bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic respiratory symptoms and associated factors among cement factory workers in Dejen town, Amhara regional state, Ethiopia, 2015
Authors: Gizaw Zemichael , Yifred Bamlaku , Tadesse Takele
Published: January 2020

Background: Chronic respiratory diseases represent a public health challenge in both industrialized and developing countries. Chronic respiratory symptoms are more prevalent in cement factories of developing countries, where occupational health and safety issues are less emphasized. This study was conducted to determine the prevalence and factors affecting chronic respiratory symptoms among workers in Dejen cement factory, 2015.

Methods: Institution based cross sectional study was conducted among 404 randomly selected study participants. Data were collected through interviewer administered structured questions derived from British Medical Research Council (BMRC) adult respiratory symptom assessment questions and observational check lists for the assessment of dust exposure, hygienic practices and use of personal protective equipments. Multivariable logistic regression model was used to identify predictor variables which have association with chronic respiratory symptoms and finally the variables which had significant association were identified on the basis of Adjusted Odds Ratio (AOR) with 95 % Confidence Interval (CI) and p < 0.05.

Results: The prevalence of chronic respiratory symptoms among Dejen cement factory workers was 62.9 %, with prevalence of chronic cough 24.5 %, chronic wheezing 36.9 %, chronic phlegm 24.5 %, chronic shortness of breath 38.6 %, and chest pain 21.0 %. Chronic respiratory symptoms were associated with sex (AOR = 2.07, 95 % CI = 1.18, 3.63), age (AOR = 4.20, 95 % CI = 1.94, 9.12), education level (AOR = 4.07,95 % CI = 1.86, 8.92), cement mill (AOR = 3.72, 95 % CI = 1.92, 7.21), burner and clinker (AOR = 2.28, 95 % CI = 1.18, 4.43), work experience (AOR = 5.44, 95 % CI = 3.09, 9.59), training on occupational safety and health (AOR = 2.73, 95 % CI = 1.41, 5.29), smoking (AOR = 5.38, 95 % CI = 1.42, 20.39) and chronic respiratory diseases (AOR = 7.79, 95 % CI = 2.02, 30.04).

Conclusion: Chronic respiratory symptoms were highly prevalent among Dejen cement factory workers. Age, sex, education level, working department, smoking, work experience, and training were identified factors. Pre employment and on service training, smoking cessation programs, improving hygienic practices are important tasks in order to maintain the health and safety of workers.
Prevalence of pulmonary tuberculosis in young adult patients with Type 1 diabetes mellitus in India
Authors: Goswami Ravinder , Nair Abilash , Guleria Randeep , Kandasamy Devasenathipathy , Sharma Raju , Tandon Nikhil , Singh Urvashi B.
Published: January 2020

Background: There is limited information on prevalence of pulmonary tuberculosis (PTB) in patients with type-1- diabetes. We assessed the prevalence of PTB in patients with type-1-diabetes attending the outpatient-clinic in a tertiary-care hospital. Methods: 151 patients with type-1-diabetes were screened for PTB by clinical examination and chest-radiography. Sputum Acid-Fast Bacilli Test (AFB) and Mycobacterium tuberculosis (M.tb) culture were performed in patients with clinical and radiological features suggestive of a possibility of PTB and also in those with history of PTB in the past. Their average glycated haemoglobin (HbA1c) during preceding 2 years was assessed. Sputum culture positive patients were managed by a pulmonologist. Results: 5/151 patients had respiratory symptoms and radiographic findings suggestive of PTB. 20/151 patients were asymptomatic but had history of PTB. Four of the five symptomatic patients and 12 with past PTB were positive for sputum M.tb by culture, giving a prevalence of 10.6 % sputum culture positive in type-1-diabetes. Average HbA1c was comparable in patients with and without positive sputum culture. ESR and Mantoux test were not discriminatory in these groups. Four clinically symptomatic M.tb culture positive and four asymptomatic patients with sputum culture positive for M.tb on two occasions (6 weeks apart) were put on antitubercular treatment (ATT). Patients who were culture positive for M.tb only on one occasion were kept on a close follow up. Conclusions: Patients with type-1-diabetes mellitus in India have high prevalence of PTB. They need to be actively screened for PTB by sputum M.tb culture in order to initiate early treatment and to prevent transmission in the community.
Acid–base balance, serum electrolytes and need for non-invasive ventilation in patients with hypercapnic acute exacerbation of chronic obstructive pulmonary disease admitted to an internal medicine ward
Authors: Schiavo Alfonso , Renis Maurizio , Polverino Mario , Iannuzzi Arcangelo , Polverino Francesca
Published: January 2020

Background: Hypoventilation produces or worsens respiratory acidosis in patients with hypercapnia due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). In these patients acid–base and hydroelectrolite balance are closely related. Aim of the present study was to evaluate acid–base and hydroelectrolite alterations in these subjects and the effect of non-invasive ventilation and pharmacological treatment. Methods: We retrospectively analysed 110 patients consecutively admitted to the Internal Medicine ward of Cava de’ Tirreni Hospital for acute exacerbation of hypercapnic chronic obstructive pulmonary disease. On admission all patients received oxygen with a Venturi mask to maintain arterial oxygen saturation at least >90 %, and received appropriate pharmacological treatment. Non-Invasive Ventilation (NIV) was started when, despite optimal therapy, patients had severe dyspnea, increased work of breathing and respiratory acidosis. Based on Arterial Blood Gas (ABG) data, we divided the 110 patients in 3 groups: A = 51 patients with compensated respiratory acidosis; B = 36 patients with respiratory acidosis + metabolic alkalosis; and C = 23 patients with respiratory acidosis + metabolic acidosis. 55 patients received only conventional therapy and 55 had conventional therapy plus NIV. Results: The use of NIV support was lower in the patients belonging to group B than in those belonging to group A and C (25 %, vs 47 % and 96 % respectively; p < 0.01). A statistically significant association was found between pCO2 values and serum chloride concentrations both in the entire cohort and in the three separate groups. Conclusions: Our study shows that in hypercapnic respiratory acidosis due to AECOPD, differently from previous studies, the metabolic alkalosis is not a negative prognostic factor neither determines greater NIV support need, whereas the metabolic acidosis in addition to respiratory acidosis is an unfavourable element, since it determines an increased need of NIV and invasive mechanical ventilation support.
Perimenstrual asthma: from pathophysiology to treatment strategies
Authors: Graziottin Alessandra , Serafini Audrey
Published: January 2020

The prevalence of asthma is about 9,7 % in women and 5,5 % in men. Asthma can deteriorate during the perimenstrual period, a phenomenon known as perimenstrual asthma (PMA), which represents a unique, highly symptomatic asthma phenotype. It is distinguished from traditional allergic asthma by aspirin sensitivity, less atopy, and lower lung capacity. PMA incidence is reported to vary between 19 and 40 % of asthmatic women. The presence of PMA has been related to increases in asthma-related emergency department visits, hospitalizations and emergency treatment including intubations. It is hypothesized that hormonal status may influence asthma in women, focusing on the role of sex hormones, and specifically on the impact of estrogens’ fluctuations at ovulation and before periods. This paper will focus on the pathophysiology of hormone triggered cycle related inflammatory/allergic events and their relation with asthma. We reviewed the scientific literature on Pubmed database for studies on PMA. Key word were PMA, mastcells, estrogens, inflammation, oral contraception, hormonal replacement therapy (HRT), and hormone free interval (HFI). Special attention will be devoted to the possibility of reducing the perimenstrual worsening of asthma and associated symptoms by reducing estrogens fluctuations, with appropriate hormonal contraception and reduced HFI. This novel therapeutical approach will be finally discussed.
Efficacy of recombinant human soluble thrombomodulin for the treatment of acute exacerbation of idiopathic pulmonary fibrosis: a single arm, non-randomized prospective clinical trial
Authors: Hayakawa Sho , Matsuzawa Yasuo , Irie Tamako , Rikitake Hagino , Okada Noriaki , Suzuki Yasuo
Published: January 2020

Background: Coagulation abnormalities are involved in the pathogenesis of acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF). The administration of recombinant human soluble thrombomodulin (rhTM), which has both anti-inflammatory and anticoagulant activities, improves outcomes and respiratory function in patients with acute respiratory distress syndrome. Therefore, we conducted a prospective clinical study to examine the effects of rhTM on respiratory function, coagulation markers, and outcomes for patients with AE-IPF. Methods: After registration of the protocol, the patients with AE-IPF who satisfied the study inclusion criteria were treated daily with 380 U/kg of rhTM for 7 days and steroid pulse therapy. The concomitant administration of immunosuppressants and polymyxin B-immobilized fiber column treatment was prohibited. The sample size was 10 subjects. The primary study outcome was the improvement of PaO2/FiO2 ratio a week after treatment initiation. Secondary outcomes were change in D-dimer level over time and 28-day survival rate in patients without intubation. Study data were compared with historical untreated comparison group, including 13 patients with AE-IPF who were treated without rhTM before the registration. Results: The mean PaO2/FiO2 ratio for the rhTM treatment group (n = 10) on day 8 significantly improved compared with that on day one (two-way analysis of variance, p = 0.01). The mean D-dimer level tended to decrease in the rhTM group on day 8, but the change was not significant. The 28-day survival rate was 50 % higher in the rhTM group than in the historical untreated comparison group, but the difference was not significant. A post hoc analysis showed that overall survival time was significantly longer in the treated group compared with that of the historical untreated comparison group (p = 0.04, log-rank test). Conclusion: rhTM plus steroid pulse therapy improves respiratory functions in patients with AE-IPF and is expected to improve overall patient survival without using other combination therapies. Trial registration: The study was registered with University Hospital Medical Information Network Clinical Trial Registry (UMIN-CTR) in October 2012 (UMIN000009082).
Once daily aerosolised tobramycin in adult patients with cystic fibrosis in the management of Pseudomonas aeruginosa chronic infection
Authors: Gramegna Andrea , Mantero Marco , Pizzamiglio Giovanna , D’Adda Alice , Tarsia Paolo , Blasi Francesco
Published: January 2020

It is estimated that about 60–70% of Cystic Fibrosis patients develop Pseudomonas aeruginosa chronic infection,with progressive loss of lung function, as well as increased antibiotic resistance and mortality. The current strategy is to maintain lung function by chronic suppressive antipseudomonas antibiotic therapy. Tobramycin inhalation solution was the first approved aerosolised antibiotic to be used against P. aeruginosa; inhalatory tobramycin frequency of administration is twice daily and inhalation time is estimated to be 15 to 20 min. From the pharmacokinetic point of view, aminoglycosides are dose-dependent antibiotics and therefore once-daily dosing intravenous regimens have shown to be superior to the conventional multiple daily dosing. Therefore, there is no pharmacological reason to prefer the b.i.d administration as it is usually performed in current clinical practice. Should this be confirmed also for inhalatory route, the use of once-daily dosed aerosolized tobramycin could be an important step in making treatment burden easier in CF patients. The aim of this proof of concept study was to explore the effectiveness of treatment with once daily inhaled tobramycin in reducing P. aeruginos a density in sputum of chronically infected patients.
The physiological basis and clinical significance of lung volume measurements
Authors: Lutfi Mohamed Faisal
Published: January 2020

From a physiological standpoint, the lung volumes are either dynamic or static. Both subclasses are measured at different degrees of inspiration or expiration; however, dynamic lung volumes are characteristically dependent on the rate of air flow. The static lung volumes/capacities are further subdivided into four standard volumes (tidal, inspiratory reserve, expiratory reserve, and residual volumes) and four standard capacities (inspiratory, functional residual, vital and total lung capacities). The dynamic lung volumes are mostly derived from vital capacity. While dynamic lung volumes are essential for diagnosis and follow up of obstructive lung diseases, static lung volumes are equally important for evaluation of obstructive as well as restrictive ventilatory defects. This review intends to update the reader with the physiological basis, clinical significance and interpretative approaches of the standard static lung volumes and capacities.
A reappraisal of the mucoactive activity and clinical efficacy of bromhexine
Authors: Zanasi Alessandro , Mazzolini Massimiliano , Kantar Ahmad
Published: January 2020

Since its introduction to the market in 1963, bromhexine, an over-the-counter drug, has been investigated for its activity in animal models and in humans with diverse respiratory conditions. Bromhexine is a derivate of the Adhatoda vasica plant used in some countries for the treatment of various respiratory diseases. Bromhexine has been found to enhance the secretion of various mucus components by modifying the physicochemical characteristics of mucus. These changes, in turn, increase mucociliary clearance and reduce cough. Principal clinical research studies were primarily developed in an era when stringent methodological approaches and good clinical practices were not developed yet. Clinical studies were conducted mainly in patients with chronic bronchitis and in patients with various respiratory diseases, and demonstrated the efficacy of bromhexine in improving respiratory symptoms. Furthermore, the co-administration of antibiotics with bromhexine amplified the actions of the antibiotic. Although the clinical evidence shows only modest but positive results, bromhexine is indicated for its mucoactive activity. Larger trials with adequate methodology are required to identify when treatment with bromhexine can improve clinical outcomes.
Tele-medicine in respiratory diseases
Authors: Ambrosino Nicolino , Makhabah Dewi Nurul , Subagio Sutanto Yusup
Published: January 2020

Information and Communication Technologies applied to health care and advances in sensor and data transmission technology allowed tele-medicine based programs of care also for patients with respiratory diseases. Different sensors, transmission devices and interventions are used in tele-medicine for some indications. Patients suffering from Chronic Obstructive Pulmonary Disease, asthma, neuromuscular diseases, ventilator assisted individuals and those undergoing pulmonary rehabilitation programs may benefit from this approach. The legal problems are still unsolved. Economic advantages for health care systems, though potentially high, are still poorly investigated. Despite the hopes, we need more evidence before this modality can be considered as a real progress in the management of patients with respiratory diseases. On one hand, these technologies can improve the care of patients with difficult access to services, particularly those in rural/remote areas, on the other hand, there is the risk that they will be used only to reduce standard services in health systems of developed countries.
Clinico-pathologic presentation of hypersensitivity pneumonitis in Egyptian patients: a multidisciplinary study
Authors: Abd El-Kareem Dalia , Akl Yosri M. , Nakhla Gina A. , Elhindawi Ali A. , Eltorky Mahmoud A.
Published: January 2020

Background: Hypersensitivity pneumonitis (HP) is a common diffuse parenchymal lung disease in Egypt which can be difficult to recognize due to the dynamic symptoms & associated environmental factors.

Methods: Forty-three Egyptian patients were enrolled in this study, presenting with dyspnea and cough, predominant ground-glass opacity (GGO) in high-resolution computed tomography (HRCT) where lung biopsy was needed to establish the diagnosis.

Results: The age range was 15 to 60 years. Females represented 90.7% (39 patients) while 9.3% (4 patients) of our patients were males. History of contact with birds was detected in 9 (20.9%) patients. Most of our patients (60.5%) didn’t have exposure history, and only 8 patients (18.6%) were living in geographic areas in Egypt that are known for the exposure to environmental etiologic factors (cane sugar exhaust fumes). The most common HRCT pattern was GGO with mosaic parenchyma in 18 patients (41.86%), followed by GGO with centrilobular nodules in 9 patients (20.93%), then isolated diffuse GGO in 5 patients (11.62%), GGO with traction bronchiectasis in 4 patients (9.3%), GGO with consolidation in 3 patients (6.97%), GGO with reticulations in 2 patients (4.65%), and GGO with cysts in 2 patients (4.65%). The most common histologic finding was isolated multinucleated giant cells in 38 patients (88.3%) commonly found in airspaces (24 patients) and less commonly in the interstitium (14 patients), followed by interstitial pneumonia and cellular bronchiolitis in 36 patients (83.7% each), interstitial ill-formed non-necrotizing granulomas in 12 patients (27.9%), fibrosis in 10 patients (23.2%), and organizing pneumonia pattern in 4 patients (9.3%).

Conclusion: The diagnosis of HP presenting with predominant GGO pattern in HRCT requires a close interaction among clinicians, radiologists, and pathologists. Some environmental and household factors may be underestimated as etiologic factors. Further environmental and genetic studies are needed especially in patients with negative exposure history.
Recent advances in capsule-based dry powder inhaler technology
Authors: Lavorini Federico , Pistolesi Massimo , Usmani Omar S.
Published: January 2020

Pulmonary drug delivery is currently the focus of accelerated research and development because of the potential to produce maximum therapeutic benefit to patients by directly targeting drug to the site of pathology in the lungs. Among the available delivery options, the dry powder inhaler (DPI) is the preferred device for the treatment of an increasingly diverse range of diseases. However, because drug delivery from a DPI involves a complex interaction between the device and the patient, the engineering development of this medical technology is proving to be a great challenge. Development of DPI systems that target the delivery of fine drug particles to the deeper airways in the lungs using a combination of improved drug formulations and enhanced delivery device technologies means that each of these factors contributes to overall performance of the aerosol system. There are a large range of devices that are currently available, or under development, for clinical use, however no individual device shows superior clinical efficacy. A major concern that is very relevant in day-to-day clinical practice is the inter- and intra-patient variability of the drug dosage delivered to the deep lungs from the inhalation devices, where the extent of variability depends on the drug formulation, the device design, and the patient’s inhalation profile. This variability may result in under-dosing of drug to the patient and potential loss of pharmacological efficacy. This article reviews recent advances in capsule-based DPI technology and the introduction of the ‘disposable’ DPI device.
Pulmonary Actinomycosis attributable to Actinomyces meyeri presenting as cardiac tamponade: a case report
Authors: Nishizawa Saori , Anan Keisuke , Tobino Kazunori , Okahisa Masanobu , Goto Yuki , Murakami Kojin , Sueyasu Takuto , Munechika Miyuki , Yoshimine Kohei , Yoshino Mai
Published: January 2020

Background: Recently, it is reported that Actinomyces meyeri is the most common species causing actinomycosis. However, to our knowledge, there was no report about pulmonary actinomycosis attributable to A. meyeri presenting as cardiac tamponade. Case presentation: Hereby we describe a case of pulmonary actinomycosis attributable to A. meyeri presenting as cardiac tamponade. At first, the patient was diagnosed with bacterial pericarditis with lung abscess in the left lower lung lobe and underwent pericardial drainage. Three days after the removal of the drainage tube, atrial fibrillation followed by cardiac arrest with asystole occurred and immediate cardiopulmonary resuscitation restored his circulation. Thereafter, he underwent pneumocentesis of the lung abscess and the culture grew A. meyeri. He was successfully treated with penicillin G. Conclusion: This is the first case of pulmonary actinomycosis attributable to A. meyeri presenting as cardiac tamponade. We believe that an increased awareness of the disease is necessary to expedite diagnosis therefore minimizing morbidity and mortality.
Acute respiratory failure as presentation of late-onset Pompe disease complicating the diagnostic process as a labyrinth: a case report
Authors: Menzella Francesco , Codeluppi Luca , Lusuardi Mirco , Galeone Carla , Valzania Franco , Facciolongo Nicola
Published: January 2020

Background: Acute respiratory failure can be triggered by several causes, either of pulmonary or extra-pulmonary origin. Pompe disease, or type II glycogen storage disease, is a serious and often fatal disorder, due to a pathological accumulation of glycogen caused by a defective activiy of acid α-glucosidase (acid maltase), a lysosomal enzyme involved in glycogen degradation. The prevalence of the disease is estimated between 1 in 40,000 to 1 in 300,000 subjects. Case presentation: This case report describes a difficult diagnosis of late-onset Pompe disease (LOPD) in a 52 year old Caucasian woman with acute respiratory failure requiring orotracheal intubation and subsequent tracheostomy for long-term mechanical ventilation 24 h/day. Despite a complex diagnostic process including several blood tests, bronchoscopy with BAL, chest CT, brain NMR, electromyographies, only a muscle biopsy allowed to reach the correct diagnosis. Discussion: The most frequent presentation of myopathies, including LOPD, is proximal limb muscle weakness. Respiratory related symptoms (dyspnea on effort, reduced physical capacity, recurrent infections, etc.) and respiratory failure are often evident in the later stages of the diseases, but they have been rarely described as the onset symptoms in LOPD. In our case, a third stage LOPD, the cooperation between pulmonologists and neurologists was crucial in reaching a correct diagnosis despite a very complex clinical scenario due to different confounding co-morbidities as potential causes of respiratory failure and an atypical presentation. In this patient, enzyme replacement therapy with infusion of alglucosidase alfa was associated with progressive reduction of ventilatory support to night hours, and recovery of autonomous walking.
Implementing TB control in a rural, resource-limited setting: the stop-TB Italia project in Senegal
Authors: Diaw Mama Moussa , Ndiaye Mamoudou , Riccardi Niccolò , Ungaro Riccardo , Alagna Riccardo , Cirillo Daniela Maria , Codecasa Luigi , Viscoli Claudio , Nicolini Laura Ambra , Besozzi Giorgio
Published: January 2020

Background: Since 2013 StopTB Italia Onlus supports the Senegalese National Tuberculosis Programme by improving diagnostic capability with technological interventions, ameliorating educational programs for health care personnel, rising awareness among civil society and providing economical support for patients during treatment. The purpose of our study was to assess the preliminary results of an interventional cooperation project in a peripheral health care facility in Senegal. Methods: An observational, retrospective, pre-post study was conducted to compare Tuberculosis (TB) retention in care and outcome between a one-year period before and a four-year period after. Results: Overall, 239 patients with active TB were included, 196 (82%) of whom after the starting of the collaboration project. At diagnosis 35/43(81.4%) vs 151/196 (77%) patients were smear sputum positive before and after the beginning of the project, respectively. At 2 months follow up 23/35 (65.7%) patients in 2012 vs. 139/151 (92%) patients in 2013–2016 had negative control AFB stain (p = 0.249), 4/35 (11.4%) vs 12/151 (8%) patients remained AFB stain positive (p = 0.17), 7/35 (20%) vs 0/151 died before the 2 months follow up (p < 0.0001). TB treatment outcome was more frequently favourable after the beginning of cooperation 29/43 (67.4%) vs. 176/196 (89.8%) patients, (p < 0.0001). Patients’ mortality during treatment decreased from 8/43 (18.6%) in 2012 to 11/196 (5.6%) patients in the following years (p = 0.009). Conclusion: The implementation of diagnostic procedures, if integrated in a socio-economical intervention, impacts favourably on TB retention in care and treatment outcomes.
Reference values for spirometry in elderly individuals: a cross-sectional study of different reference equations
Authors: Belo Joana , Palmeiro Teresa , Caires Iolanda , Papoila Ana L. , Alves Marta , Carreiro-Martins Pedro , Botelho Maria A. , Neuparth Nuno
Published: January 2020

Background: Spirometry is the single most important test for the evaluation of respiratory function. The results are interpreted by comparing measured data with predicted values previously obtained from a reference population. Reference equations for spirometry have been discussed previously. The aim of this study was to compare reference values based on National Health and Nutrition Assessment Survey (NHANES III), European Community of Steel and Coal (ECSC), and Global Lung Initiative (GLI) equations in an elderly sample population. Methods: Subjects from the Geriatric Study on Health Effects of Air Quality in elder care centres who met the inclusion criteria were enrolled. Spirometry was performed according to international guidelines. The forced vital capacity, forced expiratory volume in 1 s, and FEV1/FVC ratio were reported as percentages of the predicted value, and the lower limit of normality was calculated. Results: Out of 260 elderly patients, 69.6% were women; the mean age was 83.0 ± 6.46 years with an age range of 65– 95 years. The lowest %FVC and %FEV1 values were obtained using the GLI reference equations. However, when NHANES III equations were used, the FEV1/FVC ratio was higher than ratios obtained from GLI and ECSC equations. The prevalence of airway obstruction was highest using ECSC equations, while GLI equations demonstrated more restrictive defects. Conclusions: The present study showed meaningful differences in the reference values, and consequently, in the results obtained using NHANES III, ECSC,  and GLI reference equations. The spirometry interpretation was also influenced by the reference equations used.
Obstructive sleep apnea knowledge and attitudes among recent medical graduates training in Ecuador
Authors: Chérrez-Ojeda Iván , Calderón Juan Carlos , Fernández García Andrea , Jeffe Donna B. , Santoro Ilka , Vanegas Emanuel , Cherrez Annia , Cano José , Betancourt Freddy , Simancas-Racines Daniel
Published: January 2020

Background: We aimed to assess recent Latin American medical school graduates’ knowledge and attitudes about OSA and examine whether their knowledge and attitudes about OSA differed from practicing physicians.
Methods: Recent medical graduates completed the Spanish translation of the OSA Knowledge and Attitudes (OSAKA) questionnaire at the 2013 national primary-care residency-placement meeting in Ecuador. The OSAKA includes 18 knowledge and five attitudinal items about OSA. We compared recent graduates’ data with data collected in 2010–2011 from practicing physicians using chi-square tests of associations among categorical variables and analysis of variance of differences in mean knowledge and attitude scores. Unadjusted logistic regression models tested the odds that recent graduates (vs. practicing physicians) answered each item correctly.
Results: Of 265 recent graduates, 138 (52.1%) were male, and mean age was 25.9 years. Although mean knowledge was low overall, scores were lower for recent graduates than for the 367 practicing physicians (53.5% vs. 60.4%; p < 0.001). Practicing physicians were significantly more likely to answer specific items correctly with one exception—recent graduates were more likely to know that < 5 apneas-hypopneas/h is normal (OR 1.47, 1. 03–2.07). Physicians in practice attributed greater importance to OSA as clinical disorder and the need for identifying patients with OSA; but recent graduates reported greater confidence in managing patients with OSA and CPAP.
Conclusions: OSA-focused educational interventions during medical school should help to improve recent medical graduates’ abilities to diagnose and treat OSA. We recommend a greater number of hours of medical students’ exposure to sleep education.
Obstructive sleep apnea and comorbidities: a dangerous liaison
Authors: Bonsignore Maria R. , Baiamonte Pierpaolo , Mazzuca Emilia , Castrogiovanni Alessandra , Marrone Oreste
Published: January 2020

Obstructive sleep apnea (OSA) is a highly prevalent disease, and is traditionally associated with increased cardiovascular risk. The role of comorbidities in OSA patients has emerged recently, and new conditions significantly associated with OSA are increasingly reported. A high comorbidity burden worsens prognosis, but some data suggest that CPAP might be protective especially in patients with comorbidities. Aim of this narrative review is to provide an update on recent studies, with special attention to cardiovascular and cerebrovascular comorbidities, the metabolic syndrome and type 2 diabetes, asthma, COPD and cancer. Better phenotypic characterization of OSA patients, including comorbidities, will help to provide better individualized care. The unsatisfactory adherence to CPAP in patients without daytime sleepiness should prompt clinicians to examine the overall risk profile of each patient in order to identify subjects at high risk for worse prognosis and provide the optimal treatment not only for OSA, but also for comorbidities.
Efficacy of new intermittent abdominal pressure ventilator for post-ischemic cervical myelopathy ventilatory insufficiency
Authors: Banfi Paolo I. , Volpato Eleonora , Bach John R.
Published: January 2020

Non-invasive ventilation (NIV) is the treatment of choice for patients symptomatic for respiratory muscle dysfunction. It can normalize gas exchange and provide up to continuous non-invasive ventilator support (CNVS) as an alternative to intubation and tracheotomy. It is usually provided via non-invasive facial interfaces or mouthpieces, but these can be uncomfortable and uncosmetic. The intermittent abdominal pressure ventilator (IAPV) has been used for diurnal ventilatory support since 1938 but has been off the market since about 1990. Now, however, with greater emphasis on non-invasive management, a new IAPV is available. A patient with chronic ventilatory insufficiency post-ischemic cervical myelopathy, dependent on sleep NVS since 2003, developed symptomatic daytime hypercapnia for which he also used diurnal NVS via nasal pillows. However, he preferred not having to use facial interfaces. When not using diurnal NVS he was becoming dyspnoeic. Diurnal use of an IAPV was introduced. Arterial blood gas analysis using the IAPV decreased his blood pH from 7.45 to 7.42, PaCO2 from 58 to 37mmHg, and improved PaO2 from 62 to 92mmHg. At discharge, the patient used the IAPV 8 h/day with improved mood and quality of life. Consequently, he returned to work as a painter.
Sosiale verantwoordelikheid: 'n Mite of realiteit?
Authors: Nortje J. D.
Published: January 2020

No abstract available.
The oil crisis and South Africa: A comparison with the world situation
Authors: Kotzé D. J.
Published: January 2020

Energy as a strategic resource has become a crucial world issue, to sustain future economic growth and survival. The world depends for 95% of its total energy demand, on fossil fuel, supplies of which are limited, while world energy demand is increasing steadily along with population and economic growth. The West depends heavily on oil from the Middle East, and this has placed OPEC countries in a position to demand a twentyfold increase in crude oil prices in nine years. Alternative energy sources are discussed, but the world is still heading for a crisis due to imbalance between energy supply and demand. The energy situation in South Africa differs somewhat because local coal provides 80% of total energy requirements, and stringent conservation measures have achieved large reductions in oil consumption, while uranium, electricity generation and oil-from-coal technologies make the country less vulnerable than most other western countries.Energie as 'n strategiese hulpbron het wereldwyd krities geword, om toekomstige ekonomiese groei en oorlewing te verseker. Vir 95% van sy totale energieverbruik is die wereld afhanklik van fossielbrandstof, waarvan voorrade beperk is, terwyl die wereldvraag na energie steeds met bevolkings- en ekonomiese groei styg. Die Weste moet na die Midde-Ooste opsien vir olie, en dit het OPEC-lande in staat gestel om ruoliepryse in nege jaar twintigvoudig te verhoog. Alternatiewe energiebronne word bespreek, maar die wereld stuur steeds af op 'n krisis weens wanbalans tussen energievraag en -aanbod. Die energiesituasie in Suid-Afrika verskil ietwat omdat plaaslike steenkool 80% van totale energie benodig, verskaf, terwyl streng besparingsmaatreels groot vermindering in olieverbruik meegebring het, en uraan-, elektrisiteit- en olie-uitsteenkool-tegnologiee die land minder kwesbaar maak as meeste ander Westerse lande.
Veranderinge in aandelekapitaal
Authors: Mostert F. J.
Published: January 2020

Changes in share capital. A company's ordinary share capital can be altered by changing the amount of issued share capital or the number of issued shares or a combination of the two. Such changes can be effected through rights issues, capitalization issues, the subdivision of shares, the reduction of share capital and the consolidation of shares. Each of these avenues is dealt with in this article, which embodies selected results of an empirical survey of companies listed on the Johannesburg Stock Exchange. The discussion of rights issues includes the reasons for such issues, the discounts allowed on prevailing market prices, the factors which influence the success of an issue, and the effects of rights issues on the market prices of existing shares and letters of allotment. The reasons for and benefits of sub-divisions of shares and capitalization issues are considered, as are the reasons for and financial implications of a reduction in a company's issued share capital.'n Maatskappy se gewone aandelekapitaal kan gewysig word deur die bedrag van uitgereikte aandelekapitaal of die aantal uitgereikte aandele te verander of 'n kombinasie van die twee. Sodanige veranderings kan teweeggebring word deur regteuitgiftes, kapitalisasie-uitgiftes, die onderverdeling van aandele, die vermindering van aandelekapitaal en die konsolidasie van aandele. Elk van hierdie metodes word in die artikel bespreek wat geselekteerde resultate van 'n empiriese oorsig van maatskappye, wat op die Johannesburgse Effektebeurs genoteer is, bevat. Die bespreking van regteuitgiftes bevat die redes vir sodanige uitgiftes, die diskonto's wat op heersende markpryse toegelaat word, die faktore wat die sukses van 'n uitgifte beinvloed, en die uitwerking van regte-uitgiftes op die markpryse van bestaande aandele en toekenningsbriewe. Die redes vir en voordele van die onderverdeling van aandele en kapitalisasie-uitgiftes word bespreek sowel as die redes vir en finansiele implikasies van 'n vermindering in die maatskappy se uitgereikte aandelekapitaal.
National planning perspectives
Authors: Scheepers C. F.
Published: January 2020

No abstract available.
Paradigms apart: Black managers in a White man's world
Authors: Coldwell David A.L. , Moerdyk A. P.
Published: January 2020

Just as, in the West, Calvinism generated a philosophy and value system which is still evident today in the industrialized world - even if its precise connection with Calvinistic doctrine is forgotten - so Africa has evolved its own philosophy and corresponding world view. In this paper it is argued that this African philosophy, however amorphous and ill-defined, pervades Black managers' thinking and adversely affects their performance in Western-oriented organizations.Net soos Calvinisme 'n filosofie en waarde-sisteem in die Weste tot stand gebring het - selfs al is die presiese verband met Calvinistiese leerstellinge reeds vergete - het Afrika sy eie filosofie en ooreenstemmende wllreldsiening. In die referaat word die stelling gemaak dat hierdie Afrika-filosofie, hoewel vormloos en swak gedefinieer, die Swart bestuurder se denke oorheers en 'n nadelige uitwerking het op sy werkverrigting in Westers-georienteerde organisasies.
Microwave diathermy
Authors: Hayward L. , Statham A.
Published: January 2020

An extensive literature survey is summarised. Experimentation consisted of irradiation of paraffin wax and human subjects with microwave of frequency 2 450 MHz Results, conclusions and recommendations are briefly stated. A full reference list is given.
The role of physical education and sport in a cerebral palsy school and the interaction of therapists and physical educationists
Authors: Van Der Spuy M. M. , Good J. , Liddle G. , Scoble B.
Published: January 2020

Die junksies van terapeute en liggaamlike opvoedkundiges in skole vir serebraalverlamdes word omskryf.  Samewerking tussen terapeute en liggaamlike opvoedkundiges in die seleksie van sportaktiwiteite en posisionering van elke serebraalverlamde kind word beklemtoon. Die adolessente en volwasse serebraalverlamde het die reg om te besluit aan watter aktiwiteite hy wil deelneem, maar moet op die nadelige gevolge en fisiese agteruitgang wat verkeerde aktiwiteite tot gevolg mag gewys word. Die voor- en nadele van verskeie sportaktiwiteite word bespreek.
PD-L1 Testing in Gastric Cancer by the Combined Positive Score of the 22C3 PharmDx and SP263 Assay with Clinically Relevant Cut-offs
Authors: Park Yujun , Koh Jiwon , Na Hee Young , Kwak Yoonjin , Lee Keun-Wook , Ahn Sang-Hoon , Park Do Joong , Kim Hyung-Ho , Lee Hye Seung
Published: January 2020

Purpose We provide a comparison between 22C3 pharmDx and SP263 assay, for evaluating programmed death ligand 1 (PD-L1) expression in advanced gastric cancer (GC) patients.Materials and Methods The PD-L1 immunohistochemistry by 22C3 pharmDx and SP263 assays was performed in the center of the tumor (CT) and invasive margin (IM) in 379 GC tissues using tissue microarrays and interpreted as combined positive score (CPS) and tumor proportion score (TPS). Of the total samples, 55 samples were independently reviewed by five pathologists.Results The two assays showed a high correlation in both the CPS and TPS. At a CPS ≥ 1 cut-off, 219 (57.8%) and 231 (60.9%) GCs were positive for PD-L1 with the 22C3 and SP263 assays, and at ≥ 10 cut-off, 37 (9.8%) and 36 (9.5%) GCs were positive, respectively. The overall percent agreement (OPA) was greater than 90% with CPS ≥ 1 and ≥ 10 cut-offs, and TPS ≥ 1% and ≥ 10% cut-offs. There was higher OPA between the two assays with a CPS cut-off ≥ 10 (99.2%) than ≥ 1 (94.7%). The percent agreement between the CT and IM was higher with a CPS cut-off ≥ 10 (92.9%) than ≥ 1 (77.6%). Patient with positive expression at CPS ≥ 5 cut-off had a significantly better outcomes in both assays. Interobserver variability among five pathologists was higher than the assay variability.Conclusion Two assays for PD-L1 expression in GC showed high agreement. These results provide guidance for selecting eligible patients with GC for pembrolizumab treatment.
On scattering for the cubic defocusing nonlinear Schrödinger equation on the waveguide $\mathbb R^2 \times \mathbb T$
Authors: Cheng Xing , Guo Zihua , Yang Kailong , Zhao Lifeng
Published: January 2020

In this article, we will show the scattering of the cubic defocusing nonlinear Schrödinger equation on the waveguide

\mathbb{R}^2\times \mathbb{T}

in

H^1

. We first establish the linear profile decomposition in

H^{1}(\mathbb{R}^2 \times \mathbb{T})

motivated by the linear profile decomposition of the mass-critical Schrödinger equation in

L^2(\mathbb{R}^2)

. Then by using the solution of the cubic resonant nonlinear Schrödinger system to approximate the nonlinear profile, we can prove scattering in

H^1

by using the concentration-compactness/rigidity method.
Kriging Surrogate Model based Optimisation of Welded Bogie Frame for Fatigue Improvement
Authors: Gao Yuehua , Liu Qipeng , Zhao Dan
Published: January 2020

The welded side frame of intercity Electric Multiple Unit (EMU) bogie frame is taken as the research objective to optimize the layout of its internal stiffeners and to improve its fatigue performance. The fatigue accumulation damage value is computed in side frame for some key welds using Master S-N curve approach and the maximal value of fatigue accumulation damage is considered as a significant constraint to construct a lightweight optimisation model. To solve the optimisation model effectively, a sequential approximate method on the basis of Kriging surrogate model is presented by combining the minimum response surface sampling with multi-island genetic algorithm. The weight of the side frame is reduced by 16% after optimisation, which realized the fatigue improvement.
Mortalidade infantil por doenças infecciosas e parasitárias no estado do Pará
Authors: Sousa Julieth Ferreira , Santos Kedma Farias dos , Santos Deivid Ramos dos , Silva Adriana Veiga da Conceição , Pereira Inara Santos , Silva Ronel Correia da
Published: January 2020

Objetivo: Analisar a ocorrência da mortalidade infantil por doenças infecciosas e parasitárias no estado do Pará. Métodos: Estudo com abordagem quantitativa, analítica, retrospectiva, abrangendo uma série histórica do ano de 2008 até 2017. Para análise dos resultados, utilizou-se testes estatísticos não-paramétricos, Qui-quadrado e teste G, capazes de expressar associação estatística. Resultados: Foram notificados 1530 óbitos infantis no estado do Pará, com uma queda em 47,8% entre o período estudado. A população indígena teve a maior taxa de mortalidade. 92,5% (n = 1415) dos óbitos ocorreram no período pós-natal e 51,7% (n = 791) com escolaridade materna entre 4-11 anos. Conclusão: A mortalidade infantil ainda pode e deve ser reduzida, pois em sua grande maioria atinge indivíduos no período pós-natal e possui maior incidência quanto menor a escolaridade materna e menor acesso à saúde.
Maniobras cooperativas aplicadas a vehículos automatizados en entornos virtuales y reales
Authors: Hidalgo C. E. , Marcano M. , Fernández G. , Pérez J. M.
Published: January 2020

En los últimos años los Sistemas Inteligentes de Transporte, ITS (del inglés, Intelligent Transportation System) se han convertido en una realidad dentro de la sociedad, aportando soluciones y beneficios a la conducción. Con el fin de contribuir a su desarrollo, el presente trabajo describe un marco cooperativo híbrido capaz de validar maniobras entre múltiples vehículos (virtuales y reales), con el fin de disminuir los costos, tiempos y riesgos asociados al ajuste de los controladores. Para su validación se presentan 3 casos de estudios. El primero consiste en utilizar dos vehículos virtuales para realizar un Control de Crucero Adaptativo, ACC (del inglés, Adaptive Cruise Control) con seguidor de trayectoria. El segundo, emplea un coche real como seguidor y un coche virtual como líder para la maniobra de Stop & Go. Finalmente, se utilizan dos vehículos reales para el ACC. Los algoritmos de seguimiento empleados para las maniobras cooperativas están basados en controladores de lógica borrosa. Los resultados demuestran la versatilidad del marco propuesto, al poder ejecutar las maniobras correctamente en cada uno de los entornos.
FokI vitamin D receptor gene polymorphism and serum 25-hydroxyvitamin D in patients with cardiovascular risk
Authors: Nakhl Sahar , Sleilaty Ghassan , Chouery Eliane , Salem Nabiha , Chahine Ramez , Farès Nassim
Published: January 2020

Introduction

The biological actions of vitamin D are mediated through vitamin D receptor (VDR). Numerous single-nucleotide polymorphisms (SNPs) in the VDR gene have been identified, and some have been associated with cardiovascular disease (CVD) risk factors. This study aims to evaluate the association of five SNPs in the VDR gene with 25-hydroxyvitamin D (25[OH]D) levels in patients with at least one CVD risk factor.

Material and methods

Genomic DNA was sequenced using standard Sanger methods for five VDR SNPs (BsmI rs1544410; ApaI rs7975232; Cdx2 rs11568820; TaqI rs731236; FokI rs2228570) in 50 Mediterranean subjects having hypovitaminosis D with at least one documented CVD risk factor, aged 18 years or more. The collected variables were serum levels of (25[OH]D), HbA1c, fasting plasma glucose, triglycerides, LDL cholesterol, and total cholesterol.

Results

BsmI, ApaI, and TaqI were moderately to highly intercorrelated. Cdx2 was less frequent than expected. With respect to the number of mutations in FokI, levels of (25 [OH]D) were 11.2 ±5.5 ng/ml in the absence of mutations, 12.6 ±4.7 ng/ml in the presence of one mutation, and 16.5 ± 5.5 ng/ml in the presence of two mutations.

Conclusions

FokI polymorphism is more frequent in subjects with cardiovascular risk factors than in the general Caucasian population.
Headache secondary to nontraumatic brain hemorrhage: a single-center, retrospective clinical study
Authors: Ljubisavljevic Srdjan , Ignjatovic Aleksandra , Ljubisavljevic Marina
Published: January 2020

Introduction

The predictive accuracy of clinical and paraclinical findings for headache occurrence in patients having nontraumatic intracerebral hemorrhage (ICH) was tested.

Material and methods

The medical records of 341 consecutive nontraumatic ICH patients (106 females and 235 males), average age 56.2 ±7.7 years, presenting with headache (25.5%) and without a headache (74.5%), over a period of 5 years, were retrospectively analyzed.

Results

The presence of focal neurological symptoms (OR = 0.129, 95% CI: 0.044–0.372, p = 0.000), loss of consciousness (OR = 0.174, 95% CI: 0.060–0.504, p = 0.001), body temperature (OR = 0.586, 95% CI: 0.389–0.882, p = 0.010), and the values of C-reactive protein (OR = 0.989, 95% CI: 0.978–0.999, p = 0.048) at admission, as well as the presence of hematoma in the basal ganglia (OR = 0.308, 95% CI: 0.159–0.596, p = 0.000) and the presence of arterial hypertension in the medical history (OR = 0.478, 95% CI: 0.230–0.991, p = 0.047), are recognized as negative predictors for headache occurrence in ICH. The regular use of antihypertensive therapy is a prominent positive predictor for headache occurrence in ICH (OR = 1.906, 95% CI: 1.075–3.381, p = 0.027). Patients presenting with headache had a favorable clinical outcome compared to those without headache in ICH presentation (p < 0.001).

Conclusions

The present results might be clinically useful for considering further diagnostic and therapeutic procedures as early as possible in patients with symptoms clinically suggestive of ICH, with and without headache in ICH clinical presentation. These data require confirmation in a prospective large-scale study.