bluuebunny/crossref_metadata_2025 huggingface dataset:
General practitioners’ management of patients with psychological stress: audit results from Denmark
Authors: Lykkegaard Jesper , Prior Anders , Rosendal Marianne
Published: April 2020

Background

In western countries, psychological stress is among the most common causes of long-lasting sick leave and a frequent reason to consult the general practitioner (GP). This study aimed to investigate how GPs manage patients with psychological stress and how the management is associated with the patient’s sex, the GP’s assessment of causality, and coexisting mental disorders.

Methods

We conducted an audit of consecutive cases in Danish general practice. The GPs used electronic medical records to fill in a registration form for each 18–65-year-old patient with whom they had had at least one consultation regarding stress during the past 6 months. Only patients initially in the workforce were included. Age- and sex-adjusted binary regression was applied.

Results

Fifty-six GPs (61% women) identified 785 cases. The patients’ mean age was 44 years and 70% were women. The cause of stress was considered at least partially work-related in 69% of the cases and multifactorial in a third of cases. The management included sick leave (54%), counselling (47%), pharmaceutical treatment (37%), and referral to psychologist (38%). Compared to women, stress in men was less often considered work-related (RR: 0.84, CI95%: 0.77–0.92) and men were less often sick-listed (RR: 0.83 CI95%: 0.73–0.96) but were more often prescribed tranquilizers (RR: 1.72 CI95%: 1.08–2.74).

Conclusions

GPs’ management of patients with stress usually involve elements of counselling, sick leave, referral to psychologist, and medication. Women and men with stress are perceived of and managed differently.
Mechanism of metastasis to the spermatic cord and testis from advanced gastric cancer: a case report
Authors: Park Soyoung , Moon Sung Kyoung , Lim Joo Won
Published: April 2020

Background

The spermatic cord and testis are very rare sites for metastasis from gastric cancer. Although several mechanisms have been suggested to explain this unusual metastasis, the actual mechanism remains unclear. We report a case of right spermatic cord and testicular metastasis, review its imaging findings, and suggest a mechanism of tumor spread.

Case presentation

A 61-year-old man complained of a palpable mass in the right inguinal area. He had been treated with distal gastrectomy with chemotherapy for advanced gastric cancer 5 years ago. Computed tomography, ultrasound, and magnetic resonance imaging showed a mass surrounding the right spermatic cord, involving the right testis. Another mass was observed in the aortocaval space, presumed to be a metastatic lymph node. The imaging features of the right testicular lesion were different than those of the primary testicular cancer. The lesions at both sites showed similar radiologic features of abundant internal necrosis, which is consistent with metastatic lesions. Pathology confirmed metastatic adenocarcinoma. He underwent a series of chemotherapy sessions, and all metastatic masses had partially decreased in size at the 5-month outpatient follow-up.

Conclusions

The imaging features of testicular mass and spermatic cord involvement are important clues for accurate differential diagnosis of metastasis from other primary tumors in patients with a history of stomach cancer. This unusual metastasis can be explained via retrograde tumor spread along the lymphatic channels in terms of concurrent aortocaval lymph node metastasis. A suspicion of metastasis should not be overlooked, even if a patient has undergone curative treatment, including surgery and adjuvant chemotherapy, many years ago.
Impact of medication review via tele-expertise on unplanned hospitalizations at 3 months of nursing homes patients (TEM-EHPAD): study protocol for a randomized controlled trial
Authors: Correard F. , Montaleytang M. , Costa M. , Astolfi M. , Baumstarck K. , Loubière S. , Amichi K. , Auquier P. , Verger P. , Villani P. , Honore S. , Daumas A.
Published: April 2020

Background

Inappropriate drug prescribing causes preventable drug-related adverse events that result in increased morbidity and mortality, additional costs and diminished quality of life. Numerous initiatives have been launched to improve the quality of drug prescribing and safeguard the security of drug administration processes in nursing homes. Against the backdrop of implementation of telemedicine services, the focus of the present work is to evaluate the impact of a telemedication review carried out by a hospital physician and pharmacist as part of the telemedicine offer.

Methods

The present study is a randomized controlled clinical trial. A total of 364 patients will be randomized into two groups: (1) an experimental group (182 patients) benefiting from a telemedication review using tele-expertise and (2) a control group (182 patients) receiving standard care. The primary endpoint will be rate of all-cause unplanned hospital admissions occurring within 3 months of randomization. The secondary endpoints will be rate of unplanned admissions at 6 months, patient quality of life, incidence of behavioral disturbances, number of falls, number of residents prescribed at least one inappropriate medication, nursing staff satisfaction, proposed medication reviews and their acceptability rate, characteristics of patients whose general practitioners have taken account of tele-expertise, efficacy of tele-expertise as compared to standard prescription and acceptability and satisfaction surveys of participating caregivers.

Discussion

In the literature, various studies have investigated the utility of structured medication review processes, but outcome measures are heterogeneous, and results vary widely. Medication review can detect medication-related problems in many patients, but evidence of clinical impact is scant. Incremental cost-effectiveness ratios will be used to compare the cost and effectiveness of the experimental strategy and that of standard care. Our approach, involving the combination of an acceptability survey and a mixed-method (qualitative and quantitative) satisfaction survey, is particularly innovative. The results of this randomized trial are expected to confirm that medication review using tele-expertise has potential as a worthwhile care management strategy for nursing home residents.

Trial registration

Clinicaltrials.gov NCT03640845; registered August 21, 2018 (Clinicaltrials.gov NCT03640845).
The Lisbon patient: exceptional longevity with HIV suggests healthy aging as an ultimate goal for HIV care
Authors: Pintassilgo Ines , Cesari Matteo , Santos Henrique N. , Milic Jovana , Franconi Iacopo , Mussini Cristina , Marques Nuno , Guaraldi Giovanni
Published: April 2020

In the context of global aging, HIV infection has become a new chronic disease and requires innovative models of care. Treating isolated comorbidities represents a useless and potentially harmful practice at advanced age. Therefore, a patient-centered approach, in which the interventions are focused on the biology and function of the individual, with understanding of the importance of securing social and home environment that provides psychosocial support, better suits unmet health needs. We present a paradigmatic case of healthy aging: the first reported HIV-infected patient who achieved 100th of life – the Lisbon patient. The construct of healthy aging, recently introduced by the World Health Organization, is the best example of this comprehensive model and could represent the fourth target of UNAIDS agenda of the end of AIDS.
Comparison of cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical disc degenerative diseases on the basis of more than 60 months of follow-up: a systematic review and meta-analysis
Authors: Zhang Yijian , Lv Nanning , He Fan , Pi Bin , Liu Hao , Chen Angela Carley , Yang Huilin , Liu Mingming , Zhu Xuesong
Published: April 2020

Background

This meta-analysis was designed to investigate the long-term efficacy and safety between cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) in treating cervical disc degenerative diseases (CDDDs).

Methods

Literature search was performed on Pubmed, Embase, Cochrane Library, and Web of Science before Jan 2019. Surgical details, clinical outcomes, range of motion (ROM), complications, and reoperation rates between CDA and ACDF groups were compared and analyzed. A fixed- or random-effects model was applied based on different heterogeneity. STATA (Version 11.0) software was used to perform data analysis.

Results

A total of 13 randomized controlled trial studies with more than 60 months of follow-up (mean 83.1 months) were enrolled in this meta-analysis. Pool results indicated that the CDA group exhibited significantly better outcomes in clinical scores (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.15–2.08, p = 0.004) and preservation of ROM (mean difference = 1.77, 95% CI: 1.60–1.95, p < 0.001) than the ACDF group. Meanwhile, the incidence of adjacent segment disease (ASD) (OR = 0.51, 95% CI: 0.35–0.76, p = 0.001) and occurrence of reoperation (OR = 0.41, 95% CI: 0.25–0.69, p = 0.001) were lower in the CDA group than in the ACDF group.

Conclusions

At long-term follow-up, CDA showed better efficacy in terms of clinical outcomes, ROM, ASD, and reoperation than ACDF for treating CDDDs. However, our results require further validation in large-sample and high-quality studies.
Treatment with radiosynoviorthesis in hemophilic patients with and without inhibitor
Authors: Tena-Sanabria Mario Edgar , Rojas-Sato Yoriko Fabiola , Castañeda-Resendiz José Carlos , Fuentes-Herrera Gabriela , Álvarez-Martínez Félix Alejandro , Tena-Gonzalez Yureni Iraí , Núñez-Enríquez Juan Carlos
Published: April 2020

Background

Spontaneous bleedings occurring into joints (hemarthrosis) are the most common manifestations of hemophilia and causes severe joint damage ultimately resulting in joint disfunction known as hemophilic arthropathy. Among available therapeutic options for reducing recurrent hemarthrosis-associated damage, radiosynoviorthesis (RS) has proven effective in improving joint function.

Aim

To assess the impact of RS with Yttrium(90) citrate (C-Y(90)) on frequency of hemarthroses and joint function in a group of pediatric patients.

Methods

Between November 1998 and February 2017, we evaluated 27 pediatric patients with mild, moderate or severe hemophilia with haemophilic arthropathy. Overall, RS was applied in 60 joints. Some patients received more than one single intra-articular injection with C-Y(90).

Results

During the follow-up, one patient showed joint bleeding 15 months after RS, one patient after 12 months and one patient after 45 days. The episodes of hemarthrosis were reduced and joint function significantly improved in all patients.

Conclusion

RS with C-Y(90) is a simple and safe treatment for reducing the frequency of hemarthroses in patients with hemophilia. It decreases the use of factor VIII / IX and improves joint function.
Informal payments for inpatient health care in post-health transformation plan period: evidence from Iran
Authors: Doshmangir Leila , Sajadi Haniye Sadat , Ghiasipour Maryam , Aboutorabi Ali , Gordeev Vladimir Sergeevich
Published: April 2020

Background

In 2014, a revision of the national medical tariffs for inpatient health care services took place in Iran, and a new hotline was set up to report informal payments. It was expected that such measures would eliminate or decrease informal payments prevalence. This study estimates the prevalence of informal payments for inpatient health care services in the post-reform period, explores factors associated with informal payments and examines patients’ and healthcare providers’ views regarding the causes of informal payments and possible practical solutions for their reduction.

Methods

We surveyed by phone patients who used inpatient health care services in seven Iranian hospitals in 2016. Descriptive and regression analyses were used to estimate the prevalence and determine factors associated with informal payments. We conducted a qualitative analysis through thematic analyses based on focus group discussions and in-depth interviews.

Results

Of 2696 respondents, 14% reported paying informally for inpatient services. Informal payments were reported more frequently among private hospital users, given more frequently to physicians in public teaching hospitals and ‘other staff’ in private hospitals, in the form of cash and voluntary. Being an adult, hospital or treatment type, being insured, and household head’s education influenced the probability of paying informally. The amount paid informally was associated with being insured, the educational status of the household’s head, household size, service, and hospital types. Based on qualitative findings, the leading causes of informal payments reported by patients and healthcare providers can be categorized into four groups - financing challenges; governance challenges; service delivery challenges; and actors and stakeholders. Modifying, adjusting and applying policy interventions; supervision, monitoring and evaluation; and actors and stakeholders were identified as possible solutions for tackling informal payment in the inpatient health care services.

Conclusion

The prevalence of informal patient payments for inpatient services in the post-reform period seems to have reduced; however, they remain to be common. Regular monitoring, reviewing of payment policies to the physicians, informing patients, changing the behaviour of healthcare providers and patients, and developing ethical guidelines to prevent informal payments were suggested for reduction and elimination of informal payments in the Iranian healthcare sector.
Correction to: Barriers to and competency with the use of metered dose inhaler and its impact on disease control among adult asthmatic patients in Ethiopia
Authors: Abegaz Tadesse Melaku , Shegena Efrata Ashuro , Gessie Natnael Fentie , Gebreyohannes Eyob Alemayehu , Seid Mohammed Assen
Published: April 2020

Following publication of the original article [1], the authors flagged that the name provided for the 4th author had been misspelled; the 4th author was (incorrectly) spelled as ‘Eyob Alemayehu Gebreyohanns’.
Prognostic value of pretreatment platelet counts in lung cancer: a systematic review and meta-analysis
Authors: Yuan Yuan , Zhong Hai , Ye Liang , Li Qian , Fang Surong , Gu Wei , Qian Yingying
Published: April 2020

Background

The prognostic value of elevated pretreatment platelet counts remains controversial in lung cancer patients. We performed the present meta-analysis to determine its precise role in these patients.

Methods

We employed a multiple search strategy in the PubMed, EMBASE and Cochrane Library databases to identify eligible studies. Disease-free survival (DFS)/progression-free survival (PFS)/time to progression (TTP) and overall survival (OS) were used as outcomes with hazard ratios (HRs) and 95% confidence intervals (CIs). Heterogeneity among the studies and publication bias were also evaluated.

Results

A total of 40 studies including 16,696 lung cancer patients were eligible for the analysis. Overall, the pooled analysis showed that compared with normal platelet counts, elevated pretreatment platelet counts were associated with poorer OS (HR = 1.54, 95% CI: 1.37–1.72, P < 0.001) and poorer DFS/PFS/TTP (HR = 1.62, 95% CI: 1.33–1.98, P < 0.001) in patients with lung cancer. In subgroup analyses, elevated pretreatment platelet counts were also associated with poorer OS and DFS/PFS/TTP in most subgroups. There was no evidence of publication bias.

Conclusions

This meta-analysis revealed that elevated pretreatment platelet counts were an independent predictor of OS and DFS/PFS/TTP in lung cancer patients. Large-scale prospective studies and a validation study are warranted.
Is Procalcitonin (PCT) a reliable biomarker for preoperative diagnosing of low grade periprosthetic joint infection? A prospective study
Authors: Busch André , Jäger Marcus , Engler Harald , Haversath Marcel , Bielefeld Charlotte , Landgraeber Stefan , Wegner Alexander
Published: April 2020

Background

Since a “gold-standard” is missing, diagnosing periprosthetic joint infection (PJI) remains a challenge in orthopedic surgery. The purpose of this study was to evaluate the accuracy of serum and synovial fluid Procalcitonin (S-PCT and SF-PCT) as a diagnostic parameter and to compare it to the biomarkers recommended in the 2018 Definition of periprosthetic hip and knee infection.

Methods

Between August 2018 and July 2019, a prospective cohort study was conducted in 70 patients with painful hip, shoulder and knee arthroplasty. Besides medical history, clinical and laboratory data was gathered. PJI was diagnosed based on the 2018 Definition of periprosthetic hip and knee infection. Preoperative blood and synovial joint fluid were taken for PCT measurement. S-PCT and SF-PCT levels were measured using standard quantitative PCT enzyme immunoassays.

Results

Twenty three patients (33%) were classified as the PJI group and fourty seven patient (67%) as the aseptic group. The mean levels of S-PCT were significantly (p <  0.001) higher in the PJI group than those in the aseptic group (PJI 0.05 ± 0.21 ng/mL (0.0–1.03) vs. aseptic 0.02 ± 0.03 ng/mL (0.0–0.18)). In synovial fluid, the mean PCT values in the aseptic group were significantly higher (p <  0.001) than those of PJI group (PJI 2.7 ± 1.4 ng/mL (0.53–9.7) vs. aseptic 8.7 ± 2.5 ng/mL (0.25–87.9)). S- PCT, with a cut-off level of 0.5 ng/mL, had a sensitivity of 13.0% and a specificity of 91.0%.

SF-PCT, with a cut-off level of 5.0 ng/mL, had a sensitivity of 13.0% and a specificity of 52.0%.

Conclusion

S-PCT and SF-PCT appeared to be no reliable biomarkers in the differential diagnosis of PJI from aseptic loosening in total joint arthroplasty.
Pre-operative denosumab is associated with higher risk of local recurrence in giant cell tumor of bone: a systematic review and meta-analysis
Authors: Chen Xi , Li Hairui , Zhu Shibai , Wang Yiou , Qian Wenwei
Published: April 2020

Background

In 2013, denosumab was introduced as peri-operative adjuvant treatment for giant cell tumor (GCT) of bone as it inhibits osteoclast activity. It is suggested that denosumab relives pain, facilitate curettage in lesions requiring resection initially. However, controversy remains whether denosumab increases the risk of local recurrence after surgery.

Methods

Medline, Embase and the Cochrane Library were comprehensively searched in June 2019 to identify studies investigating the clinical outcome of GCT of bone with and without peri-operative denosumab after surgery. Data were gathered and a meta-analysis was conducted.

Result

Ten studies with 1082 cases (169 in denosumab group, 913 in control group) were included. Overall, denosumab was associated with significantly higher risk of recurrence(P < 0.02) and inferior 5 year recurrence free survival(P = 0.000). Denosumab and curettage has a relatively higher risk of recurrence comparing to curettage alone(P = 0.07). The risk of recurrence is not significantly increased if denosumab was administered both preoperatively and postoperatively(P = 0.24).

Conclusion

Administration of denosumab is associated with increased risk of recurrence due to a variety of reasons, though it is proven effective in relieving pain, enabling curettage and improved functional outcome. Post-operative denosumab is recommended as it continuously suppress/eliminate residue tumor cells.
Case report of a cystic parathyroidal adenoma with rapid growth induced by cinacalcet
Authors: Werner Christoph , Lupp Amelie , Mtuka-Pardon Gabriele , Kloos Christof , Wolf Gunter , Aschenbach René , Biermann Anika , Freesmeyer Martin , Seifert Philipp
Published: April 2020

Background

Primary hyperparathyroidism is a rare condition of disease which can seldomly present as giant retrotrhyroideal cysts, complicating the localization of the adenoma to resect.

Case presentation

A 56-year old female presented with hypercalcaemia of 3.38 mmol/L (2.2–2.65 mmol/L) and a history of breast cancer. A fast growing cystic parathyroidal adenoma was diagnosed by a multimodal approach including comprehensive diagnostic imaging (ultrasonography, scintigraphies, dynamic MRI) and cytopathological investigations after ultrasonography-guided puncture. The patient was cured by surgical extraction of the whole adenoma. In retrospect, the rapid growth was most likely induced by cinacalcet (initially 30 mg/d, later 60 mg/d) therapy which the patient received for few months only. Primary hyperparathyroidism was ascertained because surgical removal of the solitary adenoma cured the patient. Furthermore, there was no relevant renal insufficiency or history of prolonged calcium-level deregulation.

Conclusions

This phenomenon of cystic degeneration of parathyroidal adenoma under therapy with cinacalcet has previously been described in secondary hyperparathyroidism, but not in primary hyperparathyroidism and should be considered in diagnostic approach.
Longitudinal analysis of health status the first year after trauma in severely injured patients
Authors: Havermans Roos Johanna Maria , de Jongh Mariska Adriana Cornelia , de Munter Leonie , Lansink Koen Willem Wouter
Published: April 2020

Purpose

While survival rates after a trauma are increasing a considerable part of the trauma population are still at risk for both short and long term disabilities. Little is known about prognostic factors over time after a severe trauma. The aim of the present prospective cohort study was to examine trauma and patient related prognostic factors for a lower health status over time after a severe trauma.

Methods

A multicentre prospective observational cohort study was conducted. Adult trauma patients with severe injuries (ISS ≥ 16) were included from August 2015 until November 2016 if admitted to one of the hospitals in Noord-Brabant (the Netherlands). Outcome measure was health status, measured by the EuroQol-5D (EQ-5D utility and EQ-Visual analogue scale) and the Health Utilities Index (HUI2 and HUI3) one week and one, three, six, and twelve months after injury. Patient and trauma characteristics were analysed as prognostic factors with linear mixed models. The effect of each prognostic factor over time was analysed by adding the interaction term between the prognostic factor and time point in a multivariable linear mixed model, adjusted for confounders. Additionally, the risk factors for problems in the EQ-5 dimensions of HS and cognition were analysed.

Results

In total 239 severely injured patients participated. Pre-injury health status, hospital length of stay, ISS and comorbidities were significant prognostic factors for a lower health status. A younger age and extremity injury were prognostic factors for a lower health status until one month after trauma and unemployment before trauma and comorbidities six until twelve months after trauma. In the EQ-5 dimensions 44.1% remained problems in mobility, 15.3% in self-care, 46.4% in activity, 53.3% in pain, 32.5% in anxiety and 35.7% in cognition.

Conclusions

Lower pre-injury health status, longer hospital length of stay, higher ISS, and comorbidities were significant prognostic factors for a lower health status during one year after a severe injury. A younger age and an extremity injury were short-term prognostic factors and unemployment before trauma and comorbidities were long-term prognostic factors. Even after twelve months patients in our population reported more problems in all EQ-5D dimensions when compared to the Dutch reference population.
Correction to: Osteoarthritis Preoperative Package for care of Orthotics, Rehabilitation, Topical and oral agent Usage and Nutrition to Improve ouTcomes at a Year (OPPORTUNITY); a feasibility study protocol for a randomised controlled trial
Authors: Simpson A. Hamish R. W. , Howie Colin R. , Kinsella Elaine , Hamilton David F. , Conaghan Philip G. , Hankey Catherine , Simpson Sharon Anne , Bell-Higgs Anna , Craig Peter , Clement Nicholas D. , Keerie Catriona , Kingsbury Sarah R. , Leeds Anthony R. , Ross Hazel M. , Pandit Hemant G. , Tuck Chris , Norrie John
Published: April 2020

After publication of our article [1] we have been notified that two of the author names have been mistakenly removed from the authorship list: Colin R. Howie and Nicholas D. Clement.
Prevalence and incidence of vector-borne pathogens in unprotected dogs in two Brazilian regions
Authors: Dantas-Torres Filipe , Figueredo Luciana Aguiar , Sales Kamila Gaudêncio da Silva , Miranda Débora Elienai de Oliveira , Alexandre Joanna Lúcia de Almeida , da Silva Yury Yzabella , da Silva Lidiane Gomes , Valle Guilherme Ribeiro , Ribeiro Vitor Márcio , Otranto Domenico , Deuster Katrin , Pollmeier Matthias , Altreuther Gertraut
Published: April 2020

Background

Various vector-borne pathogens (VBPs) affect dogs worldwide, with their diversity and force of infection being usually higher in the tropics. Cross-sectional studies have been conducted to investigate the prevalence of VBPs in dogs, but data from longitudinal studies are scarce. Herein, we assessed the prevalence and the year-crude incidence (YCI) of Leishmania spp. and other VBPs in privately-owned dogs from two geographical regions of Brazil.

Methods

A total of 823 dogs were initially screened for Leishmania spp. by both serology and polymerase chain reaction (PCR). From the negatives, 307 (103 from São Joaquim de Bicas, Minas Gerais, and 204 from Goiana, Pernambuco) were randomly selected for the longitudinal study. These dogs were tested for various VBPs at baseline, after 8 and 12 months.

Results

Out of 823 dogs initially screened, 131 (15.9%) were positive for Leishmania spp. Out of the 307 dogs enrolled in the longitudinal study, 120 (39.1%) were lost for different reasons (e.g. animal death, owner decision, and lost to follow-up). In São Joaquim de Bicas, the baseline prevalence and YCI were as follows: 16.5% and 7.1% for Anaplasma spp.; 81.6% and 100% for Babesia spp.; 0% and 1.3% (only one faint positive) for Dirofilaria immitis; 37.9% and 22.9% for Ehrlichia spp.; 19.5% and 43.8% for Leishmania spp. In Goiana, the baseline prevalence and YCI were as follows: 45.1% and 38.3% for Anaplasma spp.; 79.9% and 96.0% for Babesia spp.; 36.3% and 39.8% for D. immitis; 64.7% and 58.5% for Ehrlichia spp.; 14.7% and 19.6% for Leishmania spp. Anti-Borrelia burgdorferi antibodies were not detected in any of the samples tested herein. The prevalence and YCI of Anaplasma spp., D. immitis and Ehrlichia spp. were significantly higher in Goiana. In contrast, the YCI of Leishmania spp. infection was significantly higher in São Joaquim de Bicas.

Conclusions

We confirmed a high prevalence and YCI of various VBPs among privately-owned dogs in two geographical regions of Brazil. Our data also indicate that the risk of infection varies significantly for individual VBPs and between the regions, which may be related to several factors that are still poorly understood.
Model set adaptive filtering algorithm using variational Bayesian approximations and Rényi information divergence
Authors: Ma Tianli , Chen ChaoBo , Gao Song
Published: April 2020

The paper presents a model set adaptive filtering algorithm based on variational Bayesian approximation (MSA-VB) for the target tracking system with the model and noise uncertainties. The Rényi information divergence, as a criterion, is to choose the best match model that has the minimum divergence between candidate models and true mode. Subsequently, the model-conditioned estimation based on variational Bayesian approximation is proposed to estimate system state and measurement noise variances. To deal with the coupled noise intractability, the moments matching technique is used to obtain the mixed statistics of measurement noise at the fusion stage. The proposed algorithm is compared with the interacting multiple models (IMM) algorithm and the variational Bayesian-interacting multiple models (IMM-VB) algorithm via two scenarios for maneuvering target tracking, and simulation results show that the MSA-VB has improved estimation and tracking performance.
Pharmacists at the frontline beating the COVID-19 pandemic
Authors: Bukhari Nadia , Rasheed Huma , Nayyer Bismah , Babar Zaheer-Ud-Din
Published: April 2020

As the lockdowns are being observed all over the globe and the national level pharmacy professionals are performing frontline roles, this editorial highlights the role of pharmacists in the COVID − 19 pandemic. Pharmacists globally are providing services amidst pandemic, including TRIAGE services, seeing patients and reducing the patients’ burden on health care facilities such as hospitals and GP practices. Pharmacists are also working to providing home deliveries, as well as dealing with the increasing number of patients coming through to pharmacies with the other ailments. Pharmacy associations have issued their guidelines and in this editorial, several global examples of pharmacists’ role in the COVID 19 are being discussed. Pakistan is used as a country case study in this editorial. The editorial also elaborates how pharmacists in the UK and Pakistan have teamed up together to compile 10-steps protection guidelines for the pharmacy teams in Pakistan in English and Urdu language. This 10-point guidance educates community pharmacies for safety and standard operation as the number of patients in the country continues to rise. These guidelines are endorsed by the government and private bodies. These can be adopted and adapted by any country; keeping in view their laws and regulations.
Boundary crossing pedagogy in STEM education
Authors: Leung Allen
Published: April 2020

This commentary aims to discuss an overarching boundary crossing framework under which integrated STEM (Science, Technology, Engineering, Mathematics) pedagogy can be conceptualized. Four potential learning dialogical processes for boundary crossing are presented and used as the main theoretical construct for the discussion. A proposal of an interactive pedagogical framework is put forward accompanied by a provisional statement to relate the connective factors that are critical in the formation of a boundary crossing STEM pedagogy. These factors are situated learning, communities of practices, problem solving, learning dialogical processes, and boundary objects. A Hong Kong school STEM case is employed to illustrate the applicability of this framework. The commentary ends with a reflective remark on boundary crossing STEM pedagogy.
The effect of scleral buckling on accommodative amplitude
Authors: Ebrahimiadib Nazanin , Hassanpoor Narges , Niyousha Mohammadreza , Modjtahedi Bobeck Seyed
Published: April 2020

Purpose

To evaluate the effect of scleral buckling on accommodative amplitude.

Design

Non-randomized, prospective, double masked clinical trial in which the fellow eye of patients undergoing scleral buckling served as a control.

Methods

Patients who underwent scleral bucking for the management of retinal detachment in at least one eye were enrolled. Accommodative amplitude was measured monocularly 1 month and 3 months post operatively by two masked optometrists using a near-point “push” technique and minus-to-blur technique. Accommodative amplitude in eyes that underwent scleral buckle surgery were compared to their fellow eyes. Buckle type, buckle location, lens status and age were analyzed. Generalized Estimation Equations (GEE) were used to compare means and percentages between two groups.

Results

Seventy-four eyes of 37 patients were included in the study. Median age was 44 years old (range: 31–67 years old) and 68.4% of patients were male (n = 24). Two patients required bilateral surgery. Thirty-six of 39 operated eyes (92.3%) were phakic and three were pseudophakic. In phakic eyes there was a significantly higher amplitude of accommodation in operated eyes compared to their fellow eyes at post-operative month one (0.99 diopters, p value = 0.002) and three (1.17 diopters, p value = 0.001). The difference in accommodative amplitude in post-operative eyes compared to control eyes did not reach statistical significance in pseudophakic eyes nor did it differ between those who had an encircling band and those with a segmental buckle at both one and 3 months after surgery (p value = 0.37 and 0.38, respectively). In those with a segmental buckle, inferior fixation resulted in a larger difference in accommodative amplitude compared to control eyes than any other location fixation. Age under 40 years old and better post-operative best corrected visual acuity (BCVA) both correlated with greater difference in accommodative amplitude compared to fellow eyes.

Conclusion

Compared to fellow eyes not undergoing surgery, those eyes that underwent scleral buckling had a greater accommodative amplitude with larger differences correlating with better post-operative BCVA and younger age.
Intrathecal administration of nusinersen for spinal muscular atrophy: report of three cases with severe spinal deformity
Authors: Nakao Sayo , Yamada Shinichi , Tsuda Katsuya , Yokomizo Taishi , Sato Teruyuki , Tanoue Shuichi , Hiraki Teruyuki
Published: April 2020

Background

Spinal muscular atrophy (SMA) is a genetic disease characterized by degeneration of the spinal cord, resulting in progressive muscle atrophy. Recently, nusinersen has been approved for treating SMA, which should be administered intrathecally.

Case presentation

Patient 1 was a 36-year-old woman with SMA type 2. Patients 2 and 3 were 10- and 17-year-old girls with SMA type 1. In patients 1 and 2, the needle was inserted into the spinal column, but outflow of cerebrospinal fluid was unable to be confirmed. CT revealed that the dural sac terminated at the L5 level in patients 1 and 3 and at the L5/S1 level in patient 2.

Conclusions

Patients with SMA often present with high-grade scoliosis, making intrathecal administration difficult. In addition, the dural sac may terminate at a level higher than normal. To ensure intrathecal administration, the level of dural sac termination must be confirmed by CT before puncture.
A fructan: the fructan 1-fructosyl-transferase gene from Helianthus tuberosus increased the PEG-simulated drought stress tolerance of tobacco
Authors: Sun Xuemei , Zong Yuan , Yang Shipeng , Wang Lihui , Gao Jieming , Wang Ying , Liu Baolong , Zhang Huaigang
Published: April 2020

Background

Jerusalem artichoke (Helianthus tuberosus) is a fructan-accumulating plant, and an industrial source of raw material for fructan production, but the crucial enzymes involved in fructan biosynthesis remain poorly understood in this plant.

Results

In this study, a fructan: fructan 1-fructosyl-transferase (1-FFT) gene, Ht1-FFT, was isolated from Jerusalem artichoke. The coding sequence of Ht1-FFT was 2025 bp in length, encoding 641 amino acids. Ht1-FFT had the type domain of the 1-FFT protein family, to which it belonged, according to phylogenetic tree analysis, which implied that Ht1-FFT had the function of catalyzing the formation and extension of beta-(2,1)-linked fructans. Overexpression of Ht1-FFT in the leaves of transgenic tobacco increased fructan concentration. Moreover, the soluble sugar and proline concentrations increased, and the malondialdehyde (MDA) concentration was reduced in the transgenic lines. The changes in these parameters were associated with increased stress tolerance exhibited by the transgenic tobacco plants. A PEG-simulated drought stress experiment confirmed that the transgenic lines exhibited increased PEG-simulated drought stress tolerance.

Conclusions

The 1-FFT gene from Helianthus tuberosus was a functional fructan: fructan 1-fructosyl-transferase and played a positive role in PEG-simulated drought stress tolerance. This transgene could be used to increase fructan concentration and PEG-simulated drought stress tolerance in plants by genetic transformation.
Digital divide among higher education faculty
Authors: Soomro Kamal Ahmed , Kale Ugur , Curtis Reagan , Akcaoglu Mete , Bernstein Malayna
Published: April 2020

Digital divide centers on access to various dimensions of information and communication technology (ICT) including physical access, motivation, skills, and actual usage of digital technologies. This divide tends to be even wider in the context of developing countries. Yet, there is a lack of literature on the digital divide among the faculty who teach in higher education settings. Thus, as a preliminary effort, by using a 57-item Faculty’s ICT Access (FICTA) scale, we investigated the digital inequalities (at the physical, motivational, skills, and usage levels) among Pakistani faculty in respect of their personal and positional categories. We also examined the relationship between faculty’s instructional usage of ICT and other dimensions of their ICT access. The findings revealed that there were significant differences in the faculty’s access to technology at the four levels in respect of their personal and positional categories. Further, the findings of the study shed light on the theoretical implications of the framework of successive kinds of ICT access suggested by van Dijk (The deepening divide: inequality in the information society, 2005).
Diagnostic performance of GI-RADS reporting system in evaluation of adnexal masses
Authors: Abd elsalam Sahar Mahmoud , Hamed Soha Talaat , Sayed Mohamed Abd elghafar
Published: April 2020

Background

Transvaginal and pelvic ultrasound are considered the primary imaging modality in evaluating adnexal masses. Gynaecologic Imaging Reporting and Data System (GI-RADS) depends on different ultrasound patterns and criteria adopted by the International Ovarian Tumour Analysis (IOTA) group. The current study aimed to detect the diagnostic accuracy of the GI-RADS classification in evaluating adnexal masses. In this prospective cross-sectional study, a total of 112 adnexal masses belonging to 100 women, age ranged 12 to 66 years old, were included. The study population was recruited throughout the period between January and November 2017. Ultrasound examination was performed to all patients; different US and Doppler criteria were assessed.

Results

Out of the 112 lesions, 36 (32.1%) were GI-RADS 2, 32 (28.6%) GI-RADS 3, 13 (11.6%) GI-RADS 4, and 31 (27.7%) GI-RADS 5. The GI-RADS classification showed sensitivity 97%, specificity 84.8%, positive predictive value (PPV) 72.7%, negative predictive value (NPV) 98.5%, and accuracy 88.4%.

Conclusion

The GI-RADS reporting system carried a high sensitivity in identifying adnexal masses at high risk of malignancy. The increased number of benign lesions misclassified as GI-RADS 4 required additional markers to improve the specificity in GI-RADS classification.
Decline Pattern of Beta-cell Function in Adult-onset Latent Autoimmune Diabetes: an 8-year Prospective Study
Authors: Li Xia , Chen Yan , Xie Yuting , Xiang Yufei , Yan Xiang , Huang Gan , Zhou Zhiguang
Published: April 2020

Objective

To explore the decline pattern and possible determinants of beta-cell function progression in patients with latent-onset autoimmune diabetes in adults (LADA).

Research Design and Methods

In this 8-year prospective study, 106 LADA individuals underwent annual follow-up and their pattern of beta-cell function progression was assessed. Beta-cell function failure was defined by fasting C-peptide (FCP) < 75 pmol/L. Other clinical characteristics, including age of onset, body mass index (BMI), and glutamic acid decarboxylase autoantibody (GADA) titer, were analyzed to find out possible determinants of beta-cell function progression.

Results

The dropout rate was 4.7%. During the 8-year follow-up period, 29 (28.7%) of the 101 subjects developed beta-cell function failure. The decline pattern of C-peptide in LADA was biphasic, showing an initial rapid linear progression and then followed by a stable mode. The declination speed of FCP was 55.19 pmol/L/year (95% CI, −62.54 to −47.84, P < 0.001) during the first 5 years and 4.62 pmol/L/year (95% CI, −69.83 to 60.60, P = 0.790) thereafter. Further analysis showed that GADA titer was the most valuable discriminatory parameter related to a higher risk of development of beta-cell function failure (GADA titer of 173.5 WHO units/mL; area under the curve [AUC], 0.824). Beta-cell function failure occurred in 71.3% of high-GADA titer patients while only 6.2% of low-titer patients.

Conclusions

The decline pattern of C-peptide was a fast-followed-by-slow biphasic mode, with about a quarter of LADA patients developing beta-cell function failure during the first 8 years. GADA titer less than 173.5 WHO units /mL was propitious for the preservation of beta-cell function.
Digenic Heterozygous Mutations in SLC34A3 and SLC34A1 Cause Dominant Hypophosphatemic Rickets with Hypercalciuria
Authors: Gordon Rebecca J , Li Dong , Doyle Daniel , Zaritsky Joshua , Levine Michael A
Published: April 2020

Context

Hypophosphatemia and metabolic bone disease are associated with hereditary hypophosphatemic rickets with hypercalciuria (HHRH) due to biallelic mutations of SLC34A3 encoding the NPT2C sodium-phosphate cotransporter and nephrolithiasis/osteoporosis, hypophosphatemic 1 (NPHLOP1) due to monoallelic mutations in SLC34A1 encoding the NPT2A sodium-phosphate cotransporter.

Objective

To identify a genetic cause of apparent dominant transmission of HHRH.

Design and Setting

Retrospective and prospective analysis of clinical and molecular characteristics of patients studied in 2 academic medical centers.

Methods

We recruited 4 affected and 3 unaffected members of a 4-generation family in which the proband presented with apparent HHRH. We performed clinical examinations, biochemical and radiological analyses, and molecular studies of genomic DNA.

Results

The proband and her affected sister and mother carried pathogenic heterozygous mutations in 2 related genes, SLC34A1 (exon 13, c.1535G>A; p.R512H) and SLC34A3 (exon 13, c.1561dupC; L521Pfs*72). The proband and her affected sister inherited both gene mutations from their mother, while their clinically less affected brother, father, and paternal grandmother carried only the SLC34A3 mutation. Renal phosphate-wasting exhibited both a gene dosage–effect and an age-dependent attenuation of severity.

Conclusions

We describe a kindred with autosomal dominant hypophosphatemic rickets in which whole exome analysis identified digenic heterozygous mutations in SLC34A1 and SLC34A3. Subjects with both mutations were more severely affected than subjects carrying only one mutation. These findings highlight the challenges of assigning causality to plausible genetic variants in the next generation sequencing era.
Comparison of performance on written and OSCE assessment during end semester pediatric examination
Authors: Memon Shazia , Shaikh Siraj-ul-Haque
Published: April 2020

Objective: To compare the scores obtained on written and OSCE examination during pediatrics end semester examination and to find out the reasons for the discrepancies among the scores obtained.

Methods: This co-relational study was carried out in pediatric department, Liaquat University of Medical and Health Sciences (LUMHS). The performance of medical students who were posted in the pediatric department for one semester (November 2016 to October 2017) was compared on the basis of scores obtained in their written and OSCE during end semester examination. To find out the reasons for discrepancies qualitative data was collected by using likert scale on Pre-designed questionnaire distributed among the students at the end of assessment. Frequencies of their responses were calculated.

Results: Data of 160 students who participated in study was analyzed by SPSS version 22. The mean and standard deviation of participant’s score was 51.25 ± 12.19. Females performed better in written as well as in OSCE. Moderate correlation was seen between MCQ and SAQ scores (r=0.5, p <0.01). Around 60% considered OSCE as their preferred mode of assessment. Deep learning approach and group discussion was found in female students (65%).

Conclusion: Our study concluded that students performed better in OSCE than in written assessment. However, in OSCE they had shown unsatisfactory performance for some important competencies like clinical examination methods and procedural skills. Female students performed better in both segments of assessment.

doi: https://doi.org/10.12669/pjms.36.4.2026

How to cite this:Memon S, Shaikh SH. Comparison of performance on written and OSCE assessment during end semester pediatric examination. Pak J Med Sci. 2020;36(4):711-716. doi: https://doi.org/10.12669/pjms.36.4.2026

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Characterization method of a mid-infrared graphene-on-silicon microring with a monochromatic laser
Authors: Han Senmiao , Chen Weicheng , Hu Haofeng , Cheng Zhenzhou , Liu Tiegen
Published: April 2020

Mid-infrared microring resonators have been extensively studied for biochemical sensing applications. To characterize such resonators, a tunable laser or spectrometer has usually been utilized in previous studies. However, it is challenging to integrate these bulky instruments on a chip, ineluctably limiting practical applications. Here, we study a method for characterizing a microring resonator by using a monochromatic laser to conquer this limitation. Specifically, we theoretically probe the quality factor, extinction ratio, and resonant wavelength shift of a graphene-on-silicon microring resonator at a wavelength of 2.7 µm. Our work paves the way for studying monochromatically chip-integrated cavities and their applications.
Enhancement of photon blockade effect via quantum interference
Authors: Zou Fen , Lai Deng-Gao , Liao Jie-Qiao
Published: April 2020

We study the photon blockade effect in a coupled cavity system, which is formed by a linear cavity coupled to a Kerr-type nonlinear cavity via a photon-hopping interaction. We explain the physical phenomenon from the viewpoint of the conventional and unconventional photon blockade effects. The corresponding physical mechanisms of the two kinds of photon blockade effects are based on the anharmonicity in the eigenenergy spectrum and the destructive quantum interference between two different transition paths, respectively. In particular, we find that the photon blockade via destructive quantum interference also exists in the conventional photon blockade regime and that the unconventional photon blockade occurs in both the weak- and strong-Kerr nonlinearity cases. The photon blockade effect can be observed by calculating the second-order correlation function of the cavity field. This model is general and hence it can be implemented in various experimental setups such as coupled optical-cavity systems, coupled photon-magnon systems, and coupled superconducting-resonator systems. We present some discussions on the experimental feasibility.
Full-field passive elastography using digital holography
Authors: Marmin Agathe , Catheline Stefan , Nahas Amir
Published: April 2020

Off-axis digital holography is an imaging technique that allows direct measurement of phase and amplitude from one image. We utilize this technique to capture displacements induced by a diffuse shear wave field with high sensitivity. A noise-correlation-based algorithm is then used to measure mechanical properties of samples. This approach enables full-field quantitative passive elastography without the need of contact or a synchronized source of a mechanical wave. This passive elastography method is first validated on agarose test samples mimicking biological tissues, and first results on an ex vivo biological sample are presented.