bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal screening for congenital hypothyroidism in an Italian Centre: a 5-years real-life retrospective study
Authors: Maggio Maria Cristina , Ragusa Saveria Sabrina , Aronica Tommaso Silvano , Granata Orazia Maria , Gucciardino Eleonora , Corsello Giovanni
Published: May 2021

Introduction

Congenital hypothyroidism is an endocrine disease with a significant incidence in the general population (1:2000–1:3000 newborns in Italy) and a different geographical distribution, partially explained by endemic iodine deficiency, genetic traits and autoimmune thyroid diseases.

Objectives

Aims of this study are: to evaluate the incidence of positive neonatal blood spot screening for CH in western Sicily, identified by the screening centre of the Children Hospital “G. Di Cristina”, ARNAS, Palermo; to evaluate the impact of a lower TSH cutoff in the neonatal blood spot screening for CH.

Materials and methods

The TSH threshold of the neonatal screening was established as ≥6 mU/L of whole blood.

We analysed the screening centre data in the period January 2013–April 2018, for a total number of 85.373 babies (45.7% males; 54.3% females).

Results

4.082 Babies (4.8%) required a second screening. Among these, 372 (0.44%) were out of range. The diagnosis of congenital hypothyroidism (CH) was confirmed in 182 babies (0.21%). 77/372 newborns (20.7%) with confirmed high TSH levels showed whole blood TSH levels ≥6 - < 7 mU/L.

In synthesis, 48.9% of the out of range re-testing had a confirmed diagnosis of CH.

Conclusion

The reduction of TSH cutoff to 6 mU/L allowed to identify 77/372 neonates (20.7%) with confirmed out of range TSH, otherwise not recruited by the previously employed TSH cutoff.
Transient hypoglycemia as a rare cause of recurring transient loss of consciousness: a case report
Authors: Wester Michael , Bergmann Tanja , Müller-Schilling Martina , Maier Lars S. , Sossalla Samuel T.
Published: May 2021

Background

Syncopes and transient loss of consciousness affect a large number of patients. Determining the underlying mechanism of a syncope is key to effectively treating and preventing future events. However, given the broad differential diagnosis of transient loss of consciousness, it can be challenging to determine the exact etiology.

Case presentation

This case presents a 42-year-old Caucasian female patient with recurrent transient loss of consciousness due to a hitherto undiagnosed impaired glucose tolerance and hyperinsulinism. The patient had been thoroughly tested for all typical causes of syncope without finding any causal explanation. An oral glucose tolerance test confirmed rapidly dropping blood glucose levels associated with rapidly fading consciousness as the underlying cause of transient loss of consciousness. Further diagnostic workup revealed that the patient suffered from impaired glucose tolerance and subsequent hyperinsulinism without overt diabetes mellitus. Nutritional counseling including reduction of glucose intake and frequently eating smaller meal portions led to a significant reduction in the frequency of transient loss of consciousness and overall improvement in quality of life.

Conclusions

The current European Society of Cardiology (ESC) guideline on syncope does not list hypoglycemia as a cause of transient loss of consciousness. However, this case report stresses that metabolic dysregulation can indeed lead to self-limited transient loss of consciousness. Thus, in the case of recurrent syncope with an unclear underlying mechanism, physicians should consider transient hypoglycemia and metabolic workup as a possible differential diagnosis.
Perceived stress, stressors, and coping strategies among nursing students in the Middle East and North Africa: an overview of systematic reviews
Authors: Chaabane Sonia , Chaabna Karima , Bhagat Sapna , Abraham Amit , Doraiswamy Sathyanarayanan , Mamtani Ravinder , Cheema Sohaila
Published: May 2021

Background

In nursing students, high stress levels can lead to burnout, anxiety, and depression. Our objective is to characterize the epidemiology of perceived stress, stressors, and coping strategies among nursing students in the Middle East and North Africa region.

Methods

We conducted an overview of systematic reviews. We systematically searched PubMed, Embase, PsycInfo, and grey literature sources between January 2008 and June 2020 with no language restrictions. We included any systematic review reporting measurable stress-related outcomes including stress prevalence, stressors, and stress coping strategies in nursing students residing in any of the 20 Middle East and North Africa countries. We also included additional primary studies identified through a hand search of the reference lists of relevant primary studies and systematic reviews.

Results

Seven systematic reviews and 42 primary studies with data from Bahrain, Egypt, Iraq, Jordan, Oman, Pakistan, Palestine, Saudi Arabia, and Sudan were identified. Most studies included nursing students undergoing clinical training. The prevalence range of low, moderate, and high perceived stress among nursing students was 0.8–65%, 5.9–84.5%, and 6.7–99.2%, respectively. Differences related to gender, training period, or the type of tool used to measure stress remain unclear given the wide variability in the reported prevalence measures across all stress levels. Common clinical training stressors were assignments, workload, and patient care. Academic training-related stressors included lack of break/leisure time, low grades, exams, and course load. Nursing students utilized problem focused (dealing with the problem), emotion focused (regulating the emotion), and dysfunctional (venting the emotions) stress coping mechanisms to alleviate their stress.

Conclusions

Available data does not allow the exploration of links between stress levels, stressors, and coping strategies. Limited country-specific prevalence data prevents comparability between countries. Reducing the number or intensity of stressors through curriculum revision and improving students’ coping response could contribute to the reduction of stress levels among students. Mentorship, counseling, and an environment conducive to clinical training are essential to minimize perceived stress, enhance learning, and productivity, and prevent burnout among nursing students.
An EEG investigation of alpha and beta activity during resting states in adults with Williams syndrome
Authors: Greer Joanna M. H. , Riby Deborah M. , McMullon Mhairi E. G. , Hamilton Colin , Riby Leigh M.
Published: May 2021

Background

Williams syndrome (WS) is neurodevelopmental disorder characterised by executive deficits of attention and inhibitory processing. The current study examined the neural mechanisms during resting states in adults with WS in order to investigate how this subserves the attention and inhibitory deficits associated with the syndrome.

Method

Adopting electroencephalography (EEG) methodology, cortical electrical activity was recorded from eleven adults with WS aged 35 + years during Eyes Closed (EC) and Eyes Open (EO) resting states, and compared to that of thirteen typically developing adults matched for chronological age (CA) and ten typically developing children matched for verbal mental ability (MA). Using mixed-design analyses of variance (ANOVA), analyses focused on the full alpha (8–12.5 Hz), low-alpha (8–10 Hz), upper-alpha (10–12.5 Hz), and beta (13–29.5 Hz) bands, as these are thought to have functional significance with attentional and inhibitory processes.

Results

No significant difference in alpha power were found between the WS and CA groups across all analyses, however a trend for numerically lower alpha power was observed in the WS group, consistent with other developmental disorders characterised by attentional/inhibitory deficits such as Attention Deficit Hyperactivity Disorder (ADHD). In contrast, comparable beta power between the WS and CA groups during both EC/EO conditions suggests that their baseline EEG signature is commensurate with successful attentional processing, though this needs to be interpreted with caution due to the small sample size. Analyses also revealed an unusual trend for low variability in the EEG signature of the WS group, which contradicts the heterogeneity typically observed behaviourally.

Conclusions

This novel finding of low variability in the EEG spectra in the WS group has been previously associated with poor behavioural performance in ADHD and is highly informative, highlighting future research needs to also consider how the role of low variability in the EEG profile of WS manifests in relation to their behavioural and cognitive profiles.
The impact of moral injury on the wellbeing of UK military veterans
Authors: Williamson Victoria , Murphy Dominic , Stevelink Sharon A. M. , Allen Shannon , Jones Edgar , Greenberg Neil
Published: May 2021

Background

Experiences of potentially morally injurious events (PMIEs) have been found to negatively impact the mental health of US personnel/veterans, yet little is known about the effect of PMIEs on the mental health of the UK Armed Forces (AF). This cross-sectional study aimed to examine the association between PMIEs and the mental health outcomes of UK AF veterans.

Method

Assessments of PMIE exposure and self-report measures of common mental disorders were administered using an online questionnaire to 204 UK veterans. Subjects were classified as having experienced a morally injurious event (n = 66), a non-morally injurious traumatic event (n = 57), a ‘mixed’ event (n = 31), or no event (n = 50).

Results

Potentially morally injurious experiences were associated with adverse mental health outcomes, including likely anxiety disorders and suicidal ideation, compared to those who reported no event exposure. The likelihood of meeting criteria for probable PTSD was greatest in those who had experienced a non-morally injurious trauma. No statistically significant association between alcohol misuse and experiencing a PMIE or traumatic event was observed.

Conclusions

The results provide preliminary evidence that potentially morally injurious experiences are associated with adverse mental health outcomes in UK AF veterans. Further work is needed to better understand the interplay between morally injurious events and threat-based trauma in order to design effective pathways for prevention and intervention for people exposed to highly challenging events.
Synergistic effect of organic and inorganic fertilization on the soil inoculum density of the soilborne pathogens Verticillium dahliae and Phytophthora spp. under open-field conditions
Authors: Cocozza Claudio , Abdeldaym Emad Abdelhameed , Brunetti Gennaro , Nigro Franco , Traversa Andreina
Published: May 2021

Background

The increasing demand of food causes an excessive exploitation of agricultural lands, often inducing phenomena of soil sickness accompanied by the development of soilborne diseases. The use of residual biomasses together with inorganic fertilizers can be considered a good agricultural practice for controlling the inoculum density of soilborne phytopathogens since soil conditioners can release inorganic nitrogen, polyphenols and fatty acids that, especially in vitro, have demonstrated various degree of suppressiveness against such pathogens. Further, soil organic amendments can also modify the population of soil culturable bacteria and fungi that, in turn, can affect the soilborne diseases in several ways. With this study, the authors aim to evaluate the impact of the synergistic application of different biomasses and inorganic fertilizers on the soil inoculum density ofVerticillium dahliaeandPhytophthoraspp.during two potato cycles under open-field conditions. The biomasses used for the fertilization of the potato crop were olive pomace residues (OPR), composts from municipal solid wastes (CMW), spent mushroom compost (SMC), and livestock manure-based compost (BRX).

Results

The inoculum density ofVerticillium dahliaeappeared inhibited by BRX due to its low C/N ratio that caused a quicker release of inorganic nitrogen with respect to the others soil conditioners. In contrast, OPR was conducive to the aforementioned soilborne pathogen since that biomass was characterized by a very high percentage of unsaturated fatty acids that, rather, stimulate the inoculum density ofV. dahliae. Finally, polyphenols did not influence the same pathogen because they apparently turned into no toxic compounds very quickly. The inoculum density ofPhytophthoraspp.was reduced equally by all the biomasses used in combination with the inorganic fertilizers, regardless of their composition and quantity, mainly because of the development of general microbial suppression. Therefore, the chemical characteristics of the soil conditioners apparently did not affect the inoculum density ofPhytophthoraspp.

Conclusions

The results of this work underline the behavioral diversity of the different pathogens towards the different means adopted.Phytophthoraspp. are sensitive to any kind of biomasses combined with inorganic fertilizers while the inoculum density ofVerticillium dahliaeshould be reduced using soil conditioners characterized by low C/N ratio and low quantity of unsaturated fatty acids.
The implementation of pharmaceutical services in public hospitals in Mexico: an analysis of the legal framework and organizational practice
Authors: Vargas López Laura C. , Viso Gurovich Fela , Dreser Mansilla Anahí , Wirtz Veronika J. , Reich Michael R.
Published: May 2021

Background

The implementation of pharmaceutical services in hospitals contributes to the appropriate use of medicines and patient safety. However, the relationship of implementation with the legal framework and organizational practice has not been studied in depth. The objective of this research is to determine the role of these two factors (the legal framework and organizational practice) in the implementation of pharmaceutical services in public hospitals of the Ministry of Health of Mexico.

Methods

Semi-structured interviews were conducted with four groups of actors involved. The analysis focused on the legal framework, defined as the rules, laws and regulations, and on organizational practice, defined as the implementation of the legal framework by related individuals, that is, how they put it into practice.

Results

The main problems identified were the lack of alignment between the rules and the incentives for compliance. Decision-makers identified the lack of managerial capacity in hospitals as the main implementation barrier, while hospital pharmacists pointed to poor regulation and the lack of clarity of the legal framework as the problems to consider.

Conclusions

Although the legal framework related to hospital pharmaceutical services in Mexico is inadequate, organizational factors (such as adequate skills of professional pharmacists and the support of the hospital director) have facilitated gradual implementation. To improve implementation, priority should be given to evaluation and modification of the current legislation along with the development of an official minimum standard for activities and services in hospital pharmacies.
Classification of chest radiographs using general purpose cloud-based automated machine learning: pilot study
Authors: Ghosh Tamaghna , Tanwar Simran , Chumber Shishir , Vani Kavita
Published: May 2021

Background

Widespread implementation of machine learning models in diagnostic imaging is restricted by dearth of expertise and resources. General purpose automated machine learning offers a possible solution.

This study aims to provide a proof of concept that a general purpose automated machine learning platform can be utilized to train a CNN to classify chest radiographs.

In a retrospective study, more than 2000 postero-anterior chest radiographs were assessed for quality, contrast, position, and pathology. A selected dataset of 637 radiographs were used to train a CNN using reinforcement learning based automated machine learning platform. Accuracy metrics of each label was calculated and model performance was compared to previous studies.

Results

The auPRC (area under precision-recall curve) was 0.616. The model achieved precision of 70.8% and recall of 60.7% (P > 0.05) for detection of “Normal” radiographs. Detection of “Pathology” by the model had a precision of 75.6% and recall of 75.6% (P > 0.05). The F1 scores were 0.65 and 0.75 respectively.

Conclusion

Automated machine learning platforms may provide viable alternatives to developing custom CNN models for classification of chest radiographs. However, the accuracy achieved is lower than a comparable traditionally developed neural network model.
Lithofacies, depositional, and diagenetic controls on the reservoir quality of the Mississippian mixed siliciclastic-carbonate system, eastern Anadarko Basin, Oklahoma, USA
Authors: Suriamin Fnu , Pranter Matthew J.
Published: May 2021

In the eastern Anadarko Basin of central Oklahoma, the variability of Mississippian lithofacies, diagenetic products, and reservoir quality is critical for reservoir development. We have investigated lithofacies variability based on sedimentological characteristics and diagenetic alteration through integration of core and thin sections by using optical microscope, scanning electron microscope, energy dispersive X-ray diffraction spectroscope, and electron probe microanalyzer-cathodoluminescence analyses. Based on detailed descriptions of five cores (approximately 260 m [approximately 850 ft]) and analysis of 34 thin sections, we concluded that the Mississippian strata consists of eight lithofacies that represent wave-influenced nearshore with restricted embayment (lagoon) and channel or lobe deposits. We observed diagenetic alteration including calcite cementation, mechanical compaction, albitization, quartz cementation, silicification, dolomitization, Fe-dolomite cementation, pyritization, and dissolution. A paragenesis scheme suggests that quartz cementation occurred earlier compared to albitization and Fe-dolomite cementation. The Fe-dolomite is the latest authigenic mineral formed, whereas the quartz and calcite cement can be attributed to earlier diagenesis. The calcite, quartz, and Fe-dolomite cementation might have potentially increased the brittleness index and frackability of the rocks. The reservoir quality is relatively good in the channel or lobe deposits and is generally poor in the upper shoreface to upper offshore environments. The reservoir quality is significantly reduced by clays, calcite cement, and mechanical compaction. However, the dissolution of calcite cement and detrital grains tends to improve reservoir quality by forming secondary pores. We prove that understanding the characteristic of lithofacies variation, depositional environments, and diagenetic alterations of the Mississippian strata is crucial for optimal development of the Mississippian reservoirs in the eastern Anadarko Basin. We develop a predictive framework that aids in reservoir characterization.
What mental health professionals and organisations should do to address climate change
Authors: Monsell Adam , Krzanowski Jacob , Page Lisa , Cuthbert Sharon , Harvey Guy
Published: May 2021

Aims and method

The climate change emergency is also a mental healthcare emergency. We seek to provide a framework for what mental health professionals and organisations should do to make their practice more sustainable.

Results

There are ethical, legal and organisational imperatives to make mental healthcare more sustainable. Mental healthcare must be refocused with an emphasis on prevention, building social capital and community resilience. Patients must be empowered to manage their own mental health. Efficiencies should be found within the system. Low-carbon ways to deliver care must be found, measured and improved upon. Greater adaptability needs to be built into the system to mitigate the impact of climate change. Sustainability should be integrated into training programmes, and good examples of practice shared and celebrated.

Clinical implications

Mental health organisations and individuals must act now to prevent and adapt for the climate and ecological emergency. Sustainable practice is also good practice.
Examining the effects of national initiatives to improve the physical health of people with psychosis in England: secondary analysis of data from the National Clinical Audit of Psychosis
Authors: Williams Ryan , Natkulasingam Sagana , Tooke Beatrice , Webster Ella , Quirk Alan , Gupta Veenu , French Paul , Smith Jo , Crawford Mike J.
Published: May 2021

Aims and Methods

To examine whether national initiatives have led to improvements in the physical health of people with psychosis. Secondary analysis of a national audit of services for people with psychosis. Proportions of patients in ‘good health’ according to seven measures, and one composite measure derived from national standards, were compared between multiple rounds of data collection.

Results

The proportion of patients in overall ‘good health’ under the care of ‘Early Intervention in Psychosis’ teams increased from 2014–2019, particularly for measures of smoking, alcohol and substance use. There was no overall change in the proportion of patients in overall ‘good health’ under the care of ‘Community Mental Health Teams’ from 2011–2017. However, there were improvements in alcohol use, blood glucose and lipid levels.

Clinical implications

There have been modest improvements in the health of people with psychosis over the last nine years. Continuing efforts are required to translate these improvements into reductions in premature mortality.
Examining the relationship between altered brain functional connectome and disinhibition across 33 impulsive and compulsive behaviours
Authors: Chye Yann , Suo Chao , Romero-Garcia Rafael , Bethlehem Richard A.I. , Hook Roxanne , Tiego Jeggan , Goodyer Ian , Jones Peter B. , Dolan Ray , Bullmore Edward T. , Grant Jon E. , Yücel Murat , Chamberlain Samuel R.
Published: May 2021

Impulsive and compulsive problem behaviours are associated with a variety of mental disorders. Latent phenotyping indicates the expression of impulsive and compulsive problem behaviours is predominantly governed by a transdiagnostic ‘disinhibition’ phenotype. In a cohort of 117 individuals, recruited as part of the Neuroscience in Psychiatry Network (NSPN), we examined how brain functional connectome and network properties relate to disinhibition. Reduced functional connectivity within a subnetwork of frontal (especially right inferior frontal gyrus), occipital and parietal regions was linked to disinhibition. Findings provide insights into neurobiological pathways underlying the emergence of impulsive and compulsive disorders.
Video intervention to increase treatment-seeking by healthcare workers during the COVID-19 pandemic: randomised controlled trial
Authors: Amsalem Doron , Lazarov Amit , Markowitz John C. , Smith Thomas E. , Dixon Lisa B. , Neria Yuval
Published: May 2021

Background

Many healthcare workers do not seek help, despite their enormous stress and greater risk for anxiety, depression and post-traumatic stress disorder (PTSD).

Aims

This study screened for psychopathology and evaluated the efficacy of a brief, social contact-based video intervention in increasing treatment-seeking intentions among healthcare workers (trial registration: NCT04497415). We anticipated finding high rates of psychopathology and greater treatment-seeking intentions post-intervention.

Method

Healthcare workers (n= 350) were randomised to (a) a brief video-based intervention at day 1, coupled with a booster video at day 14; (b) the video at day 1 only; or (c) a non-intervention control. In the 3 min video, a female nurse described difficulty coping with stress, her anxieties and depression, barriers to care and how therapy helped her. Assessments were conducted pre- and post-intervention and at 14- and 30-day follow-ups.

Results

Of the 350 healthcare workers, 281 (80%) reported probable anxiety, depression and/or PTSD. Participants were principally nurses (n= 237; 68%), physicians (n= 52; 15%) and emergency medical technicians (n= 30; 9%). The brief video-based intervention yielded greater increases in treatment-seeking intentions than the control condition, particularly among participants in the repeat-video group. Exploratory analysis revealed that in both video groups, we found greater effect among nurses than non-nurses.

Conclusions

A brief video-based intervention increased treatment-seeking intention, possibly through identification and emotional engagement with the video protagonist. A booster video magnified that effect. This easily disseminated intervention could increase the likelihood of seeking care and offer employers a proactive approach to encourage employees to search for help if needed.
Optimal Donor Selection for Hematopoietic Cell Transplantation Using Bayesian Machine Learning
Authors: Logan Brent R. , Maiers Martin J. , Sparapani Rodney A. , Laud Purushottam W. , Spellman Stephen R. , McCulloch Robert E. , Shaw Bronwen E.
Published: May 2021

PURPOSE

Donor selection practices for matched unrelated donor (MUD) hematopoietic cell transplantation (HCT) vary, and the impact of optimizing donor selection in a patient-specific way using modern machine learning (ML) models has not been studied.

METHODS

We trained a Bayesian ML model in 10,318 patients who underwent MUD HCT from 1999 to 2014 to provide patient- and donor-specific predictions of clinically severe (grade 3 or 4) acute graft-versus-host disease or death by day 180. The model was validated in 3,501 patients from 2015 to 2016 with archived records of potential donors at search. Donor selection optimizing predicted outcomes was implemented over either an unlimited donor pool or the donors in the search archives. Posterior mean differences in outcomes from optimal donor selection versus actual practice were summarized per patient and across the population with 95% intervals.

RESULTS

Event rates were 33% (training) and 37% (validation). Among donor features, only age affected outcomes, with the effect consistent regardless of patient features. The median (interquartile range) difference in age between the youngest donor at search and the selected donor was 6 (1-10) years, whereas the number of donors per patient younger than the selected donor was 6 (1-36). Fourteen percent of the validation data set had an approximate 5% absolute reduction in event rates from selecting the youngest donor at search versus the actual donor used, leading to an absolute population reduction of 1% (95% interval, 0 to 3).

CONCLUSION

We confirmed the singular importance of selecting the youngest available MUD, irrespective of patient features, identified potential for improved HCT outcomes by selecting a younger MUD, and demonstrated use of novel ML models transferable to optimize other complex treatment decisions in a patient-specific way.
Socjodemograficzne determinanty aktywności turystycznej beneficjentów programu socjalnego Rodzina 500+ w Polsce
Authors: Bolechowski Franciszek
Published: May 2021

Głównym celem rozdziału jest wskazanie socjodemograficznych determinant aktywności turystycznej beneficjentów programu socjalnego Rodzina 500+ w Polsce. W oparciu o wyniki badań przeprowadzonych od stycznia do maja 2020 r. za pomocą sondażu diagnostycznego wśród 64 Polaków korzystających z tego rodzaju wsparcia socjalnego pozytywnie zweryfikowano tezę główną mówiącą o tym, że po zaspokojeniu potrzeb podstawowych na pewnym poziomie rodziny mogą sobie pozwolić na konsumpcję według upodobania, a w jej ramach na aktywność turystyczną lub częstsze jej podejmowanie. Ponadto, stosując test zależności chi-kwadrat Pearsona, potwierdzono następujące hipotezy cząstkowe: 1. Wraz ze wzrostem miesięcznego dochodu na członka rodziny wzrasta częstotliwość wyjazdów turystycznych. 2. Im liczniejsze gospodarstwo domowe, tym rzadziej jego członkowie podróżują za granicę. 3. Im wyższe wykształcenie rodzica, tym częściej rodzina wyjeżdża w celach poznawczych. Część empiryczną poprzedził przegląd piśmiennictwa na temat wpływu pomocy socjalnej na gospodarkę i rynek.
Dziedzictwo kulinarne województwa małopolskiego w opinii podróżujących
Authors: Zatorska Żaneta
Published: May 2021

Celem niniejszego rozdziału jest dokonanie ogólnej charakterystyki dziedzictwa kulinarnego województwa małopolskiego oraz poznanie stanu wiedzy i opinii podróżujących po tym regionie turystów na jego temat. W pierwszej części pracy krótko przedstawiono bogactwo kulinarne Małopolski. W drugiej natomiast omówiono wyniki badań własnych, przeprowadzonych z wykorzystaniem anonimowego kwestionariusza ankiety. W podsumowaniu znalazły się uwagi i wnioski wynikające z analiz, w tym odnoszące się do weryfikacji czterech postawionych hipotez badawczych.
Hypertrophic Gastric folds with Hypomagnesemia, linking the dots
Authors: Zafar Mansoor , Muhammad Tila , Saher Najam us , Toqeer Muhammad
Published: May 2021

A Caucasian man in early 80s was seen in Gastroenterology Clinic, following, referral from the Endocrinology Clinic for concerns for CT Abdomen requested for tiredness and weight loss of three kilograms. The patient also had microcytic picture with low MCV and Ferritin and hypomagnesemia. The CT suggested gross circumferential thickening of the wall of stomach with advice for invasive investigations to further characterise the CT findings. The Endoscopy suggested grossly enlarged rugae in the stomach, and enlarged gastric polyps. Patient was assured no new sinister abnormality.

Treatment challenges to consider were to stop acid suppression by prescribing Proton Pump Inhibitors (PPIs) which would lead to stomach ulcers, or to continue with PPIs with sequalae of worsening of hypertrophic gastric folds, enlarged gastric polyps and hypomagnesemia. It would be necessary to consider risk versus benefits in either situation to determine an appropriate treatment plan in the long term.

With background of Zollinger-Ellison Syndrome and MEN1 with heterozygous mutation with gastrinoma of the duodenum, and frailty he was advised to continue with Proton Pump Inhibitors with twice weekly correction of Magnesium infusions, and Iron tablets following Multi-disciplinary meeting.

doi: https://doi.org/10.12669/pjms.37.4.3984

How to cite this:Zafar M, Muhammad T, Najam-us-Saher, Toqeer M. Hypertrophic Gastric folds with Hypomagnesemia, linking the dots. Pak J Med Sci. 2021;37(4):1237-1240. doi: https://doi.org/10.12669/pjms.37.4.3984

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.
Demystifying media sources of information and levels of knowledge about COVID-19: a rapid mini-review of cross-sectional studies in Africa
Authors: Aruhomukama Dickson , Bulafu Douglas
Published: May 2021

COVID-19 control is highly affected by knowledge levels which are also affected by receipt of information on the disease. Therefore, this review examined knowledge levels and media sources of information findings of the studies on knowledge, attitudes, perceptions, and practices towards COVID-19 done in low- and middle-income countries in Africa to shed light on the interplay of the use of different media platforms and populations’ knowledge about the COVID-19 pandemic and identify shorter- and longer-term priorities for COVID-19 research to improve the continent’s capacity to not only deal with COVID-19 but also future pandemics. Searches were conducted in PubMed and CINAHL databases/sites with major terms being “knowledge”, “attitudes”, “perceptions”, “practices”, “COVID-19 “, and “Africa”. 319 were where identified and subjected to the exclusion and inclusion criteria retaining only 10 free, full-text research articles related to knowledge, attitudes, perceptions, and practices towards COVID-19. This review summarized the levels of knowledge and media information sources among African populations. The review indicated a largely higher level of knowledge towards COVID-19 among populations who received information through various media platforms and alluded to the different media platforms that could be appropriate to spread COVID-19 related information to African populations.
target: an R package to predict combined function of transcription factors
Authors: Ahmed Mahmoud , Kim Deok Ryong
Published: May 2021

Researchers use ChIP binding data to identify potential transcription factor binding sites. Similarly, they use gene expression data from sequencing or microarrays to quantify the effect of the factor overexpression or knockdown on its targets. Therefore, the integration of the binding and expression data can be used to improve the understanding of a transcription factor function. Here, we implemented the binding and expression target analysis (BETA) in an R/Bioconductor package. This algorithm ranks the targets based on the distances of their assigned peaks from the factor ChIP experiment and the signed statistics from gene expression profiling with factor perturbation. We further extend BETA to integrate two sets of data from two factors to predict their targets and their combined functions. In this article, we briefly describe the workings of the algorithm and provide a workflow with a real dataset for using it. The gene targets and the aggregate functions of transcription factors YY1 and YY2 in HeLa cells were identified. Using the same datasets, we identified the shared targets of the two factors, which were found to be, on average, more cooperatively regulated.
Limitations to current methods to estimate cause of death: a validation study of a verbal autopsy model
Authors: Menéndez Clara , Quintó Llorenç , Castillo Paola , Carrilho Carla , Ismail Mamudo R. , Lorenzoni Cesaltina , Fernandes Fabiola , Hurtado Juan Carlos , Rakislova Natalia , Munguambe Khátia , Maixenchs Maria , Macete Eusebio , Mandomando Inacio , Martínez Miguel J , Bassat Quique , Alonso Pedro L , Ordi Jaume
Published: May 2021

Background: Accurate information on causes of death (CoD) is essential to estimate burden of disease, track global progress, prioritize cost-effective interventions, and inform policies to reduce mortality. In low-income settings, where a significant proportion of deaths take place at home or in poorly-resourced peripheral health facilities, data on CoD often relies on verbal autopsies (VAs). Validations of VAs have been performed against clinical diagnosis, but never before against an acceptable gold standard: the complete diagnostic autopsy (CDA).

Methods: We have validated a computer-coded verbal autopsy method –the InterVA- using individual and population metrics to determine CoD against the CDA, in 316 deceased patients of different age groups who died in a tertiary-level hospital in Maputo, Mozambique between 2013 and 2015.  

Results: We found a low agreement of the model across all age groups at the individual (kappa statistic ranging from -0.030 to 0.232, lowest in stillbirths and highest in adults) and population levels (chance-corrected cause-specific mortality fraction accuracy ranging from -1.00 to 0.62, lowest in stillbirths, highest in children). The sensitivity in identifying infectious diseases was low (0% for tuberculosis, diarrhea, and disseminated infections, 32% for HIV-related infections, 33% for malaria and 36% for pneumonia). Of maternal deaths, 26 were assigned to eclampsia but only four patients actually died of eclampsia.

Conclusions: These findings do not lead to building confidence in current estimates of CoD. They also call to the need to implement autopsy methods where they may be feasible, and to improve the quality and performance of current VA techniques.
COVID-19 and vaccines in Africa: a descriptive and thematic analysis of Twitter content
Authors: Mwendwa Purity , Githui Simon , Marete Eunice , Kroll Thilo
Published: May 2021

Introduction: As coronavirus disease 2019 (COVID-19) vaccines become available, it becomes important to understand public perceptions of the vaccines and implementation plans. The social media platform TwitterTM, which publicly shares information, serves as an important source of content related to COVID-19 vaccines. This study employed a qualitative descriptive design to examine content related to COVID-19 vaccines posted by Twitter users located in Africa.

Methods: Data were collected from Twitter between the 11th and the 16th of December 2020 using the NCapture tool. We searched Twitter using the terms 'coronavirus', 'COVID-19 vaccine' and 'Africa' to identify the nature and content of tweets related to COVID-19 and vaccines shared by Twitter users from the African region. Descriptive statistics were used to describe the characteristics of Twitter accounts and thematic analysis helped determine, analyse, and clarify patterns of meaning (themes) emerging from the tweets.

Results: The study found n=208 Twitter accounts, the majority (n=69; 33%) from South Africa and most (42%; n=87) from news agencies. The final dataset included n=212 tweets. The most used hashtag was #Covid19vaccine(s). Four themes were identified: i) capacity for vaccine production, ii) vaccine procurement, iii) vaccine logistics, and iv) perceived safety and efficacy of vaccines. The capacity of countries in Africa to manufacture a COVID-19 vaccine was deemed minimal and most tweets questioned Africa’s ability to procure vaccines based on the costs. Tweets also centred around the distribution of vaccines, storage and roll-out and the need to leverage existing solar-powered technologies to enhance the cold supply chain in Africa's remote locations. Questions about the safety and efficacy of vaccines developed in under one year were also raised.

Conclusions: Concerns about vaccine procurement and readiness for distribution were dominant topics. These public concerns can be important in informing policymakers in preparation for the roll-out of vaccines in these contexts.
ИНКЛЮЗИВНЫЙ ПОДХОД В РАБОТЕ С ПОЖИЛЫМИ ЛЮДЬМИ. МОДЕЛИ ПРЕОДОЛЕНИЯ ГЕРОНТОЛОГИЧЕСКОГО ЭЙДЖИЗМА
Authors: Furiaeva Tatiana V. , Klimatckaia Liudmila G. , Furyaev Evgeny A. , Shpakou Andrei I.
Published: May 2021

Цель. Выявить и проанализировать особенности инклюзивного подхода в интегрированной медико-социальной помощи пожилым людям в рамках концептуальных моделей преодоления геронтологического эйджизма в разных странах.
Результаты. Проанализированы результаты актуальных отечественных и зарубежных исследований по проблеме преодоления возрастной дискриминаци, выявлены пять концептуальных моделей социальной инклюзии (социально-экологическая, интеракционистская, ресурсно-потенциальная, модели социального пространства и социального участия), раскрыто их сущностное содержание и возможности применения в реальной социальной практике работы с пожилыми людьми.
Заключение. Инклюзивный подход при решении проблемы преодоления геронтологического эйджизма в работе с пожилыми людьми в разных странах находит свое отражение в наличии разнообразных концептуальных интегрированных моделей. Их выявление и анализ содержания свидетельствует об актуализации социально-политических и организационных задач по раскрытию, усилению личностного потенциала пожилых людей, по обеспечению доступности социальной и пространственной среды проживания. Полученные результаты компаративистского анализа свидетельствует о необходимости и возможности применения инклюзивного подхода в интегрированной медико-социальной помощи пожилым людям для улучшения качества их жизни.
New in the Legislation on Syndicated Lending
Authors: Smirnov I.
Published: May 2021

In line with the improvement of fi nancial legislation in Russia, Federal Law No. 447-FZ of December 22, 2020 was adopted, which signifi cantly increases the effi ciency of syndicated lending, i.e. lending that is carried out by groups (syndicates) of jointly acting lenders.
The Organization of Pedagogical Communication in the E-Learning of the Mathematical Disciplines
Authors: Maskina Mariya , Davydochkina Svetlana
Published: May 2021

In the current sanitary and epidemiological situation and the total transition to a distance format of communication between the teacher and the student, the problem of maintaining the quality of the educational services provided at the proper level becomes especially urgent. One of the options for solving this problem is seen by the authors in a well-established feedback loop with students and a competent organization of pedagogical communication within the framework of e-learning. This article describes the experience of organizing distance communication in the classroom in the disciplines of the mathematical cycle with junior-year students of economic specialties, conducted using video conferencing, electronic information and educational environment and author's workbooks on the subject. The effectiveness of this method is confirmed by the results of checking the residual knowledge of students in mathematics, carried out when licensing their specialty.
Los procesos de desvinculación y reintegración de las niñas asociadas con fuerzas o grupos armados: “thinking outside the box”
Authors: Abril Stoffels Ruth , Ojinaga Ruiz Rosario
Published: May 2021

La intersección entre género y edad hace que las niñas asociadas con grupos armados no sean protegidas adecuadamente en los procesos que ponen fin a su vinculación con tales grupos. Este estudio, partiendo de las experiencias de los organismos humanitarios que tratan con ellas y de la literatura al respecto, e centrará en la posible inadecuación de los procesos DDR para las niñas, tal y como son ideados, implantados y evaluados en la actualidad por los Estados, las OI y las ONG. Se concluye con una serie de propuestas para mejorar las deficiencias presentadas.
Positive psychology and the I-FLOW model: a new dynamic model of homeostatic wellbeing for mental health nursing
Authors: Macfarlane Jan
Published: May 2021

This is the tenth article in a series that explores the meaning of positive psychology and the importance of applying the latest related research findings, for the wellbeing of the mental health workforce. It will focus on the innovative I-Flourishing and Languishing Opportunities Wheel (I-FLOW) model, which can be applied to mental health nursing from a different perspective to many other frameworks. It positions realistic optimism and flow at its epicentre, suggesting that these are in a constant dynamic state of homeostatic balance. It recognises that wellbeing can be a combination of managing positive and negative feelings, thoughts and behaviours and that this is central to successful navigation of our life experiences. This article will frame the historical context of the model's development as a multi-dimensional concept through a range of positive psychology theorists and their respective frameworks. Finally, it encourages the reader to consider how the application of I-FLOW could be of benefit to them, through increased self-awareness and feedback. The practical tasks provided in the boxes throughout the article will help the reader identify what flourishing and wellbeing means to them and understand how to further develop its transferability through evidence-based, user-friendly exercises.
Non-medical prescribing nurses in primary care: a positive response to restructuring
Authors: Fernandez Jeff
Published: May 2021

This article examines a shared care model used in a primary care alcohol and drugs service, with experienced clinical staff trained as non-medical prescribing nurses. Shared care based around the resource of the non-medical prescribing nurse situated in primary care can be a solution in a time of scare resources. Non-medical prescribing is illustrated further by a patient case study in a London borough to show its potential for treating patients. There needs to be good governance and supervision of this role to be effective and safe for patients, and this article discusses how this can be achieved by detailing a safe process.
Brachycephalic ocular syndrome in dogs
Authors: Nutbrown-Hughes David
Published: May 2021

Small brachycephalic breeds, such as the Pug and French Bulldog, among others, are currently extremely popular. The conformation of these breeds is part of their appeal to owners, although this can lead to ocular surface disease such as corneal ulceration and pigmentation. The eye problems associated with these breeds are collectively known as brachycephalic ocular syndrome. In dolicocephalic and mesocephalic dogs there is usually a close interaction between the tear film, the eyelids and the cornea. This does not seem to be the case in breeds with brachycephalic ocular syndrome, where poor skull and eyelid conformation, corneal sensation and tear films are associated with ocular problems such as corneal ulceration and pigmentation, as well as a predisposition to globe proptosis. Treatment needs to address the causes of the problems and combinations of both medical and surgical treatment are required.
Alternative drugs to phenobarbital in canine epileptic patients
Authors: Skovola Eleftheria , Cherubini Giunio Bruto , Ferrini Sara
Published: May 2021

Epilepsy is one of the most common chronic neurological diseases in companion animals. The first choice for anti-epileptic drugs has consistently been phenobarbital. However, the presence of side effects or contraindications for its use, or poor control of seizures in some canine patients, may require the replacement of phenobarbital, or the addition of more anti-epileptic drugs to the treatment protocol. This article describes the indications, mechanism of action, pharmacokinetics, recommended doses and adverse effects of anti-epileptic drugs whic can be used in place of phenobarbital. A review of the current literature and the administration of each anti-epileptic drug in veterinary practice is also presented. Bromide and imepitoin are overall good options for adjunctive or alternative anti-epileptic medications. However, the pros and cons of each drug need to be considered, in order to choose the most suitable therapeutic protocol for each case. Pharmaco-resistant epilepsy occurs when seizure activity fails to be controlled with two or more anti-epileptic drugs. In the latter situation, some more recently studied alternative anti-epileptic drugs can be considered, such as levetiracetam, gabapentin, pregabalin, zonisamide, felbamate and topiramate. Non-medical options include a medium chain triglyceride oil enriched diet, and cannabidiol.