bluuebunny/crossref_metadata_2025 huggingface dataset:
The US-China Rivalry in the Middle East: Confrontation or Competitive Coexistence
Authors: Chaziza Mordechai
Published: April 2024

A new era of great power rivalry has returned to the center of the global stage. The Middle East has emerged as one of the key arenas where this rivalry is being played out, and analyzing it through the lens of power transition theory provides valuable insights into the dynamics at play. This study focuses on the great power rivalry between the United States and China in the Middle East through the lens of power transition theory. It examines whether this great power rivalry in the region will allow them to pursue competitive coexistence or if they can expect increasing levels of confrontation and mutual deterrence. The study maintains that the US-China rivalry in the Middle East is multidimensional and spans primarily three dimensions: geo-economic (the Belt and Road Initiative framework), geopolitical (partnership diplomacy), and the race for technological supremacy (the Digital Silk Road). While conflict is not inevitable, it is essential to recognize the potential for confrontation and build a coordinated mechanism to manage and mitigate these tensions.
Epistemic Violence Embedded in Urban Policy: Locating Internal Migrants in Pune’s Smart City Mission
Authors: Rajput Kuldeepsingh
Published: April 2024

This article argues that the fundamental cause for migrants’ exclusion, precarity and the othering process in the ‘smart city’ lies in the epistemic violence against them, embedded in the Smart City Mission itself, which develops the knowledge framework of ‘inclusion and exclusion’. An epistemology constructs and shapes the knowledge and ideas of smart cities and the power structures which consequently influence urban government functionaries, urban planners and officials of the Smart City Mission Project Corporation. This constructed knowledge and perception of the smart city serves the interests of the ‘middle-class citizen’ by giving overwhelming importance to smart technologies and infrastructure growth. On the other hand, it systematically disadvantages internal migrants by excluding them at several levels. This epistemic violence has successfully distorted the reality of the existence and contribution of migrants in cities and portrayed a picture of ‘feel-good cities’ pleasing their middle-class citizens. At the same time, it deflects inclusion-directed interventions which would have had a significant positive impact on the lives of the migrants. It normalises the miseries of migrants and validates the salience of urban policy in protecting migrants’ rights. Consequently, migrants experience multiple and interconnected forms of violence and victimhood in their everyday life and remain unheard.
Axial Rotation Analysis in Total Ankle Arthroplasty Using Weight-Bearing Computer Tomography and Three-Dimensional Modeling
Authors: Efrima Ben , Barbero Agustin , Ovadia Joshua , Indino Cristian , Maccario Camilla , Usuelli Federico Giuseppe
Published: April 2024

Introduction/Purpose:

Post-operative alignment is the most critical indicator for a successful total ankle arthroplasty (TAA). Total ankle malrotation is associated with an increased risk for polyethylene wear and medial gutter pain. Currently, there is no consensus on the correct way to measure the alignment of the tibial and talar component rotations in the axial plane. In the current study, the post-operative analysis system was assessed using weight-bearing computer tomography and a three- dimensional (3D) model. The purpose of the study was to assess the inter-observer and intra-observer agreement of this system.

Methods:

Four angles were measured by two raters independently in two separate readings: posterior tibial component rotation angle (PTIRA), posterior talar component rotation angle (PTARA), tibia talar component axial angle (TTAM), and tibial component to the second metatarsal angle (TMRA). Agreement analysis was quantified according to the interclass coefficient.

Results:

Sixty TAAs across 60 patients were evaluated. A good inter-observer agreement and intra-observer agreement when measuring the PTIRA, PTARA, and TTAM angles was observed along with an excellent inter-observer agreement and intra- observer agreement when measuring the TMRA angle.

Conclusion:

In conclusion, the current 3D model-based measurement system demonstrates good to excellent inter and intra- agreement. According to these results, 3D modelling can be reliably used to measure and assess the axial rotation of TAA components. Figure 3: Example case of how to measure the angles for assessing axial rotation of TAA and forefoot. 3 A) Posterior TIbial component Rotational Angle (PTIRA). The chosen slice is the one with the straightest posterior wall component of the tibia. The angle is measured on the following steps. First a reference is put on the posterior wall of the tibial component (blue horizontal line). Then the angle is measured starting from the center of the tibial axis (red dot explained on fig. 2), going to the fibular axis (medial part of the red line at the right of the draw), and finally ending 90° to the posterior reference line. 3 B) Posterior TAlar component Rotational Angle (PTARA). The chosen slice is the one with the straightest posterior wall component of the talus. For the angle measurement. The same steps as figure 3 A are followed with the talar component. 3 C) Talar component to 2nd Metatarsal Rotational Angle (TMRA): Defined as an intersection between a line parallel to the lateral border of the tibia component and a line perpendicular to the anatomical axis of the second metatarsal. This was measured using a 3D rendering tool
Comparison of Complication Rates and Surgical Costs for Total Ankle Replacements Performed in the Outpatient vs Inpatient Setting
Authors: Nixon Devon , Ko Hyunkyu , Martin Brook
Published: April 2024

Introduction/Purpose:

Increasing data has highlighted the safety and cost-effectiveness of outpatient hip, knee, and shoulder arthroplasty. However, limited evidence – mainly small, single institution case series – has explored complication rates and costs between outpatient and inpatient total ankle arthroplasty (TAA) surgeries.

Methods:

Utilizing Medicare claims from 2016 to 2019, we retrospectively identified patients ≥65 years of age who underwent TAA based on CPT coding. Patients on Medicare HMO, under age 65, and dual-eligible patients were excluded. Within this dataset, we compared surgeries performed in the outpatient versus inpatient setting. We compared groups based on readmission, all-complication, and infection rates within 1-year of TAA using logistic regressions controlling for age, sex, race, and comorbidity. To help mitigate bias, we also performed a propensity matched model with the same variables. Data were reported as percentage point (PPT) differences (95% CI) between groups, with a positive number indicating higher complication rates and costs among patients treated in the inpatient setting.

Results:

In total, 8,281 total ankle arthroplasty cases were identified (outpatient: 5,524 and inpatient: 2,757. Compared to inpatient cases, outpatient TAA surgeries were performed on younger, healthier (as assessed by Charlson Comorbidity Index (CCI) scores) patients who were more likely to be female (p < 0.001). In logistic regression analyses, outpatient TAA cases had lower readmission, all-complication, infection, mortality, and device-associated complication rates (p < 0.001) as compared to inpatient surgeries. Further, outpatient surgeries had sizable cost reductions compared to inpatient surgeries (p < 0.001).

Conclusion:

TAA performed in the outpatient setting appears to have less complications and decreased cost compared to inpatient procedures – though inpatient surgeries were presumably riskier as they were performed on older patients with increased co-morbidities. When clinically appropriate, though, TAA as an outpatient procedure appears to provide substantial reductions in cost with notable reductions in surgical risk.
Outcomes Following Extracellular Matrix Cartilage Allograft for the Management of Osteochondral Lesions of the Talus: A Systematic Review
Authors: Butler James J. , Hartman Hayden , Vargas Luilly , Dhillon Ravneet , Randall Grace W. , Wingo Taylor , Kennedy John G.
Published: April 2024

Introduction/Purpose:

The purpose of this systematic review was to evaluate the clinical and radiographic outcomes in patients who received extracellular matrix cartilage allograft (EMCA) during surgical intervention for osteochondral lesions of the talus (OLT).

Methods:

During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies evaluating outcomes in patients who received EMCA during surgical intervention for osteochondral lesions of the talus. Data regarding lesion characteristics, surgical characteristics, subjective clinical outcomes, radiographic outcomes, complication rates, failure rates and secondary surgical procedure rates were extracted and analysed. In total, 5 clinical studies were included in this review.

Results:

In total, 162 patients received EMCA during surgical intervention for OLT at a weighted mean follow-up of 23.8 ± 4.2 months. The weighted mean lesion area was 77.9 ± 42.6 mm2. Overall, 111 (68.5%) of OLTs were located medially, 45 (27.8%) of OLTs were located laterally and 6 (3.7%) OLTs were located centrally. Four studies performed arthroscopic debridement and bone marrow stimulation with ECMA, 3 studies utilized concentrated bone marrow aspirate and 1 study performed autologous osteochondral transplantation. Improvements were noted in AOFAS, FAOS and VAS scores following surgical intervention. The weighted mean post-operative MOCART score was 76.3 ± 2.9. In total, 17 (10.5%) complications were reported across the 5 studies. Twelve failures (7.4%) were recorded, all of which required further surgical intervention.

Conclusion:

This systematic review demonstrated improvements in subjective clinical outcomes and radiological outcomes at short-term follow-up following surgical intervention for OLTs augmented with ECMA. A low failure rate and moderate complication rate was noted. However, there was marked heterogeneity between the included studies with regards to surgical technique utilized, lesion size and patient cohort size. Further research is warranted to determine the optimal role of ECMA in the management of OLT.
Visual Improvement Despite Macular Pucker After Inverted Internal Limiting Membrane Flap Technique for Idiopathic Macular Hole
Authors: Buckle Miranda , Jawaheer Lona , Keller Johannes
Published: April 2024

Purpose: To report a case of a macular pucker forming after macular hole (MH) repair with the inverted internal limiting membrane (ILM) flap technique, with resolution after secondary inverted ILM flap peeling. Methods: A single case was evaluated. Results: A 76-year-old woman presented with reduced central vision (28 letters) in the right eye. Optical coherence tomography (OCT) identified an idiopathic full-thickness MH measuring 629 µm in diameter. The patient had pars plana vitrectomy with inverted ILM flap formation. One month postoperatively, the visual acuity (VA) in the right eye was 47 letters and OCT confirmed MH closure. However, the patient developed deterioration in the central vision 10 months postoperatively. A macular pucker in the inverted ILM flap region was found on OCT. Repeat vitrectomy with inverted ILM flap peeling was performed. Postoperatively, the VA in the right eye improved to 60 letters and OCT showed resolution of the macular pucker. Conclusions: A complication of the inverted ILM flap technique for MH is formation of a macular pucker in the region of the inverted ILM flap. Secondary inverted ILM flap peeling results in resolution of the macular pucker.
A mixed-methods systematic review investigating the use of digital health interventions to provide palliative and end-of-life care for patients in low- and middle-income countries
Authors: Dilhani Weerasingha Navarathnage Sachintha , Mitchell Sarah , Dale Jeremy , Toor Kavanbir , Javaid Mikail , MacArtney John I.
Published: April 2024

Background:

The need for palliative care is rising globally with 76% of those who are in need living in low- and middle-income countries (LMICs). Digital health interventions (DHIs) have been identified as a means of making palliative care more widely accessible. This review summarizes the range and characteristics of DHIs used to deliver palliative care in LMICs and sought to identify factors that influence their implementation and utilization.

Objectives:

This review aims to summarize the range and characteristics of DHIs used to deliver palliative care in LMICs and identify factors that influence their implementation and utilization.

Design:

Mixed-method systematic review incorporating both quantitative and qualitative data.

Data sources and methods:

All studies focusing on DHIs for patients who need palliative care (adults/children) and their caregivers (patient and caregiver centred) in LMICs and published in English were identified through a systematic search of MEDLINE, EMBASE, PsycINFO and CINAHL databases. Data synthesis and analysis were carried out following the convergent integrated approach based on the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews.

Results:

Fifteen studies were included (three qualitative, four mixed-methods and eight quantitative studies). Telemedicine/mHealth was the most reported DHI utilized in LMICs in delivering palliative care. Patients and caregivers benefited from using DHIs in many ways including increased access to care with reduced discomfort, travel time and risk of health care-associated infections. Health care providers also reported that using DHI such as telemedicine enables them to provide care in a more effective and efficient way. Four factors were identified as the main barriers to implementation: resource constraints; literacy, training and skills; governance, operational and communication issues and technical issues.

Conclusion:

DHIs, such as telemedicine, have the potential to enhance accessibility to palliative care in LMICs, particularly in rural areas. Comprehensive strategies for their use are required to address the identified barriers.
Mechanical properties of recycled brick powder engineering cementitious composites under freeze-thaw cycling environment
Authors: Ji Yongcheng , Ji Wenhao , Li Wei
Published: April 2024

With the continuous advancement of urbanization construction, the number of discarded red bricks caused by construction demolition is impressive because of the characteristics of construction materials in the early stage of our country. This study used the recycled brick powder produced in crushing red waste bricks to partially or wholly replace quartz sand, combined with different doses of PVA fiber to prepare green recycled brick powder engineering cementitious composites (ECC). First, the strain hardening and multiple cracking behaviors of recycled brick powder ECC with different fitting ratios were verified using four-point bending tests. Then, a rapid freeze-thaw experiment was conducted to study the effects of different fitting ratios on the quality failure rate, phase dynamic elastic modulus, and compressive flexural resistance of recycled brick powder ECC. Based on the evaluation parameters of compressive strength loss rate and frost resistance, the ECC freeze-thaw prediction model of recycled brick powder was established by the Monte Carlo method to expand the number of samples. The research results show the best frost resistance of recycled brick powder ECC with a 25% recycled brick powder ratio and 1% PVA fiber. Scanning electron microscopy was used to observe raw materials and cement-based materials, and the reasons of macroscopic phenomena were explained from a microscopic perspective.
Empirical ground-motion basin response in the California Great Valley, Reno, Nevada, and Portland, Oregon
Authors: Ahdi Sean K , Aagaard Brad T , Moschetti Morgan P , Parker Grace A , Boyd Oliver S , Stephenson William J
Published: April 2024

We assess how well the Next-Generation Attenuation-West 2 (NGA-West2) ground-motion models (GMMs), which are used in the US Geological Survey’s (USGS) National Seismic Hazard Model (NSHM) for crustal faults in the western United States, predict the observed basin response in the Great Valley of California, the Reno basin in Nevada, and Portland and Tualatin basins in Oregon. These GMMs rely on site parameters such as the time-averaged shear-wave velocity ( VS) in the upper 30 m of Earth’s crust ( VS30) and depths to 1.0 and 2.5 km/s shear-wave isosurfaces ( Z1.0 and Z2.5) to capture basin effects and were developed using observations and simulations primarily from the Los Angeles region in southern California. Using ground-motion records from mostly small-to-moderate earthquakes and mixed-effects regression analysis, we find that the GMMs perform well with our local basin-depth models for the California Great Valley. With our local basin-depth models for Reno, the GMMs do not perform as well for this relatively shallow basin and exhibit little sensitivity to the basin parameters used in the NGA-West2 GMMs. We also find good performance for the local Z1.0 model across the Portland region, whereas the local Z2.5 model provides little predictive power except at sites in the deepest part of the Tualatin basin. Additional work could improve the performance of the site and basin terms in the NGA-West2 GMMs for regions with geologic structure different than the deep basins in southern California and the Great Valley. In addition, we find significant discrepancies among the GMMs in how the uncertainty in the ground motion varies with basin depth and pseudospectral period. Our results can help guide seismic hazard analyses on whether to include these local basin-depth models.
Governance in a Crisis and the Decision to Replace the Project Manager
Authors: Pinto Jeffrey , Davis Kate , Turner Neil
Published: April 2024

This article explores the concept of governance behaviors during project crises, which demand rapid responses. Grounded in the Cynefin model for decision-making and inspired by Iftikhar et al., (2021) , we sought to explore in greater detail the challenge of a particular and common response to crisis: project manager replacement. We address governance as essentially a two-level function: sensemaking under crisis conditions and offering guidance within the critical early stages of project manager replacement, when the need for governance is crucial. Finally, this article offers some guidance for the employment of governance within different Cynefin complexity domains for maximizing effective replacement steps.
Airway clearance management in people with bronchiectasis: data from the European Bronchiectasis Registry (EMBARC)
Authors: Spinou Arietta , Hererro-Cortina Beatriz , Aliberti Stefano , Goeminne Pieter C. , Polverino Eva , Dimakou Katerina , Haworth Charles S. , Loebinger Michael R. , De Soyza Anthony , Vendrell Montserrat , Burgel Pierre Regis , McDonnell Melissa , Sutharsan Sivagurunathan , Škrgat Sabina , Maiz-Carro Luiz , Sibila Oriol , Stolz Daiana , Kauppi Paula , Bossios Apostolos , Hill Adam T. , Clifton Ian , Crichton Megan L. , Walker Paul , Menendez Rosario , Borekci Sermin , Obradovic Dusanka , Nowinski Adam , Amorim Adelina , Torres Antoni , Lorent Natalie , Welte Tobias , Blasi Francesco , Jankovic Makek Mateja , Shteinberg Michal , Boersma Wim , Elborn J. Stuart , Chalmers James D. , Ringshausen Felix C.
Published: April 2024

Background

International guidelines recommend airway clearance management as one of the important pillars of bronchiectasis treatment. However, the extent to which airway clearance is used for people with bronchiectasis in Europe is unclear. The aim of the study was to identify the use of airway clearance management in patients with bronchiectasis across different countries and factors influencing airway clearance use.

Methods

This was a prospective observational study using data from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) Registry between January 2015 and April 2022. Prespecified options for airway clearance management were recorded, including airway clearance techniques, devices and use of mucoactive drugs.

Results

16 723 people with bronchiectasis from 28 countries were included in the study. The mean age was 67 years (interquartile range 57–74 years, range 18–100 years) and 61% were female. 72% of the participants reported daily sputum expectoration and 52% (95% CI 51–53%) of all participants reported using regular airway clearance management. Active cycle of breathing technique was used by 28% of the participants and airway clearance devices by 16% of participants. The frequency of airway clearance management and techniques used varied significantly between different countries. Participants who used airway clearance management had greater disease severity and worse symptoms, including a higher daily sputum volume, compared to those who did not use it regularly. Mucoactive drugs were also more likely to be used in participants with more severe disease. Access to specialist respiratory physiotherapy was low throughout Europe, but particularly low in Eastern Europe.

Conclusions

Only a half of people with bronchiectasis in Europe use airway clearance management. Use of and access to devices, mucoactive drugs and specialist chest physiotherapy appears to be limited in many European countries.
A novel combined approach to placement of a double lumen endobronchial tube using a video laryngoscope and fiberoptic bronchoscope: a retrospective chart review
Authors: Maracaja Luiz , Coffield Alexandra , Smith L. Daniela , Bradshaw J. David , Saha Amit K. , McLauglin Christopher S. , Templeton T. Wesley
Published: April 2024

Background

The objective of this study was to evaluate a modern combined video laryngoscopy and flexible fiberoptic bronchoscope approach to placement of a double lumen endobronchial tube and further characterize potential strengths and weaknesses of this approach.

Methods

Retrospective chart review was conducted at our single institution, academic medical center, tertiary-care hospital. Patients aged 18 years of age or older were evaluated who underwent thoracic surgery and one-lung ventilation with placement of a double lumen endobronchial tube using a novel combined video laryngoscopy and flexible fiberoptic bronchoscope approach. No interventions were performed.

Results

Demographics and induction and intubation documentation were reviewed for 21 patients who underwent thoracic surgery and one-lung ventilation with placement of a double lumen endobronchial tube using a novel combined video laryngoscopy and flexible fiberoptic bronchoscope approach. First pass success using the combined approach was 86% (18/21). The five patients with an anticipated difficult airway had successful double lumen endobronchial tube placement on the first attempt. There were no instances of desaturation during double lumen endobronchial tube placement. No airway complications related to double lumen endobronchial tube placement were recorded.

Conclusion

Use of a combined approach employing video laryngoscopy and a flexible fiberoptic bronchoscope may represent a reliable alternative approach to placement of double lumen endobronchial tubes.
One-year survival of aneurysmal subarachnoid hemorrhage after airplane transatlantic transfer – a monocenter retrospective study
Authors: Martino Frédéric , Fleuri Antoine , Engrand Nicolas , Rolle Amélie , Piotin Michel , Carles Michel , Delta Delphine , Do Laurent , Pons Adrien , Portecop Patrick , Sitcharn Mathys , Valette Marc , Camous Laurent , Pommier Jean-David , Demoule Alexandre
Published: April 2024

Background

Aneurysmal subarachnoid hemorrhage (aSAH) is preferentially treated by prompt endovascular coiling, which is not available in Guadeloupe. Subsequently, patients are transferred to Paris, France mainland, by commercial airplane (6751 km flight) after being managed according to guidelines. This study describes the characteristics, management and outcomes related to these patients.

Methods

Retrospective observational cohort study of 148 patients admitted in intensive care unit for a suspected aSAH and transferred by airplane over a 10-year period (2010–2019).

Results

The median [interquartile range] age was 53 [45–64] years and 61% were female. On admission, Glasgow coma scale was 15 [13–15], World Federation of Neurological Surgeons (WFNS) grading scale was 1 [1–3] and Fisher scale was 4 [2–4]. External ventricular drainage and mechanical ventilation were performed prior to the flight respectively in 42% and 47% of patients. One-year mortality was 16% over the study period. By COX logistic regression analysis, acute hydrocephalus (hazard ratio [HR] 2.34, 95% confidence interval [CI] 0.98–5.58) prior to airplane transfer, WFNS grading scale on admission (HR 1.53, 95% CI 1.16–2.02) and age (OR 1.03, 95% 1.00–1.07) were associated with one-year mortality.

Conclusion

When necessary, transatlantic air transfer of patients with suspected aSAH after management according to local guidelines seems feasible and safe.
Factors affecting hospital admission, hospital length of stay and new discharge destination post proximal humeral fracture: a retrospective audit
Authors: McDonald B. R. , Vogrin S. , Said C. M.
Published: April 2024

Background

Outcomes following proximal humeral fracture (PHF) may be impacted by a range of clinical, fracture and premorbid factors. The aim of this study was to examine factors impacting hospital admission; length of stay (LOS) and new discharge destination for patients presenting to hospital with PHF.

Methods

Retrospective audit conducted at a tertiary health service. Data was collected from adult patients presenting to hospital with a PHF over a 54-month period. Fractures that were pathological or sustained during admission were excluded. Univariable and multivariable logistic and negative binomial regression were used to explore factors associated with hospital admission, LOS and new discharge destination.

Results

Data were analyzed from 701 participants (age 70 years (IQR 60, 81); 72.8% female); 276 (39.4%) participants required a hospital admission. New discharge destination was required for 109 (15.5%) participants, of whom 49 (45%) changed from home alone to home with family/friend(s). Greater comorbidities, as indicated by the Charlson Comorbidity Index score, were associated with hospital admission, longer LOS and new discharge destination. Premorbid living situations of home with family/friend(s) or from an external care facility were associated with a decreased likelihood of hospital admission, shorter LOS and reduced risk of a new discharge destination. Surgical treatment was associated with shorter LOS. Older age and dementia diagnosis were associated with a new discharge destination.

Conclusions

Many factors potentially impact on the likelihood or risk of hospitalization, LOS and new discharge destination post PHF. Patients with greater comorbidities are more likely to have negative outcomes, while patients who had premorbid living situations of home with family/friend(s) or from an external care facility are more likely to have positive outcomes. Early identification of factors that may impact patient outcomes may assist timely decision making in hospital settings. Further research should focus on developing tools to predict hospital outcomes in the PHF population.
Red blood cell distribution width as a predictor of mortality and poor functional outcome after acute ischemic stroke: a meta-analysis and meta-regression
Authors: Shen Huiqin , Shen Lihong
Published: April 2024

Background

This study aimed to review evidence on the ability of red cell distribution width (RDW) to predict mortality and poor functional outcomes after acute ischemic stroke (AIS).

Methods

Databases of PubMed, CENTRAL, Scopus, Embase, and Web of Science were searched online from inception to 25th Jul 2023 for all studies reporting the association between RDW and outcomes as adjusted ratios. A random-effects meta-analysis was done. Meta-regression was conducted using multiple moderators.

Results

15 studies with 14,968 patients were included. Meta-analysis found that RDW, both as a categorical variable (OR: 2.10 95% CI: 1.74, 2.55 I2 = 42%) and continuous variable OR: 1.16 95% CI: 1.05, 1.28 I2 = 64%) was a significant predictor of mortality after AIS. Age and number of hypertensives were found to be significant moderators in the meta-regression. Also, high RDW, as a categorical variable (OR: 1.68 95% CI: 1.20, 2.35 I2 = 84%), was associated with significantly higher odds of poor functional outcomes after AIS, but not as a continuous variable (OR: 1.07 95% CI: 0.99, 1.16 I2 = 61%). Meta-regression showed that the association was stronger in small sample-sized studies.

Conclusion

RDW can be a useful, readily available, and cost-effective biomarker to rapidly stratify AIS patients at risk of poor outcomes. High RDW was consistently associated with an increased risk of mortality after AIS, however, its ability to predict poor functional outcomes needs to be verified by further studies.
Uraemic brainstem encephalopathy mimicking ocular myasthenia: a case report
Authors: Ruwanpathirana Pramith , Chang Thashi
Published: April 2024

Background

Uraemia causes a generalised encephalopathy as its most common neurological complication. Isolated brainstem uraemic encephalopathy is rare. We report a case of fatigable ptosis and complex ophthalmoplegia in brainstem uraemic encephalopathy.

Case presentation

A 22-year-old Sri Lankan man with end stage renal failure presented with acute onset diplopia and drooping of eyelids progressively worsening over one week. The patient had not complied with the prescribed renal replacement therapy which was planned to be initiated 5 months previously. On examination, his Glasgow coma scale score was 15/15, He had a fatigable asymmetrical bilateral ptosis. The ice-pack test was negative. There was a complex ophthalmoplegia with bilateral abduction failure and elevation failure of the right eye. The diplopia did not worsen with prolonged stare. The rest of the neurological examination was normal. Serum creatinine on admission was 21.81 mg/dl. The repetitive nerve stimulation did not show a decremental pattern. Magnetic resonance imaging (MRI) of the brain demonstrated diffuse midbrain and pontine oedema with T2 weighted/FLAIR hyperintensities. The patient was haemodialyzed on alternate days and his neurological deficits completely resolved by the end of the second week of dialysis. The follow up brain MRI done two weeks later demonstrated marked improvement of the brainstem oedema with residual T2 weighted/FLAIR hyperintensities in the midbrain.

Conclusions

Uraemia may rarely cause an isolated brainstem encephalopathy mimicking ocular myasthenia, which resolves with correction of the uraemia.
Stillbirth rate and associated factors at the Bamenda Regional hospital, North-West region, Cameroon, from 2018 to 2022: a case control study
Authors: Mforteh Achuo Ascensius Ambe , Pisoh Dobgima Walter , Boten Merlin , Andoh Nkomodio Enanga-Linda , Tameh Theodore Yangsi , Mbi-Kobenge Audrey-Fidelia Eyere , Ombaku Kingsley Sama , Takang William Ako , Mbu Robinson Enow
Published: April 2024

Background

Stillbirth is a common adverse pregnancy outcome worldwide, with an estimated 2.6 million stillbirths yearly. In Cameroon, the reported rate in 2015 was 19.6 per 1000 live births. Several risk factors have been described, but region-specific risk factors are not known in the northwest region of Cameroon. This study aims to determine the stillbirth rate and associated factors at the Bamenda Regional hospital, North-West region of Cameroon.

Materials and methods

A Hospital-based case‒control study conducted from December 2022 to June 2023 on medical files from 2018 to 2022 at the Bamenda Regional Hospital. Cases were women with stillbirths that occurred at a gestational age of ≥ 28 weeks, while controls were women with livebirths matched in a 1:2 (1 case for 2 controls) ratio using maternal age. Sociodemographic, obstetric, medical, and neonatal factors were used as exposure variables. Multivariable logistic regression was used to determine adjusted odds ratios of exposure variables with 95% confidence intervals and a p value of < 0.05.

Results

A total of 12,980 births including 116 stillbirths giving a stillbirth rate of 8.9 per 1000 live births. A hundred cases and 200 controls were included. Factors associated with stillbirths after multivariable analysis include nulliparity (aOR = 3.89; 95% CI: 1.19–12.71; p = 0.025), not attending antenatal care (aOR = 104; 95% CI: 3.17–3472; p = 0.009), history of stillbirth (aOR = 44; 95% CI: 7-270; p < 0.0001), placenta abruption (aOR = 14; 95% CI: 2.4–84; p = 0.003), hypertensive disorder in pregnancy (aOR = 18; 95% CI: 3.4–98; p = 0.001), malaria (aOR = 8; 95% CI: 1.51-42; p = 0.015), alcohol consumption (aOR = 9; 95% CI: 1.72-50; p = 0.01), birth weight less than 2500 g (aOR = 16; 95% CI: 3.0–89; p = 0.001), and congenital malformations (aOR = 12.6; 95% CI: 1.06–149.7;p = 0.045).

Conclusion

The stillbirth rate in BRH is 8.9 per 1000 live births. Associated factors for stillbirth include nulliparity, not attending antenatal care, history of stillbirth, placental abruption, hypertensive disorder in pregnancy, malaria, alcohol consumption, birth weight less than 2500 g, and congenital malformations. Close antenatal care follow-up of women with such associated factors is recommended.
Moderating and mediating effects of resilience between childhood trauma and psychotic-like experiences among college students
Authors: Hu Heqiong , Chen Chunping , Xu Bingna , Wang Dongfang
Published: April 2024

Background

Extensive literature revealed that childhood trauma serves as a significant risk factor for developing psychotic-like experiences (PLEs) among the general population. Resilience has been regarded as a protective factor against PLEs. However, it remains unclear what role resilience plays in the relationship between childhood trauma and PLEs.

Methods

A total of 4302 college students completed the web-based survey in January 2021. Participants completed self-report measures of sample characteristics variables, childhood trauma, and PLEs. Moderation and mediation analyses were adopted to examine the associations linking childhood trauma, resilience, and PLEs.

Results

PLEs were positively associated with childhood trauma while negatively associated with resilience. Resilience played a partially mediating role in the relationship between childhood trauma and PLEs. Additionally, resilience moderated the association of childhood trauma with PLEs.

Conclusions

These findings indicated that resilience plays a crucial role in mediating the relationship between childhood trauma and PLEs, suggesting the potential clinical implication of enhancing resilience for the prevention and intervention of PLEs among college students.
Face-to-face bullying in and outside of schools and cyberbullying are associated with suicidality in Kenyan high school students: a public health issue
Authors: Ndetei David M. , Mutiso Victoria , Shanley Jenelle R. , Musyimi Christine , Nyamai Pascalyne , Munyua Timothy , Osborn Tom L. , Johnson Natalie E. , Gilbert Sonja , Abio Anne , Javed Afzal , Sourander Andre
Published: April 2024

Background

Childhood bullying has been classified as a major public health concern by WHO, with negative effects on the health education and social outcomes of both bullies and victims. There is no current Kenyan data on the prevalence of face-to-face bullying and cyberbullying co-occurring in the same cohort of youth and how they are associated with different aspects of suicidality and socio-demographic characteristics. This study aims to fill these gaps in the Kenyan situation so as to inform current policy and practice.

Methodology

This cross-sectional study involved 2,652 students from ten secondary schools in Kenya, selected from three regions representing different levels of public funded schools and socioeconomic spaces. The outcome variable was derived from the questionnaire which asked students questions related to self-harm, suicide thoughts, plans, and attempts. Predictor variables were based on response on experience of bullying in school, out of school, at home, and cyberbullying. Other variables such as gender, age, family background, and class were also collected from the self-reported questions. Data were analyzed using SPSS version 25, with descriptive summary statistics and chi-square tests used to examine variables, and logistic regression analysis used to determine the associations between suicidality and experience of bullying.

Results

The mean age was 16.13 years. More than half of the participants were male, with the largest proportion living in rural areas. Face-to-face bullying was more prevalent than cyberbullying, with 82% of participants experiencing bullying and 68% experiencing it almost daily in the past six months. Both face-to-face bullying and cyberbullying were associated with suicidal thoughts, plans, and attempts. Predictors of suicidal attempts included being bullied outside of school and being a victim of group bullying, while being bullied every day and being bullied by adult men were predictors of suicidal attempts in cyberbullying.

Conclusion

There is a high prevalence of face-to-face bullying both in and outside schools. There is also a high prevalence of cyberbullying. Both face-to-face and cyberbullying are associated with suicidality in Kenyan high school students.
The protective effect of CALD identity in the presence of low income on missing teeth of Australian adults over time
Authors: Jamieson Lisa , Mejia Gloria , Haag Dandara G , Soares Gustavo H , Luzzi Liana , Ju Xiangqun
Published: April 2024

Background

‘Culturally And Linguistically Diverse (CALD)’ populations have diverse languages, ethnic backgrounds, societal structures and religions. CALD populations have not experienced the same oral health benefits as non-CALD groups in Australia. However, the socio-demographic profile of Australian CALD populations is changing. This study examined how household income modifies the oral health of CALD and non-CALD adults in Australia.

Methods

Data were from two National Surveys of Adult Oral Health (NSAOH) conducted in 2004-06 (NSAOH 2004-06) and 2017-18 (NSAOH 2017-18). The outcome was self-reported number of missing teeth. CALD status was identified based on English not the primary language spoken at home and country of birth not being Australia. Social disadvantage was defined by total annual household income. Effect-measure modification was used to verify differences on effect sizes per strata of CALD status and household income. The presence of modification was indicated by Relative Excess Risk due to Interactions (RERIs).

Results

A total of 14,123 participants took part in NSAOH 2004-06. The proportion identifying as CALD was 11.7% and 56.7% were in the low-income group, and the mean number of missing teeth was 6.9. A total of 15,731 participants took part in NSAOH 2017-18. The proportion identifying as CALD was 18.5% and 38.0% were in the low-income group, and the mean number of missing teeth was 6.2. In multivariable modelling, the mean ratio (MR) for CALD participants with low household income in 2004-06 was 2% lower than the MR among non-CALD participants with high household income, with the RERI being − 0.23. Non-CALD participants from lower income households had a higher risk of having a higher number of missing teeth than low income CALD individuals (MR = 1.66, 95%CI 1.57–1.74 vs. MR = 1.43 95%CI 1.34–1.52, respectively). In 2017-18, the MR for CALD participants with low household income was 3% lower than the MR among non-CALD participants with high household income, with the RERI being − 0.11. Low income CALD participants had a lower risk of missing teeth compared to their non-CALD counterparts (MR = 1.43, 95% CI 1.34–1.52 vs. MR = 1.57, 95% CI 1.50–1.64).

Conclusions

The negative RERI values indicate that the effect-measure modification operates in a negative direction, that is, there is a protective element to being CALD among low income groups with respect to mean number of missing teeth.
Why is there a gap in self-rated health among people with hypertension in Zambia? A decomposition of determinants and rural‒urban differences
Authors: Mweemba Chris , Mutale Wilbroad , Masiye Felix , Hangoma Peter
Published: April 2024

Background

Hypertension affects over one billion people globally and is one of the leading causes of premature death. Low- and middle-income countries, especially the sub-Saharan Africa region, bear a disproportionately higher share of hypertension globally. Recent evidence shows a steady shift in the burden of hypertension from more affluent and urban populations towards poorer and rural communities. Our study examined inequalities in self-rated health (SRH) among people with hypertension and whether there is a rural‒urban gap in the health of these patients. We then quantified factors driving the health gap. We also examined how much HIV accounts for differences in self-rated health among hypertension patients due to the relationship between HIV, hypertension and health in sub-Saharan Africa.

Methods

We utilized the Zambia Household Health Expenditure and Utilization Survey for data on SRH and other demographic and socioeconomic controls. District HIV prevalence information was from the Zambia Population-Based HIV Impact Assessment (ZAMPHIA) survey. We applied the Linear Probability Model to assess the association between self-rated health and independent variables as a preliminary step. We then used the Blinder-Oaxaca decomposition to identify self-rated health inequality between urban and rural patients and determine determinants of the health gap between the two groups.

Results

Advanced age, lower education and low district HIV prevalence were significantly associated with poor health rating among hypertension patients. The decomposition analysis indicated that 45.5% of urban patients and 36.9% of rural patients reported good self-rated health, representing a statistically significant health gap of 8.6%. Most of the identified health gap can be attributed to endowment effects, with education (73.6%), district HIV prevalence (30.8%) and household expenditure (4.8%) being the most important determinants that explain the health gap.

Conclusions

Urban hypertension patients have better SRH than rural patients in Zambia. Education, district HIV prevalence and household expenditure were the most important determinants of the health gap between rural and urban hypertension patients. Policies aimed at promoting educational interventions, improving access to financial resources and strengthening hypertension health services, especially in rural areas, can significantly improve the health of rural patients, and potentially reduce health inequalities between the two regions.
Common misconceptions and myths about ovarian cancer causation: a national cross-sectional study from palestine
Authors: Elshami Mohamedraed , Jaber Inas , Alser Mohammed , Al-Slaibi Ibrahim , Jabr Hadeel , Ubaiat Sara , Tuffaha Aya , Khader Salma , Khraishi Reem , Arafeh Zeina Abu , Al-Madhoun Sondos , Alqattaa Aya , Yaseen Areej , El Hadi Asmaa Abd , Barhoush Ola , Hijazy Maysun , Eleyan Tamara , Alser Amany , Hziema Amal Abu , Shatat Amany , Almakhtoob Falasteen , Mohamad Balqees , Farhat Walaa , Abuamra Yasmeen , Mousa Hanaa , Adawi Reem , Musallam Alaa , Albarqi Shurouq I. , Abu-El-Noor Nasser , Bottcher Bettina
Published: April 2024

Background

Women’s inability to recognize ovarian cancer (OC) causation myths to be incorrect may lead to behavioral changes that could distract them from actual risk factors and impact their treatment decision making. This study examined Palestinian women’s recognition of OC mythical causes, and explored factors associated with good recognition.

Methods

A national cross-sectional study was conducted. Adult Palestinian women were recruited from hospitals, primary healthcare facilities, and public areas in 11 governorates. The Cancer Awareness Measure-Mythical Causes Scale was modified and utilized for data collection. Awareness level was determined based on the number of myths around OC causation recognized to be incorrect: poor (0–4), fair (5–9), and good (10–13).

Results

A total of 5618 participants agreed and completed the questionnaire out of 6095 approached (response rate = 92.1%), and 5411 questionnaires were included in the final analysis. The most recognized food-related myth was ‘drinking from plastic bottles’ (n = 1370, 25.3%) followed by ‘eating burnt food’ (n = 1298, 24.0%). The least recognized food-related myth was ‘eating food containing additives’ (n = 611, 11.3%). The most recognized food-unrelated myth was ‘having a physical trauma’ (n = 2899, 53.6%), whereas the least recognized was ‘using mobile phones’ (n = 1347, 24.9%). Only 273 participants (5.1%) had good awareness of OC causation myths as incorrect. Earning higher monthly incomes as well as visiting governmental healthcare facilities were associated with a decrease in the likelihood of exhibiting good awareness.

Conclusion

The overall recognition of OC causation myths was low. Addressing mythical beliefs should be included in OC prevention strategies and public health interventions to improve women’s understanding of OC risk factors versus mythical causes.
Witnessing inter-parental violence in childhood and help-seeking behaviours in violence against women in Peru
Authors: Bazo-Alvarez Juan Carlos , Copez-Lonzoy Anthony , Ipanaqué-Zapata Miguel , Bazalar-Palacios Janina , Rivera Elizabeth López , Flores-Ramos Elaine C.
Published: April 2024

Background

Violence against women (VAW) severely impacts their physical and mental health. In some cultures, women can normalize certain types of violence if they were linked to home models in childhood and, eventually, do not seek for help in adulthood. We aimed to determine, in Peruvian women, (1) the association between witnessing violence in their family of origin and VAW experienced in adulthood, (2) the extent to which women who have experienced VAW seek some help, and (3) identify VAW prevalence by Peruvian region.

Methods

Cross-sectional study of secondary data obtained from the 2019 National Demographic and Family Health Survey (ENDES). The outcome was VAW (psychological, physical and sexual violence), whereas the exposure was witnessing violence in the home of origin. Help-seeking behavior was a secondary outcome, for which VAW was the exposure. Prevalence ratios (PR) were estimated to assess both associations, unadjusted and adjusted for covariates (aPR).

Results

Data from 14,256 women aged 15 to 49 years were analysed. 51.5% reported having experienced VAW and 43.8% witnessed violence in the home of origin during childhood. Witnessing inter-parental violence in childhood was associated with psychological violence aPR = 1.25 (95% CI: 1.17–1.33), physical aPR = 1.52 (95% CI: 1.38–1.67), and sexual aPR = 1.99 (95% CI: 1.57–2.52). Women who have experienced both types of violence (physical and sexual) were more likely to help-seeking (aPR = 1.30, 95% CI: 1.14–1.50) than women suffering only one type of violence.

Conclusion

Women who reported having witnessed home violence in their childhood are more likely to experience Violence Against Women (VAW) by their current partner. Physical and sexual violence with a current partner was more associated with witnessing inter-parental violence in childhood, and when physical and sexual violence jointly occurred women were more help-seeking. The southern region of Peru is identified as an area of high vulnerability for women. It is crucial to promote educative and community-based programs aimed at the prevention and early recognition of VAW.