalyzer. Also, anthropometric and blood pressure measurements were taken from each participant. T2D patients had significantly higher FBG (P= <0.0001), total cholesterol (P= <0.0001), LDL-C (P= <0.0001), and GGT (P= <0.0001) while, HDL-C was significantly lower in T2D patients (P= 0.021). In correlation analysis, serum GGT levels were positively associated with systolic BP (r= 0.134; P= 0.025), diastolic BP (r= 0.218; P= <0.001), FBG (r= 0.216; P= <0.0001), total cholesterol (r= 0.196; P= 0.0001), triglyceride (r= 0.123; P= 0.038), and LDL-C (r= 0.209; P= <0.0001). Also, serum ALT and GGT levels were significantly associated with increased incident T2D risk (P= 0.006 for ALT and 0.022 for GGT) and the odds ratio at 95% CI comparing highest versus lower tertiles of ALT and GGT were 2.75(2.01-3.48) and 1.17(1.83-6.42) respectively. In conclusion, higher levels of ALT and GGT are positively associated with increased blood glucose levels and may be used as the predictive biomarkers in developing higher risk of diabetes. Thus, routine screening of ALT and GGT in T2D patients is recommended for the early detection of liver disorders.
Biventricular surgical repair of “Swiss Cheese” ventricular septal defects with two-patch and right ventricle apex excluding technique: preliminary experience and clinical results
Authors: Wu Qin , Shi Lei , Chen Rui , Xing Quansheng
Published: January 2021

Background “Swiss Cheese” ventricular septal defects (VSDs) is a kind of rare and complex congenital heart defects and the surgical management remains controversial and a challenge. We reviewed our preliminary clinical experience on biventricular surgical repair of “Swiss Cheese” VSDs with two-patch and right ventricle apex excluding technique in 10 cases.Methods From May 2014 to December 2019, a series of 10 patients (M/F=3/7) were admitted in our center. 9 cases underwent one-stage surgical repair with two-patch and right ventricle apex excluding technique and 1 case received two-stage surgical repair with the same technique. Surgical repair was done with cardiopulmonary bypass (CPB) in all cases. 2 fresh autologous pericardium patches were used to close defects of the outflow tract area and the apex trabecular area respectively and as a result, the right ventricular apex was excluded from the right ventricular inflow tract.Results All operations were successful. Median CPB time and aortic clamping time were 96 min and 68 min respectively. Delayed chest closure was performed in 2 cases within 48-72 hours postoperatively. The Median time of mechanical ventilation and ICU stay were 131.3 hours and 8 days respectively. Median length of hospital stay after operation was 11 （9-42）days. There was no mortality and major complication except for 2 cases of ventilator associated pneumonia. There was no death and major complication during a median follow-up time of 3.2 years.. The latest echocardiography results showed the left and right heart function was normal in all the cases.Conclusions Biventricular surgical repair of “Swiss Cheese” VSDs with two-patch of fresh autologous pericardium and right ventricle apex excluding technique in infants is safe and feasible with favorable early and mid-term results. Long term results need to be evaluated with more cases.
The meaning of postpartum sexual health for women living in Spain: A phenomenological inquiry.
Authors: Pardell-Dominguez Lidia , Palmieri Patrick Albert , Dominguez-Cancino Karen A. , Camacho-Rodriguez Doriam E. , Edwards Joan E. , Watson Jean , Leyva-Moral Juan M.
Published: January 2021

Background: Sexual health is a multidimensional phenomenon constructed by personal, social, and cultural factors but continues to be studied with a biomedical approach. During the postpartum period, a woman transitions to mother, as well as partner-to-parent and couple-to-family. There are new realities in life in the postpartum period, including household changes and new responsibilities that can impact the quality of sexual health. This phenomenon is understudied especially in the context of Spain. The purpose of this study was to describe the lived experience of postpartum sexual health among primiparous women giving birth in Catalonia (Spain).Methods: This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi's seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis.Results: Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model.Conclusion: Evidence-based practices should incorporate the best evidence from research, consider the postpartum sexual health experiences and preferences of the woman, and use clinician expertise in discussions that include the topic of postpartum sexual health to make decisions. As such, human caring practices should be incorporated into clinical guidelines to recognize the preferences of women. Clinicians need to be authentically present, engage in active communication, and individualize their care. More qualitative studies are needed to understand postpartum sexual health in different contexts, cultures, and countries and to identify similarities and differences through meta-synthesis.
Regulation of Osteoclastogenesis by Mast Cell in Rheumatoid Arthritis
Authors: Kim Kyoung-Woon , Kim Bo-Mi , Won Ji-Yeon , Min Hong-Ki , Lee Kyung-Ann , Lee Sang-Heon , KIM HAE-RIM
Published: January 2021

Background: We aimed to define the inflammatory and tissue-destructive roles of mast cells in rheumatoid arthritis (RA). Methods: Serum and synovial fluid (SF) concentration levels of tryptase, chymase, and histamine were quantified using ELISA. After activating mast cells using IL-33, the production of TNF-a, IL-1b, IL-6, IL-17, RANKL, and MMPs was determined using real-time PCR and ELISA. Osteoclastogenesis was assessed in CD14+ monocytes from peripheral blood and SF, which were cultured with IL-33-activated mast cells, by counting TRAP-positive multinucleated cells. Results: The concentration levels of serum tryptase, chymase, and histamine and SF histamine were higher in patients with RA than in controls. FceR1 and c-kit-positive mast cells were higher in RA synovium than in osteoarthritic (OA) synovium. Stimulation of mast cells by IL-33 increased the number of trypatse+chymase- and tryptase+chymase+ mast cells. IL-33 stimulation also increased the gene expression levels of TNF-a, IL-1b, IL-6, IL-17, RANKL, and MMP-9 in mast cells. Furthermore, IL-33 stimulated human CD14+ monocytes to differentiate into TRAP+ multinucleated osteoclasts. When CD14+ monocytes were co-cultured with mast cells, osteoclast differentiation was increased. Additionally, IL-33-activated mast cells stimulated osteoclast differentiation. The inhibition of intercellular contact between mast cells and monocytes using inserts reduced osteoclast differentiation. Conclusions: IL-33 increased inflammatory and tissue destructive cytokines by activation of mast cells. Mast cells stimulated osteoclast differentiation in monocytes. Mast cells could stimulate osteoclastogenesis indirectly through production of tissue destructive cytokines and directly through stimulation of osteoclast precursors.
Comparison of levonorgestrel level and creamatocrit in milk following immediate vs. delayed postpartum placement of the levonorgestrel IUD
Authors: Hopelian Niaree , Simmons Rebecca G. , Sanders Jessica N , Ward Katherine , Jenkins Sabrina Malone , Espey Eve , Turok David K
Published: January 2021

Background: Breastfeeding and postpartum contraception critically influence infant and maternal health outcomes. In this pilot study, we explore the effects of timing and duration of postpartum levonorgestrel exposure on milk lipid and levonorgestrel content to establish baseline data for future research.Methods: This sub-study recruited a balanced convenience sample from 259 participants enrolled in a parent randomized controlled trial comparing immediate to delayed (4-8 weeks) postpartum levonorgestrel IUD placement. All planned to breastfeed, self-selected for sub-study participation, and provided the first sample at 4-8 weeks postpartum (before IUD placement for the delayed group) and the second four weeks later. We used the Wilcoxon rank sum (inter-group) and signed rank (intra-group) tests to compare milk lipid content (creamatocrit) and levonorgestrel levels between groups and time points.Results: We recruited 15 participants from the immediate group and 17 from the delayed group with 10 and 12, respectively, providing both early and late samples. Initially, median levonorgestrel concentration of the immediate group (n=10) (32.5 pg/mL, IQR: 24.8, 59.4) exceeded that of the delayed group (n=12) (17.5 pg/mL, IQR: 0.0, 25.8) (p=0.01). Four weeks later, the values aligned: 26.2 pg/mL (IQR: 20.3, 37.3) vs. 28.0 pg/mL (IQR: 25.2, 40.8). Creamatocrits were similar between both groups and timepoints.Conclusions: Immediate postpartum levonorgestrel IUD placement results in steady, low levels of levonorgestrel in milk without apparent effects on lipid content. These findings provide initial support for the safety of immediate postpartum levonorgestrel IUD initiation, though the study was not powered to detect noninferiority between groups. Trial Registration: This randomized controlled trial was registered with ClinicalTrials.gov (registry number NCT01990703) on November 21, 2013.
Electronic Forms For Patient Reported Outcome Measures (PROMs) ARE AN Effective, Time-Efficient, And Cost-Minimizing Alternative To Paper Forms
Authors: Yu Jennifer Y , Goldberg Talia , Lao Nicholas , Feldman Brian M , Goh Y. Ingrid
Published: January 2021

BACKGROUND: Patient reported outcome measures (PROMs) provide valuable insight on patients’ well-being and facilitates communication between healthcare providers and their patients. The increased integration of the technology within the healthcare setting presents the opportunity to collect PROMs electronically, rather than on paper. The Childhood Health Assessment Questionnaire (CHAQ) and Quality of My Life (QoML) are common PROMs collected from pediatric rheumatology patients. The objectives of this study are to a) determine the equivalence of the paper and electronic forms (e-form) of CHAQ and QoML questionnaires; b) identify potential benefits and barriers associated with using an e-form to capture PROMs; and c) gather feedback on user experience. METHODS: Participants completed both a paper and an e-form of the questionnaires in a randomized order, following which they completed a feedback survey. Agreement of the scores between the forms were statistically analyzed using the intraclass correlation coefficient (ICC) (95% Confidence Interval (CI)) and bias was assessed using a Bland-Altman plot. Completion and processing times of the forms were compared using mean and median measures. Quantitative analysis was performed to assess user experience ratings, while comments were qualitatively analyzed to identify important themes.RESULTS: 196 patients participated in this project. Scores on the forms had high ICC agreement >0.9. New patients took longer than returning patients to complete the forms. Overall, the e-form was completed and processed in a shorter amount of time than the paper form. 83% of survey respondents indicated that they either preferred the e-form or had no preference. Approximately 10% of respondents suggested improvements to improve the user interface.CONCLUSIONS: E-forms collect comparable information in an efficient manner to paper forms. Given that patients and caregivers indicated they preferred completing PROMs in this manner, we will implement their suggested changes and incorporate e-forms as standard practice for PROMs collection in our pediatric rheumatology clinic.
Microorganisms and clinical outcomes of early- and late-onset ventilator-associated pneumonia at Srinagarind Hospital, a tertiary center in Northeastern Thailand
Authors: Arayasukawat Pavarit , So-ngern Apichart - , Reechaipichitkul Wipa , Chumpangern Worawat , Arunsurat Itthiphat , Ratanawatkul Pailin , Chuennok Wanna
Published: January 2021

Background: Ventilator-associated pneumonia (VAP) is a common nocosomial infection in intensive care unit (ICU). Local microbiological surveillance of pathogens and resistance patterns for early-onset VAP (EOVAP) and late-onset VAP (LOVAP) will help to choose appropriate empiric antibiotics. Objective: To compare the multi-drug resistant (MDR) pathogens, treatment outcomes, and factors associated with hospital mortality of VAP. Method: A cross-sectional study between 1 January 2015 and 31 December 2017 at Srinagarind hospital, Khon Kaen University was conducted. The demographic data, causative pathogens, hospital length of stay (LOS), ICU LOS, mechanical ventilator (MV) days, and hospital mortality were retrospectively reviewed. Results: One hundred and ninety patients were enrolled; 42 patients (22%) were EOVAP and 148 patients (78%) were LOVAP. Acinetobacter baumannii was the most common pathogen in both groups (50 % EOVAP vs 52.7% LOVAP). MDR pathogens were significant greater in LOVAP (81.8 %) than EOVAP (61.9%) (p = 0.007). The EOVAP had a significantly better ICU LOS (median (interquartile range, IQR) 20.0 (11.0, 30.0) vs. 26.5 (17.0, 43.0) days), hospital LOS (median (IQR) 26.5 (15.0, 44.0) vs. 35.5 (24.0, 56.0) days) shorter MV days (median (IQR) 14.0 (10.0, 29.0) vs. 23.0 (14.0, 35.5) days) and lower hospital mortality (16.7% VS 35.1%) than LOVAP (p < 0.05). The factor associated with hospital mortality was having simplified acute physiology (SAP) II score ≥ 40 with an adjusted odds ratio (aOR) of 2.22 (95% confidence interval (CI), 1.08-4.54, p = 0.02). Conclusion: LOVAP had significantly higher MDR pathogens, MV days, ICU LOS, hospital LOS and hospital mortality than EOVAP. A broad-spectrum antibiotic to cover MDR pathogens should be considered in LOVAP. The factor associated with hospital mortality of VAP was a SAPII score ≥ 40.
Sociodemographic and lifestyle correlates of exclusive breastfeeding practices among mothers on antiretroviral therapy in the Eastern Cape, South Africa
Authors: Goon Daniel Ter , Ajayi Anthony Idowu , Adeniyi Oladele Vincent
Published: January 2021

Background: Exclusive breastfeeding (EBF) is associated with a reduction of postnatal HIV transmission and optimal infant growth. Given that the factors influencing exclusive breastfeeding are multi-factorial and context-specific, we examined the prevalence and factors associated with exclusive breastfeeding practice in the first six months among mothers on antiretroviral therapy in the Eastern Cape, South Africa. Methods: This was a cross-sectional study conducted between January – May 2018 on 469 parturient women enlisted in the prevention of mother-to-child HIV transmission cohort study in the Eastern Cape. Mothers were asked to recall whether they breastfed their infant exclusively with breast milk from birth and if so, to state how long they did. We collected relevant sociodemographic, lifestyle, and maternal information by interview. Bivariate and multivariable logistic regression analyses were fitted to determine the sociodemographic and lifestyle factors associated with exclusive breastfeeding practice.Results: The prevalence of six-month exclusive breastfeeding, measured since birth, was 32.0%. EBF’s prevalence was significantly higher among married women (36.8%), unemployed women (36.6%), non-smokers (32.7%), and those who never drank alcohol (37.0%). Unemployed women [adjusted odds ratio (AOR) = 1.66, 95% Confidence Interval CI), 1.08-2.56] and those with grade 12 or less level of education (AOR =2.76, 95% CI, 1.02-7.49) had a higher likelihood of practising EBF for six months since birth while mothers who consumed alcohol (AOR = 0.54, 95% CI, 0.34-0.85) were less likely to practice EBF for six months. Conclusions: The prevalence of six-month exclusive breastfeeding in the study, although comparable with sub-Saharan Africa and worldwide prevalence, remains suboptimal. Advocacy campaigns on EBF must target alcohol cessation and the creation of a favourable workplace environment for lactating mothers.