bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased METTL3 expression and m6A RNA methylation may contribute to the development of dry eye in primary Sjögren’s syndrome
Authors: Ma Jun , Wang Xiaotang , Yang Xue , Wang Xi , Tan Tongshan , Fang Hongping , Zhong Yu , Zhang Qi
Published: June 2023

Background

Primary Sjögren’s syndrome (pSS) is a chronic autoimmune disorder defined by xerostomia and keratoconjunctivitis sicca, and its etiology remains unknown. N6-methyladenosine (m6A) is the predominant posttranscriptional modification in eukaryotic mRNAs and is dynamically regulated by m6A regulators. Dysregulation of m6A modification is closely associated with several autoimmune disorders, but the role of m6A modification in pSS remains unknown. This study investigated the potential role of m6A and m6A-related regulators in pSS patients with dry eye.

Methods

This cross-sectional study included forty-eight pSS patients with dry eye and forty healthy controls (HCs). Peripheral blood mononuclear cells (PBMCs) were isolated, and the level of m6A in total RNA was measured. The expression of m6A regulators was determined utilizing real-time PCR and western blotting. The serological indicators detected included autoantibodies, immunoglobulins (Igs), complement factors (Cs), and inflammatory indicators. Dry eye symptoms and signs were measured, including the ocular surface disease index, Schirmer’s test (ST), corneal fluorescein staining score (CFS), and tear break-up time. Spearman’s correlation coefficient was employed to assess the associations of m6A and m6A-related regulator expression with clinical characteristics.

Results

The expression level of m6A was markedly increased in the PBMCs of pSS patients with dry eye compared to HCs (P value<0.001). The relative mRNA and protein expression levels of the m6A regulators methyltransferase-like 3 (METTL3) and YT521-B homology domains 1 were markedly elevated in pSS patients with dry eye (both P value<0.01). The m6A RNA level was found to be positively related to METTL3 expression in pSS patients (r = 0.793, P value<0.001). Both the m6A RNA level and METTL3 mRNA expression correlated with the anti-SSB antibody, IgG, ST, and CFS (all P values < 0.05). The m6A RNA level was associated with C4 (r = -0.432, P value = 0.002), while METTL3 mRNA expression was associated with C3 (r = -0.313, P value = 0.030).

Conclusions

Our work revealed that the upregulation of m6A and METTL3 was associated with the performance of serological indicators and dry eye signs in pSS patients with dry eye. METTL3 may contribute to the pathogenesis of dry eye related to pSS.
Infusing wellness opportunities into integrated youth services
Authors: Glowacki Krista , Affolder Jennifer , Macnab Brooke , Ewert Alayna , Tee Karen , Wenger Matt , Chan Godwin , Mathias Steve , Barbic Skye
Published: June 2023

Background

Appropriate health services and health promotion strategies for young people with mental health and substance use (MHSU) concerns are critical for recovery. Foundry, an integrated youth services (IYS) initiative for young people ages 12-24 in British Columbia (BC), Canada, has recently added leisure and recreational activities (referred to as the Wellness Program) into its services. The objectives of this study were to: (1) describe how the Wellness Program was implemented over a two-year period into IYS (2) provide an overview of what the Wellness Program is, who accessed the program since inception and initial evaluation results.

Methods

This study was part of the developmental evaluation of Foundry. A phased approach was used to implement the program at nine centres. Data was accessed from Foundry’s centralized platform ‘Toolbox’ and included activity type, number of unique youth and visits, additional services sought, information about how youth found out about the centre, and demographics. Qualitative data was also accessed from focus groups (n=2) conducted with young people (n=9).

Results

Over the two-year period, 355 unique youth accessed the Wellness Program, with 1319 unique visits. Almost half (40%) of youth identified the Wellness Program as the first point of access to Foundry. A total of 384 different programs were offered targeting five wellness domains (physical, mental/emotional, social, spiritual, and cognitive/intellectual). The majority of youth identified as young girls/women (58.2%), 22.6% as gender diverse, and 19.2% as young men/boys. The mean age was 19 years, and most participants were between the ages of 19-24 years (43.6%). From the thematic analysis of focus groups, we found young people enjoyed the social aspect of the program with peers and facilitators, and identified program improvements that are being considered as the program grows.

Conclusions

This study provides insight into the development and implementation of leisure-based activities (known as the Wellness Program) into IYS and can be used as a guide by international IYS initiatives. The initial reach of programs over two years is promising, and these programs are acting as a potential gateway for young people to access other health services.
Barriers and facilitators to COVID-19 testing among staff and parents from San Diego schools
Authors: Nguyen Megan , Flores Marlene , Van Vo Anh , Omaleki Vinton , Streuli Samantha , Fielding-Miller Rebecca
Published: June 2023

COVID-19 testing is an important risk mitigation strategy for COVID-19 prevention in school settings, where the virus continues to pose a public health challenge for in-person learning. Socially vulnerable school communities with the highest proportion of low-income, minority, and non-English speaking families have the least testing access despite shouldering a disproportionate burden of COVID-19 morbidity and mortality. Through the Safer at School Early Alert (SASEA) program, we investigated community perceptions of testing in San Diego County schools, with a focus on barriers and facilitators from the perspective of socially vulnerable parents and school staff. Using a mixed-methods approach, we administered a community survey and conducted focus group discussions (FGDs) with staff and parents from SASEA-affiliated schools and childcares. We recruited 299 survey respondents and 42 FGD participants. Protecting one’s family (96.6%) and protecting one’s community (96.6%) were marked as key motivators to testing uptake. School staff in particular reported that the reassurance of a negative status mitigated concerns about COVID-19 infection in schools. Participants expressed that COVID-19-related stigma, loss of income as a result of isolation/quarantine requirements, and lack of multilingual materials were the most significant barriers to testing. Our findings suggest that the testing barriers faced by school community members are predominantly structural. Testing uptake efforts must provide support and resources to manage the social and financial consequences of testing while continuously communicating its benefits. There is a clear need to continue to incorporate testing as a strategy to maintain school safety and facilitate access for vulnerable community members.
A SARS-CoV-2 outbreak in a plastics manufacturing plant
Authors: Graham Alice , Raja Amber I. , van Veldhoven Karin , Nicholls Gillian , Simpson Andrew , Atkinson Barry , Nicholls Ian , Higgins Hannah , Cooke Joan , Bennett Allan , Morgan Derek , Keen Chris , Fletcher Tony , Pearce Neil , Atchison Christina , Brickley Elizabeth B. , Chen Yiqun
Published: June 2023

Background

A SARS-CoV-2 outbreak with an attack rate of 14.3% was reported at a plastics manufacturing plant in England.

Methods

Between 23rd March and 13th May 2021, the COVID-OUT team undertook a comprehensive outbreak investigation, including environmental assessment, surface sampling, molecular and serological testing, and detailed questionnaires, to identify potential SARS-CoV-2 transmission routes, and workplace- and worker-related risk factors.

Results

While ventilation, indicated using real-time CO2 proxy measures, was generally adequate on-site, the technical office with the highest localized attack rate (21.4%) frequently reached peaks in CO2 of 2100ppm. SARS-CoV-2 RNA was found in low levels (Ct ≥35) in surface samples collected across the site. High noise levels (79dB) were recorded in the main production area, and study participants reported having close work contacts (73.1%) and sharing tools (75.5%). Only 20.0% of participants reported using a surgical mask and/or FFP2/FFP3 respirator at least half the time and 71.0% expressed concerns regarding potential pay decreases and/or unemployment due to self-isolation or workplace closure.

Conclusions

The findings reinforce the importance of enhanced infection control measures in manufacturing sectors, including improved ventilation with possible consideration of CO2 monitoring, utilising air cleaning interventions in enclosed environments, and provision of good-quality face masks (i.e., surgical masks or FFP2/FFP3 respirators) especially when social distancing cannot be maintained. Further research on the impacts of job security-related concerns is warranted.
Cross-cultural adaptation and validation of the Northwick park neck pain questionnaire to Urdu language
Authors: Farooq Muhammad Nazim , Naz Somiya , Kousar Ambrin , Shahzad Komal
Published: June 2023

Background

Despite its widespread use for assessing pain and disability in patients suffering from neck pain, the Northwick Park Neck Pain Questionnaire (NPQ) has yet to be translated and validated in Urdu. The purpose of the present study was to translate and cross-culturally adapt the NPQ into Urdu language (NPQ-U), and to investigate the NPQ-U’s psychometric properties in patients with non-specific neck pain (NSNP).

Methods

The NPQ was translated and cross-culturally adapted into Urdu in accordance with the previously described guidelines. The study included 150 NSNP patients and 50 healthy participants. The NPQ-U, Urdu version of neck disability index (NDI-U), neck pain and disability scale (NPDS), and numerical pain rating scale (NPRS) were completed by all participants on first visit. After three weeks of physical therapy, the patients completed all of the questionnaires listed above, along with the global rating of change scale. Test-retest reliability was determined on 46 randomly selected patients who completed the NPQ-U again two days after the first response. The NPQ-U was evaluated for internal consistency, content validity, construct (convergent and discriminative) validity, factor analysis, and responsiveness.

Results

The NPQ-U demonstrated excellent test-retest reliability (intra-class correlation coefficient = 0.96) and high internal consistency (Cronbach’s alpha = 0.89). There were no floor or ceiling effects for the NPQ-U total score, indicating good content validity. A single factor was extracted, which explained 54.56% of the total variance. For convergent validity, the NPQ-U showed a strong correlation with NDI-U (r = 0.89, P < 0.001), NPDS (r = 0.71, P < 0.001), and NPRS (r = 0.73, P < 0.001). The results revealed a significant difference between patients and healthy controls in the NPQ-U total scores (P < 0.001) demonstrating significant discriminative validity. A significant difference in the NPQ-U change scores between the stable and the improved groups (P < 0.001) confirmed its responsiveness. Furthermore, the NPQ-U change score showed a moderate correlation with NPDS change score (r = 0.60, P < 0.001) and NPRS change score (r = 0.68, P < 0.001), but a strong correlation with NDI-U change score (r = 0.75, P < 0.001).

Conclusion

The NPQ-U is a reliable, valid, and responsive tool for assessing neck pain and disability in Urdu-speaking patients with NSNP.
Orthodontic care in orthodontic patients during the COVID-2019 pandemic: emergency, emergency response and orthodontic treatment preference
Authors: Miao Zeyao , Zhang Haijuan , Han Yandong , Wang Lirong , Wang Shuang
Published: June 2023

Background

The objective of this study was to investigate the characteristics of emergencies and the requirement for emergency treatment after the suspension of orthodontic appointments. The attitude towards orthodontic treatment preference was evaluated as well, including receiving orthodontic treatment and the preference for orthodontic appliances.

Subjects and methods

An electronic questionnaire was distributed to the patients, including 4 sections: Section 1 – demographic and basic information; Section 2 – the characteristics of emergencies and emergency treatment requirements; Section 3 – the NRS-11 for pain and Manchester Orofacial Pain Disability Scale used to evaluate the intensity of orofacial pain and disability; and Section 4 – attitudes towards receiving orthodontic treatment and appliance preference. Descriptive statistics, Pearson’s chi-square test, Wilcoxon's rank-sum test and stepwise generalized linear model (GLM) were performed with significance set at P < 0.05.

Result

Most participants’ (91.61%) follow-up appointments were suspended. The emergency rate and emergency treatment requirements were not different between the fixed appliance (FA) and clear aligner (CA) groups. Patients who reported emergencies (P < 0.01) in the FA group (P < 0.05) and some emergencies in the FA (P < 0.05) suffered worse pain and disability. More FA participants preferred alternative appliances (P < 0.05) due to pain and disability (P < 0.05).

Conclusion

FA patients’ emergencies caused worse pain and disability when orthodontic appointments were suspended. Pain and disability were not the causes of emergency treatment requirements. The CA group seemed to show a tendency towards orthodontic appliance preference, which was an ideal modality to weather the epidemic, combined with telemedicine.
Translation, adaptation, and validation of the Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) scale for use in Japan
Authors: Fujikawa Hirohisa , Son Daisuke , Hayashi Mikio , Kondo Kayo , Eto Masato
Published: June 2023

Background

Ambiguity is inherent to the medical field; hence, assessing and educating medical trainees regarding ambiguity tolerance is essential. The Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) scale—a novel instrument that assesses ambiguity tolerance in clinical settings—has been widely used for medical education research in Western countries. However, a version of this scale applicable to the intricate clinical contexts of Japan has not yet been developed. In this study, we developed the Japanese version of the TAMSAD (J-TAMSAD) scale and tested its psychometric properties.

Methods

In this multicenter study, we collected data through a cross-sectional survey in two universities (medical students) and ten hospitals (residents) across Japan, and evaluated the structural validity, criterion-related validity, and internal consistency reliability of the J-TAMSAD scale.

Results

We analyzed the data of 247 participants. The sample was randomly divided in half, with exploratory factor analysis (EFA) performed on one half and confirmatory factor analysis (CFA) on the other. EFA led to an 18-item J-TAMSAD scale comprising five factors. CFA showed acceptable fit for this five-factor model (comparative fit index = 0.900, root mean square error of approximation = 0.050, standardized root mean square residual = 0.069, goodness of fit index = 0.987). There was a positive correlation between the J-TAMSAD scale scores and total reverse scores on the Japanese version of the Short Intolerance of Uncertainty Scale (Pearson correlation coefficient 0.41). The internal consistency was found to be satisfactory (Cronbach’s alpha 0.70).

Conclusions

The J-TAMSAD scale was developed, and its psychometric properties were confirmed. The instrument can be useful for assessing tolerance of ambiguity among medical trainees in Japan. With further validation, it could be used to verify the educational effectiveness of curricula that foster ambiguity tolerance in medical trainees, or even in research assessing the relationship with other variables.
Rise of public e-learning opportunities in the context of COVID-19 pandemic-induced curtailment of face-to-face courses, exemplified by epidural catheterization on YouTube.
Authors: Flinspach Armin N. , Sterz Jasmina , Neef Vanessa , Flinspach Mairen H. , Zacharowski Kai , Ruesseler Miriam , Janker Lena , Raimann Florian J.
Published: June 2023

Background

In the context of the coronavirus pandemic, countless face-to-face events as well as medical trainings were cancelled or moved to online courses, which resulted in increased digitalization in many areas. In the context of medical education, videos provide tremendous benefit for visualizing skills before they are practised.

Methods

Based on a previous investigation of video material addressing epidural catheterization available on the YouTube platform, we aimed to investigate new content produced in the context of the pandemic. Thus, a video search was conducted in May 2022.

Results

We identified twelve new videos since the pandemic with a significant improvement in the new content in terms of procedural items (p = 0.03) compared to the prepandemic video content. Video content released in the course of the COVID-19 pandemic was more often created by private content creators and were significantly shorter in total runtime than those from university and medical societies (p = 0.04).

Conclusion

The profound changes in the learning and teaching of health care education in relation to the pandemic are largely unclear. We reveal improved procedural quality of predominantly privately uploaded content despite a shortened runtime compared to the prepandemic period. This might indicate that technical and financial hurdles to producing instructional videos by discipline experts have decreased. In addition to the teaching difficulties caused by the pandemic, this change is likely to be due to validated manuals on how to create such content. The awareness that medical education needs to be improved has grown, so platforms offer specialized sublevels for high-quality medical videos.
Evaluation of peripheral cannulation technique among nurses in maternity and Dr. Jamal Ahmad Rashid pediatric teaching hospitals in Sulaimaniyah, Iraq
Authors: Faris Gona Othman , Abdulkareem Awayi Ghazy , Ismael Niyan Hakim , Qader Delan Jamal
Published: June 2023

Background

Obedience to the excellent standards of nursing practice is the ultimate attitude to develop patient outcomes and avoid nursing process related-infections. Inserting the peripheral intravenous cannula is the utmost mutual aggressive technique achieved in nursing care for patients. Therefore, nurses must have adequate knowledge and practice to ensure the procedure’s success.

Objectives

To determine the peripheral cannulation technique evaluation among nurses working in the emergency departments.

Methods

This descriptive-analytical study was conducted at Maternity and Pediatric Teaching Hospitals in Sulaimaniyah, Iraq on 101 randomly selected nurses, from 14th December 2021 to 16th March 2022. Data collection was carried out through a structured interview questionnaire aimed to gather the nurses’ general characteristics and an observational checklist to assess the nurses’ pre, during and post practices regarding peripheral cannulation technique.

Results

According to general practice, 43.6% of nurses had an average level, 29.7% had a good level, and 26.7% had a poor level of practice in the evaluation of the peripheral cannulation technique. Our study also showed a positive association between socio-demographic characteristics of the studied samples with the overall level of practice regarding peripheral cannulation technique.

Conclusions

Nurses were not practised peripheral cannulation technique appropriately; however, half of the nurses’ had an average level of practice, although their practices were not followed the standard protocols.
Implementing interprofessional video consultations with general practitioners and psychiatrists in correctional facilities in Germany: results from a mixed-methods study
Authors: Colombo Miriam Giovanna , Joos Stefanie , Koch Roland
Published: June 2023

Background

Adequate health care in correctional facilities is often limited by staff shortage, which entails time-consuming consultations with physicians outside of these facilities. Video consultations (VC) have been implemented in many different health care settings and may also be useful in correctional facilities. As part of a pilot project, synchronous VC were implemented in five correctional facilities in Germany in June 2018. The aim of this study was to describe the implementation process from the providers’ perspective and to identify factors promoting or inhibiting the implementation process of VC with a focus on interprofessional collaboration between nursing staff and telemedicine physicians.

Methods

As part of the mixed-methods evaluation of the pilot project, site visits to the five correctional facilities were carried out. Nursing staff from the five correctional facilities (n=49) and telemedicine physicians (n=10) were asked to participate in interviews and a questionnaire survey. Interviews were analyzed using qualitative content analysis and questionnaires were evaluated using descriptive statistical methods. The results from both data sources were integrated and discussed in the framework of Normalization Process Theory.

Results

Interviews were conducted with 24.5% (n=12) of nursing staff and 20.0% (n=2) of telemedicine physicians, while questionnaires were returned by 22.5% (n=11) of nursing staff and 33.3% (n=3) of telemedicine physicians. VC with general practitioners and psychiatrists were perceived as an additional support during times when physicians were absent from the correctional facilities. Allocating telemedicine physicians to specific correctional facilities might further improve interprofessional collaboration with nursing staff during VC. Inhibiting factors comprised the lack of integrating nursing staff into the implementation process, increased workload, insufficient training and the implementation of VC at an inconvenient time.

Conclusions

To summarize, VC are a promising supplement to face-to-face health care in correctional facilities despite several limitations. These might be compensated by improving interprofessional cooperation and by integrating telemedicine physicians into local health care teams.
MicroRNA-27a-3p enhances the inflammatory phenotype of Juvenile Idiopathic Arthritis fibroblast-like synoviocytes
Authors: Bullock Claire H. , McAlpine Sarah M. , Roberts Sarah E. , Derfalvi Beata
Published: June 2023

Background

Juvenile Idiopathic Arthritis (JIA) is the most prevalent chronic pediatric rheumatic disorder. In joints of JIA patients, aggressive phenotypic changes in fibroblast-like synoviocytes (FLS) of the synovial lining play a key role in inflammation. MicroRNAs are dysregulated in rheumatoid arthritis and JIA, including miR-27a-3p. However, it is not understood if miR-27a-3p, enriched in JIA synovial fluid (SF) and leukocytes, alters FLS function.

Methods

Primary JIA FLS cells were transfected with a miR-27a-3p mimic or a negative control microRNA (miR-NC) and stimulated with pooled JIA SF or inflammatory cytokines. Viability and apoptosis were analyzed by flow cytometry. Proliferation was evaluated using a 3H-thymidine incorporation assay. Cytokine production was assessed by qPCR and ELISA. Expression of TGF-β pathway genes was determined using a qPCR array.

Results

MiR-27a-3p was constitutively expressed in FLS. Overexpression of miR-27a-3p caused increased interleukin-8 secretion in resting FLS, and interleukin-6 was elevated in SF-activated FLS compared to miR-NC. Furthermore, stimulation with pro-inflammatory cytokines augmented FLS proliferation in miR-27a-3p-transfected FLS relative to miR-NC. Expression of multiple TGF-β pathway genes was modulated by overexpression of miR-27a-3p.

Conclusions

MiR-27a-3p significantly contributes to FLS proliferation and cytokine production, making it a potential candidate for epigenetic therapy that targets FLS in arthritis.
Novel cerebrospinal fluid biomarkers correlating with shunt responsiveness in patients with idiopathic normal pressure hydrocephalus
Authors: Weiner Sophia , Junkkari Antti , Sauer Mathias , Luikku Antti , Rauramaa Tuomas , Kokkola Tarja , Herukka Sanna-Kaisa , Blennow Kaj , Zetterberg Henrik , Leinonen Ville , Gobom Johan
Published: June 2023

Background

Idiopathic Normal pressure hydrocephalus (iNPH) is a form of adult hydrocephalus that is clinically characterized by progressive gait impairment, cognitive dysfunction, and urinary incontinence. The current standard method of treatment involves surgical installation of a CSF diversion shunt. However, only a fraction of patients shows an alleviation of symptoms from shunt surgery. Thus, the purpose of this prospective explorative proteomic study was to identify prognostic CSF biomarkers to predict shunt responsiveness in iNPH patients. Further, we evaluated the ability of the core Alzheimer’s disease (AD) CSF biomarkers phosphorylated (p)-tau, total (t)-tau, and amyloid-β 1–42 (Aβ1–42) to serve as predictors of shunt response.

Methods

We conducted a tandem mass tag (TMT) proteomic analysis of lumbar CSF from 68 iNPH patients, sampled pre-shunt surgery. Tryptic digests of CSF samples were labelled with TMTpro reagents. The TMT multiplex samples were fractionated in 24 concatenated fractions by reversed-phase chromatography at basic pH and analysed by liquid chromatography coupled to mass spectrometry (LC–MS) on an Orbitrap Lumos mass spectrometer. The relative abundances of the identified proteins were correlated with (i) iNPH grading scale (iNPHGS) and (ii) gait speed change 1 year after surgery from baseline to identify predictors of shunt responsiveness.

Results

We identified four CSF biomarker candidates which correlated most strongly with clinical improvement on the iNPHGS and were significantly changed in shunt-responsive compared to shunt-unresponsive iNPH patients 1 year post-surgery: FABP3 (R = − 0.46, log2(fold change (FC)) = − 0.25, p < 0.001), ANXA4 (R = 0.46, log2(FC) = 0.32, p < 0.001), MIF (R = -0.49, log2(FC) =  − 0.20, p < 0.001) and B3GAT2 (R = 0.54, log2(FC) = 0.20, p < 0.001). In addition, five biomarker candidates were selected based on their strong correlation with gait speed change 1 year after shunt installation: ITGB1 (R = − 0.48, p < 0.001), YWHAG (R = − 0.41, p < 0.01), OLFM2 (R = 0.39, p < 0.01), TGFBI (R = − 0.38, p < 0.01), and DSG2 (R = 0.37, p < 0.01).

Concentrations of the CSF AD core biomarkers did not differ significantly with shunt responsiveness.

Conclusion

FABP3, MIF, ANXA4, B3GAT2, ITGB1, YWHAG, OLFM2, TGFBI and DSG2 in CSF are promising prognostic biomarker candidates to predict shunt responsiveness in iNPH patients.
COVID-19-specific adult basic life support guideline strategies for chiropractors and other healthcare providers to maximize the safety and efficacy of resuscitation: a commentary
Authors: Woo Chun-Cheung
Published: June 2023

Background

The emergence of an unprecedented novel severe acute respiratory syndrome coronavirus-2 (SARS-C0V-2), which causes the coronavirus disease 2019 (COVID-19) pandemic, has created new scenarios in basic life support (BLS) management. According to current evidence, SARS-CoV-2 can be transmitted airborne in aerosol particles during resuscitation. Research evidence found an alarming global increase in out-of-hospital cardiac arrests during the COVID-19 pandemic. Healthcare providers are legally obliged to respond to cardiac arrest as soon as possible. Chiropractors will likely encounter potential exercise-related and non-exercise-related cardiac emergencies at some point in their professional lives. They have a duty of care to respond to emergencies such as cardiac arrest. Chiropractors are increasingly involved in providing care, including emergency care, for athletes and spectators at sporting events. Also, exercise-related cardiac arrest in adult patients may occur during exercise testing or rehabilitation with exercise prescriptions in chiropractic and other healthcare settings. Little is known about the COVID-19 BLS guidelines for chiropractors. Knowledge of the current COVID-19-specific adult BLS guidelines is essential to developing an emergency response plan for the on-field and sideline management of exercise-related cardiac arrest and non-athletic, non-exercise-related cardiac arrest.

Main text

Seven peer-reviewed articles on the COVID-19-specific BLS guidelines, including two updates, were reviewed for this commentary. Responding to the COVID-19 pandemic, the national and international resuscitation organizations recommended interim COVID-19-specific BLS guidelines with precaution, resuscitation, and education strategies. BLS safety is paramount. A precautionary approach with the bare minimum of appropriate personal protective equipment for resuscitation is recommended. There was disagreement among the COVID-19 BLS guidelines on the level of personal protective equipment. All healthcare professionals should also undergo self-directed BLS e-learning and virtual skill e-training. The summarized COVID-19-specific adult BLS guideline strategies and protocols are tabled, respectively.

Conclusions

This commentary provides a practical overview and highlights current evidence-based intervention strategies of the COVID-19-specific adult BLS guidelines that may help chiropractors and other healthcare providers reduce BLS-related exposures to SARS-CoV-2 and the risks of SARS-CoV-2 transmission and maximize the efficacy of resuscitation. This study is relevant to and impacts future COVID-19-related research in areas such as infection prevention and control.
The influence of prosthetic positioning and proximal femoral morphology on leg length discrepancy and early clinical outcomes of cementless total hip arthroplasty
Authors: Huang Zhenchao , Zhang Zian , Lu Xinzhe , Liu Yikai , Zhang Haining
Published: June 2023

Background

Leg length discrepancy (LLD) is a common complication of total hip arthroplasty (THA). However, the relationship between femoral prosthesis filling, proximal femoral morphology, and acetabular prosthesis positioning with postoperative LLD and clinical outcomes is unclear. The aims of this study were to investigate the influence of canal flare index (CFI), canal fill ratio (CFR), center of rotation (COR), and femoral offset (FO) on (1) postoperative LLD; and (2) clinical outcomes in the two stem designs with different coating distribution.

Methods

The study cohort included 161 patients who underwent primary cementless THA between January 2021 and March 2022 with either proximal coating or full coating stems. Multivariate logistic regression was used to assess the effect of CFI, CFR, COR, and FO on postoperative LLD, and linear regression to assess their effect on clinical outcomes.

Results

No statistical difference was found in clinical outcomes or postoperative LLD between the two groups. High CFI (p = 0.014), low ΔVCOR (p = 0.012), and Gender (p = 0.028) were found independent risk factors for LLD one day postoperative. High CFI was also an independent risk factor for postoperative subjectively perceived LLD (p = 0.013). CFR at the level of 2 cm below the LT (p = 0.017) was an independent risk factor for Harris Hip Score.

Conclusions

Proximal femoral morphology and acetabular prosthesis positioning but not femoral prosthesis filling affected the LLD. High CFI was an independent risk factor for postoperative LLD and subjectively perceived LLD, and low ΔVCOR was also an independent risk factor for postoperative LLD. Women were susceptible to postoperative LLD.
Assessment of the WHO non-communicable diseases kit for humanitarian emergencies in South Sudan: a retrospective, prospective, observational study
Authors: Alani Ahmad Hecham , Miller Laura , Darji Bhavika , Waweru Isaac , Atwiine Aston Benjamin , Tonelli Marcello , Mogga Joseph Lou Kenyi , Adams Ali , Ndinda Lilian , Jongo Said , Kiapi Lilian
Published: June 2023

Background

The WHO Non-Communicable Diseases Kit (NCDK) was developed to support care for non-communicable diseases (NCDs) in humanitarian settings. Targeting primary healthcare, each kit contains medicines and supplies that are forecasted to meet the needs of 10,000 people for 3 months. This study aimed to evaluate the NCDK deployment process, contents, usage and limitations, and to explore its acceptability and effectiveness among healthcare workers (HCWs) in South Sudan.

Methods

This mixed-method observational study captured data from pre-and-post NCDK deployment. Six data collection tools included: (i) contextual analysis, (ii) semi-structured interviews, in addition to surveys measuring/assessing (iii) healthcare workers’ knowledge about NCDs, and healthcare workers’ perceptions of: (iv) health facility infrastructure, (v) pharmaceutical supply chain, and (vi) NCDK content. The pre- and post-deployment evaluations were conducted in four facilities (October-2019) and three facilities (April-2021), respectively. Descriptive statistics were used for quantitative data and content analysis for open-ended questions. A thematic analysis was applied on interviews findings and further categorized into four predetermined themes.

Results

Compared to baseline, two of the re-assessed facilities had improved service availability for NCDs. Respondents described NCDs as a growing problem that is not addressed at a national level. After deployment, the same struggles were intensified with the COVID-19 pandemic. The delivery process was slow and faced delays associated with several barriers. After deployment, poor communications and the “push system” of inventories were commonly perceived by stakeholders, leading to expiry/disposal of some contents. Despite being out-of-stock at baseline, at least 55% of medicines were found to be unused post-deployment and the knowledge surveys demonstrated a need for improving HCWs knowledge of NCDs.

Conclusions

This assessment further confirmed the NCDK role in maintaining continuity of care on a short-term period. However, its effectiveness was dependent on the health system supply chain in place and the capacity of facilities to manage and treat NCDs. Availability of medicines from alternative sources made some of the NCDK medicines redundant or unnecessary for some health facilities. Several learnings were identified in this assessment, highlighting barriers that contributed to the kit underutilization.
A pregnant lady with compound bowel obstruction managed with thoracic epidural as sole anesthesia in a resource-restricted setting: a case report
Authors: Wonte Mesay Milkias , Bantie Abere Tilahun , Tadesse Muhiddin
Published: June 2023

Background

Preserving the mother’s safety, sustaining the pregnancy state, and achieving the optimal fetal outcome are the major priorities when managing obstetric patients for non-obstetric surgery. Only necessary and urgent surgeries are carried out during pregnancy due to the effects of anesthesia and surgery on the fetus. Compound bowel obstruction (small and large bowel obstruction) is rare, especially during the third trimester of pregnancy. Besides this, the procedure (laparotomy) was done with awake opioid-based thoracic epidural anesthesia as the sole anesthesia. This case report of awake laparotomy for major abdominal surgery is the first of its kind with an excellent feto-maternal outcome.

Case presentation

A 30-year-old African pregnant lady presented to the emergency department with a chief complaint of abdominal pain and vomiting for an 8-hour duration; associated with this, she had a history of blurred vision, lightheadedness, loss of appetite, low-grade fever, and constipation. Later, she was diagnosed with large bowel obstruction and underwent an emergency laparotomy, managed with a thoracic epidural sole anesthesia.

Conclusion

A multidisciplinary team approach is greatly recommended to safeguard a sufficient standard of care for both the mother and fetus. The provision of regional anesthesia for patients with high risks in perioperative periods is crucial for a better postoperative outcome. We have confidence that thoracic epidural anesthesia can be used as another anesthetic option for major abdominal surgery in a resource-restricted setting for patients who are expected to have a significant risk of perioperative adverse events under general anesthesia.
Succession and determinants of the early life nasopharyngeal microbiota in a South African birth cohort
Authors: Claassen-Weitz Shantelle , Gardner-Lubbe Sugnet , Xia Yao , Mwaikono Kilaza S. , Mounaud Stephanie Harris , Nierman William C. , Workman Lesley , Zar Heather J. , Nicol Mark P.
Published: June 2023

Background

Bacteria colonizing the nasopharynx play a key role as gatekeepers of respiratory health. Yet, dynamics of early life nasopharyngeal (NP) bacterial profiles remain understudied in low- and middle-income countries (LMICs), where children have a high prevalence of risk factors for lower respiratory tract infection. We investigated longitudinal changes in NP bacterial profiles, and associated exposures, among healthy infants from low-income households in South Africa.

Methods

We used short fragment (V4 region) 16S rRNA gene amplicon sequencing to characterize NP bacterial profiles from 103 infants in a South African birth cohort, at monthly intervals from birth through the first 12 months of life and six monthly thereafter until 30 months.

Results

CorynebacteriumandStaphylococcuswere dominant colonizers at 1 month of life; however, these were rapidly replaced byMoraxella-orHaemophilus-dominated profiles by 4 months. This succession was almost universal and largely independent of a broad range of exposures. Warm weather (summer), lower gestational age, maternal smoking, no day-care attendance, antibiotic exposure, or low height-for-agezscore at 12 months were associated with higher alpha and beta diversity. Summer was also associated with higher relative abundances ofStaphylococcus,Streptococcus,Neisseria, or anaerobic gram-negative bacteria, whilst spring and winter were associated with higher relative abundances ofHaemophilusorCorynebacterium, respectively. Maternal smoking was associated with higher relative abundances ofPorphyromonas. Antibiotic therapy (or isoniazid prophylaxis for tuberculosis) was associated with higher relative abundance of anerobic taxa (Porphyromonas,Fusobacterium, andPrevotella) and with lower relative abundances of health associated-taxaCorynebacteriumandDolosigranulum. HIV-exposure was associated with higher relative abundances ofKlebsiellaorVeillonellaand lower relative abundances of an unclassified genus within the family Lachnospiraceae.

Conclusions

In this intensively sampled cohort, there was rapid and predictable replacement of early profiles dominated by health-associatedCorynebacteriumandDolosigranulumwith those dominated byMoraxellaandHaemophilus, independent of exposures. Season and antibiotic exposure were key determinants of NP bacterial profiles. Understudied but highly prevalent exposures prevalent in LMICs, including maternal smoking and HIV-exposure, were associated with NP bacterial profiles.
Nurses’ knowledge and practice regarding mixing medications with food: a multicenter cross-sectional study from a developing country
Authors: Daibes Marah A. , Qedan Rawan I. , Al-Jabi Samah W. , Koni Amer A. , Zyoud Sa’ed H.
Published: June 2023

Background

Different pharmaceutical characteristics of the dosage form (DF) have a direct effect on how easily oral solid medicine is swallowed. The practice of crushing tablets or opening the capsule occurs daily in the hospital, and most nurses are unknowledgeable regarding these issues. Coadministration of medications with food can cause changes in drug absorption and lead to an alteration in gastrointestinal motility, which can cause an unexpected effect on the dissolution and absorption of the drug. Therefore, this study aimed to investigate nurses' knowledge and practices regarding the mixing of medications with food or drink in Palestine.

Methods

From June 2019 to April 2020, a cross-sectional study was conducted, encompassing nurses working in government hospitals across various districts of Palestine. The data were collected through face-to-face interviews, using questionnaires that assessed nurses' understanding and implementation of mixing medications with food. The sampling method employed was convenience sampling. To analyze the gathered information, the Statistical Package for the Social Sciences version 21 (IBM-SPSS) was utilized.

Results

A total of 200 nurses participated in the study. The data show a significant difference between the median knowledge scores according to the department of work (p < 0.001). The highest median [interquartile] knowledge score of 15 [12–15] was found for nurses working in the neonatal intensive care unit. In addition, nurses in the pediatric ward and the men’s medical ward had high scores of 13 [11.5–15] and 13 [11–14], respectively. In general, the results show that 88% of nurses modified oral DF prior to administration to patients. Regarding the type of food used, mixing medicine into juice was the most common procedure performed by nurses (approximately 84%); 35% of nurses used orange juice to mix with medicine. The most common reason for crushing was to administer medications to patients with a nasogastric tube (41.5%). In regard to medications, aspirin was the most frequently used drug that was crushed by the nurses (44%); however, 35.5% of nurses did not feel sufficiently trained to carry out this practice. Concerning the sources of information, 58% of nurses usually asked pharmacists for information about medications.

Conclusions

The results of this study show that crushing and mixing medications with food is common among nurses, and most nurses are unaware of the dangerous effect of this practice on patient health. Pharmacists, as medication experts, should participate in sharing knowledge about unnecessary crushing situations or when crushing should be avoided and try to find an alternative, when available, to aid administration.
Primary pilocytic astrocytoma of cerebello-pontine angle in the pediatric age group: literature review and case report
Authors: Mahakul Dibya Jyoti , Premsagar Ishwar Chandra
Published: June 2023

Background

Primary pilocytic astrocytoma of the CPA (Cerebello-pontine angle), in the pediatric age group is an extremely rare entity, with just three cases reported so far. It mostly arises from the root entry zone of the cranial nerves found in this cistern.

Case presentation

A 11-year boy presented with headache, hearing impairment in right ear. Pure tone audiogram and BAER (Brainstem auditory evoked response) suggested retro-cochlear sensori-neural hearing loss. MRI revealed a heterogeneously enhancing extra-axial lesion in the right CPA. Tumor was approached through right retromastoid suboccipital craniotomy. Intraoperatively it seemed to arise from the REZ (root entry zone) of CN VIII and histopathology confirmed it to be pilocytic astrocytoma. We have reported this as only the fourth case and reviewed the already existing literature. In the previous case reports an extensive immunohistochemical analysis was not done and the final diagnosis was not as per the Harlem consensus guidelines.

Conclusion

In this case, we have tried to report the final histopathology in accordance with the 5th edition of WHO classification of CNS tumors. In the current era of molecular diagnosis and layered structural format of reporting a histopathology, this case is the first of its kind and emphasizes the need to consider PA as one of the differentials for lesions in CPA.
Cut-off scores for mild and moderate dementia on the Addenbrooke's Cognitive Examination-III and the Mini-Addenbrooke's Cognitive Examination compared with the Mini-Mental State Examination
Authors: McCarthy Louise , Rubinsztein Judy , Lowry Ellen , Flanagan Emma , Menon Vandana , Vearncombe Silvia , Mioshi Eneida , Hornberger Michael
Published: June 2023

Aims and method

We aimed to establish cut-off scores to stage dementia on the Addenbrooke's Cognitive Examination-III (ACE-III) and the Mini-Addenbrooke's Cognitive Examination (M-ACE) compared with scores traditionally used with the Mini-Mental State Examination (MMSE). Our cross-sectional study recruited 80 patients and carers from secondary care services in the UK.

Results

A score ≤76 on the ACE-III and ≤19 on the M-ACE correlated well with MMSE cut-offs for mild dementia, with a good fit on the receiver operating characteristic analysis for both the ACE-III and M-ACE. The cut-off for moderate dementia had lower sensitivity and specificity. There were low to moderate correlations between the cognitive scales and scales for everyday functioning and behaviour.

Clinical implications

Our findings allow an objective interpretation of scores on the ACE-III and the M-ACE relative to the MMSE, which may be helpful for clinical services and research trials.
Anthracycline-Free Protocol for Favorable-Risk Childhood ALL: A Noninferiority Comparison Between Malaysia-Singapore ALL 2003 and ALL 2010 Studies
Authors: Ariffin Hany , Chiew Edwynn Kean Hui , Oh Bernice Ling Zhi , Lee Shawn Hsien Ren , Lim Evelyn Huizi , Kham Shirley Kow Yin , Abdullah Wan Ariffin , Chan Lee Lee , Foo Koon Mian , Lam Joyce Ching Mei , Chan Yiong Huak , Lin Hai Peng , Quah Thuan Chong , Tan Ah Moy , Yeoh Allen Eng Juh
Published: June 2023

PURPOSE

To investigate whether, for children with favorable-risk B-cell precursor ALL (BCP-ALL), an anthracycline-free protocol is noninferior to a modified Berlin-Frankfurt-Muenster ALL-IC2002 protocol, which includes 120 mg/m2 of anthracyclines.

PATIENTS AND METHODS

Three hundred sixty-nine children with favorable-risk BCP-ALL (age 1-9 years, no extramedullary disease, and no high-risk genetics) who cleared minimal residual disease (≤0.01%) at the end of remission induction were enrolled into Ma-Spore (MS) ALL trials. One hundred sixty-seven standard-risk (SR) patients (34% of Malaysia-Singapore ALL 2003 study [MS2003]) were treated with the MS2003-SR protocol and received 120 mg/m2 of anthracyclines during delayed intensification while 202 patients (42% of MS2010) received an anthracycline-free successor protocol. The primary outcome was a noninferiority margin of 1.15 in 6-year event-free survival (EFS) between the MS2003-SR and MS2010-SR cohorts.

RESULTS

The 6-year EFS of MS2003-SR and MS2010-SR (anthracycline-free) cohorts was 95.2% ± 1.7% and 96.5% ± 1.5%, respectively ( P = .46). The corresponding 6-year overall survival was 97.6% and 99.0% ± 0.7% ( P = .81), respectively. The cumulative incidence of relapse was 3.6% and 2.6%, respectively ( P = .42). After adjustment for race, sex, age, presenting WBC, day 8 prednisolone response, and favorable genetic subgroups, the hazard ratio for MS2010-SR EFS was 0.98 (95% CI, 0.84 to 1.14; P = .79), confirming noninferiority. Compared with MS2003-SR, MS2010-SR had significantly lower episodes of bacteremia (30% v 45.6%; P = .04) and intensive care unit admissions (1.5% v 9.5%; P = .004).

CONCLUSION

In comparison with MS2003-SR, the anthracycline-free MS2010-SR protocol is not inferior and was less toxic as treatment for favorable-risk childhood BCP-ALL.