bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring Project Management Complexity Dimensions, Factors, and Strategies
Authors: Adel Ahmad Jamshed , Cleveland Simon
Published: October 2020

Constant changes in the internal and external environmental factors impact organizations, people, systems, and processes. This impact increases complexity in projects exponentially. The more diverse tools, systems, and people involved in a project, the more interdependent and complex the project will be. This study explores complexity from several vantage points. It examines complexity from a project type, technological, organizational, and environmental perspective. Next, it examines human behavior, stakeholders, resource capability, and leadership as factors to project complexity. Moreover, it reviews emotions, biases, and emotional intelligence in decision making as sources of complexity. Finally, analysis of uncertainty as a leading factor of project complexity is performed through appropriate risk management, project planning, and proactive project monitoring and controlling mechanisms.
Candidate Identification Technique for Lung Cancer
Authors: Naqvi Sadaf Batool , Shah Abad Ali
Published: October 2020

Intensive research work has been done related to lung cancer prognosis. However, the current research mainly emphasises on decreasing the mortality rate, and increasing the survival rate of lung cancer patients. In this paper, the authors argue that an early identification and candidate identification (CI) of this disease can change the early detection treatment of lung cancer and hence can markedly reduce the mortality rate. The proposed technique CI will recognize the disease well in advance and can potentially save the candidate's life. In other words, a candidate of lung cancer is identified and treated in Stage 0 (explained later) instead of in Stage 1 or in the later stages of the lung cancer. In this paper, the authors have introduced a technique, called candidate identification, to identify candidates of the lung cancer. In the proposed technique, a backward forecasting function (BFF) is also proposed to generate Stage 0 data of the patients who have already lung cancer.
COVID-19 Infection in Pediatric Population
Authors: Ferentinou Eftychia , Pappa Despoina , Dafogianni Chrysoula
Published: October 2020

COVID-19 disease, caused by SARS-CoV-2 virus infection, started in the province of Wuhan in China in December 2019 and has reached pandemic proportions by March 2020 affecting many countries worldwide. The purpose of this review is to present scientific evidence found until April 30, 2020 on the characteristics of COVID-19 in the pediatric population. Bibliographical review of articles has been conducted through PubMed and Google Scholar, from January to April. Most of the research included was conducted in China because only a small number of studies from Europe and other affected areas could be found, as the pandemic is still in progress. As for the children, the disease turns up with mild symptoms while the mortality rate in childhood is particularly low. The diagnosis of the disease is made through specific criteria, while a therapeutic protocol is applied for the treatment of the disease. The virus is mainly transmitted through the respiratory tract, although it has not been scientifically proven that the virus is transmitted through vertical transmission from mother to fetus.
How Does Social Identification Moderate the Repurchase Intention?
Authors: Horng Shwu-Min
Published: October 2020

This research studied user repurchase intentions on online group buying services. In the research model, satisfaction is hypothesized to have a positive relationship with trust that will have a positive impact on repurchase intention. Each of the three dimensions is divided into two constructs, one for the product and the other for the website. In addition, the moderating effects of social identification on the relationships between trust and repurchase intention, and between satisfaction and trust were tested. A survey collected 300 effective samples to test the research model. The results of PLS showed that all of the causal relationships were all significant while the moderating effects of social identification were significant for several relationships. When social identification is low, the influences of trust toward the product on repurchase intention for the product, satisfaction toward the product on trust toward the product, and satisfaction toward the website on trust toward the website, are stronger. Managerial implications and suggestions for future research were also discussed.
Designing a XSS Defensive Framework for Web Servers Deployed in the Existing Smart City Infrastructure
Authors: Gupta Brij B. , Chaudhary Pooja , Gupta Shashank
Published: October 2020

Cross-site scripting is one of the notable exceptions effecting almost every web application. Hence, this article proposed a framework to negate the impact of the XSS attack on web servers deployed in one of the major applications of the Internet of Things (IoT) i.e. the smart city environment. The proposed framework implements 2 approaches: first, it executes vulnerable flow tracking for filtering injected malicious scripting code in dynamic web pages. Second, it accomplished trusted remark generation and validation for unveiling any suspicious activity in static web pages. Finally, the filtered and modified webpage is interfaced to the user. The prototype of the framework has been evaluated on a suite of real-world web applications to detect XSS attack mitigation capability. The performance analysis of the framework has revealed that this framework recognizes the XSS worms with very low false positives, false negatives and acceptable performance overhead as compared to existent XSS defensive methodologies.
Lucky Reply Effect
Authors: Chen Ming , Huang Yidan , Yu Shih-Heng , Wu Chia-Huei
Published: October 2020

As social media has developed, online interaction between consumers and companies has increased rapidly. This research explores how companies' replies to consumers' past online comments affect consumers' predictions of their chances of winning randomly determined associated rewards (e.g., a random drawing). The results of two studies show that consumers who left positive comments (encouragement/appreciation) and then received a reply from the company predicted a higher likelihood of winning a random drawing than those whose comments did not receive company replies. Both the boundary and the underlying mechanism of the effect are discussed in the research. The present research contributes to the literature on companies' online reply patterns by linking their online replies with consumer predictions concerning randomly determined rewards, extends consumer efforts from offline purchases to online comments, and provides insights into the differences between consumer predictions regarding traditional offline promotional events and online promotional events.
Selective DNA Demethylation Accompanies T Cell Homeostatic Proliferation and Gene Regulation in Lupus-Prone lpr Mice
Authors: Scharer Christopher D , Fortner Karen A , Dragon Julie A , Tighe Scott , Boss Jeremy M , Budd Ralph C
Published: October 2020

Systemic lupus erythematosus (SLE) is characterized by increased DNA demethylation in T cells, although it is unclear whether this occurs primarily in a subset of SLE T cells. The process driving the DNA demethylation and the consequences on overall gene expression are also poorly understood and whether this represents a secondary consequence of SLE or a primary contributing factor. Lupus-prone lpr mice accumulate large numbers of T cells with age because of a mutation in Fas (CD95). The accumulating T cells include an unusual population of CD4−CD8−TCR-αβ+ (DN) T cells that arise from CD8+ precursors and are also found in human SLE. We have previously observed that T cell accumulation in lpr mice is due to dysregulation of T cell homeostatic proliferation, which parallels an increased expression of numerous genes in the DN subset, including several proinflammatory molecules and checkpoint blockers. We thus determined the DNA methylome in lpr DN T cells compared with their CD8+ precursors. Our findings show that DN T cells manifest discrete sites of extensive demethylation throughout the genome, and these sites correspond to the location of a large proportion of the upregulated genes. Thus, dysregulated homeostatic proliferation in lpr mice and consequent epigenetic alterations may be a contributing factor to lupus pathogenesis.
Vaccination with Intradermal Bacillus Calmette–Guérin Provides Robust Protection against Extrapulmonary Tuberculosis but Not Pulmonary Infection in Cynomolgus Macaques
Authors: Tsujimura Yusuke , Shiogama Yumiko , Soma Shogo , Okamura Tomotaka , Takano Junichiro , Urano Emiko , Murakata Yoshiko , Kawano Akira , Yamakawa Natsuko , Asaka Masamitsu N. , Matsuo Kazuhiro , Yasutomi Yasuhiro
Published: October 2020

Recently, the efficacy of Mycobacterium bovis bacillus Calmette–Guérin (BCG) vaccination is being reassessed in accordance with the achievements of clinical tuberculosis (TB) vaccine research. However, the mechanisms ultimately determining the success or failure of BCG vaccination to prevent pulmonary TB remain poorly understood. In this study, we analyzed the protective effects of intradermal BCG vaccination by using specific pathogen–free cynomolgus macaques of Asian origin that were intradermally vaccinated with BCG (Tokyo strain) followed by Mycobacterium tuberculosis (Erdman strain) infection. Intradermal BCG administration generated TB Ag-specific multifunctional CD4 T cell responses in peripheral blood and bronchoalveolar lavage and almost completely protected against the development of TB pathogenesis with aggravation of clinical parameters and high levels of bacterial burdens in extrapulmonary organs. However, interestingly, there were no differences in bacterial quantitation and pathology of extensive granulomas in the lungs between BCG-vaccinated monkeys and control animals. These results indicated that the changes in clinical parameters, immunological responses, and quantitative gross pathology that are used routinely to determine the efficacy of TB vaccines in nonhuman primate models might not correlate with the bacterial burden and histopathological score in the lung as measured in this study.
The correlation between severity of melasma with facial wrinkles in Yogyakarta, Indonesia
Authors: Murniastuti Dinda Sarasati , Etnawati Kristiana , Pudjiati Satiti Retno
Published: October 2020

Melasma is a common disfiguring condition involving acquired hyperpigmentation especially on the face, for which the pathogenesis is still uncertain, however histopathological studies showed that there is not only hyperpigmentation in the epidermis, but also solar elastosis or photo-aging due to abnormality of dermal extracellular matrix which contributes to clinical wrinkles. This study aimed to examine a link between the severity of melasma and facial wrinkles as a manifestation of photoaging in a tropical area. This study was an observational study with crosssectional design, conducted in Yogyakarta, Indonesia involving 51 patients with melasma aged 30-50 years who had fulfilled the inclusion and exclusion criteria. The melasma severity was measured clinically with the modified Melasma Severity Index (mMASI), and objectively with the Melanin Index (MI) and Erythema Index (EI) assessed with Mexameter Courage Khazaka. The wrinkle severity was measured clinically by scoring from forehead horizontal lines, crow’s feet, glabellar and nasolabial lines, and total scores were obtained from all of them. The correlation analysis was done statistically with Spearman’s rank tests. The results showed a weak positive but not significant correlation between the mMASI score and total facial wrinkle score (r: 0.165), and a weak positive non-significant correlation between EI and total facial wrinkle score (r: 0.06). There were significant positive moderate correlations between MI and total facial wrinkle score (r: 0.441), due to significant positive moderate correlations between MI and glabella wrinkle (r: 0.392), and between MI and nasolabial wrinkle (r: 0.339). In conclusion, a positive moderate correlation was found between MI and total facial wrinkle score, especially relating to glabellar and nasolabial wrinkles. However, there was no correlation between mMASI score and total facial wrinkle score.
Successful treatment of progressive macular hypomelanosis
Authors: Leonard Nicholas , Krueger Steven , Rashighi Mehdi
Published: October 2020

Progressive Macular Hypomelanosis (PMH) is a common but often misdiagnosed disorder of acquired hypopigmentation. An adolescent female presented with irregular, hypopigmented patches ultimately diagnosed as PMH. Complete repigmentation was achieved with narrowband UVB phototherapy, benzoyl peroxide wash, and clindamycin lotion.
Case series of cutaneous Langerhans cell histiocytosis in Indonesian children; The clinicopathological spectrum
Authors: Widodo Irianiwati , Sahara Nita , Dwianingsih Ery Kus , Ferronika Paranita
Published: October 2020

Langerhans Cell Histiocytosis (LCH) is a rare disease characterized by the clonal proliferation of Langerhans cells, which are immunoreactive to S-100 and CD-1a/ CD207 (Langerin). Cutaneous involvement is the most common presentation of LCH in children. It is suggested that the patients with single-system LCH limited to the skin have a better prognosis than those with systemic involvement. Three histologic reactions of cutaneous LCH have been reported and are associated with the clinical types of LCH. These histological reactions include: proliferative, granulomatous, and xanthomatous. This study presents the clinicopathological features of ten cutaneous LCH cases collected from Dr. Sardjito General Hospital Yogyakarta Indonesia between 2014-2018. The ten cases showed various clinical features, in which some features mimic other diseases. The microscopic features of skin biopsies showed granulomatous reaction in 80% of cases and proliferative reaction in the other 20%. Five patients (50% of cases) who died had systemic manifestation of thrombocytopenia, anemia, icterus, hepatosplenomegaly, and revealed the granulomatous type from their skin biopsy specimens. The clinical recognition of LCH and subsequent histological reaction determination are important since some cases may develop multisystem disease and have a poor prognosis.
Un La psiche tra salute e malattia. Evidenze ed epidemiologia, David Lazzari
Authors: Ceccanti Simona
Published: October 2020

David Lazzari pone al centro del suo nuovo libro il concetto di psiche, che definisce come “elemento regolatore tra equilibri interni ed esterni, tra le esigenze fisiologiche e quelle del contesto”. Tale ruolo “regolatore” è ciò che permette l’integrazione di più sistemi a livelli diversi di complessità (biologico, psicologico, sociale). (...)
You, Me, Her, John Scott Shepherd; Wanderlust, Luke Snellin e Lucy Tcherniak
Authors: Vanni Fabio
Published: October 2020

I media, si sa, sono spesso ottimi sensori di ciò che si muove nella pancia di una cultura, e non è forse tanto rilevante ai nostri fini di esperti della soggettualità umana se poi questa rilevazione venga utilizzata per scopi economici, oltre che culturali.

Di fatto in questo periodo Netflix ha trasmesso almeno due serie che hanno al centro una particolare declinazione della vita amorosa, un’interpretazione, certo, non nuova, ma che forse non era mai emersa in modo così evidente e, potremmo dire, spudorato, come in questo periodo.

Si tratta della declinazione multipla della vita amorosa stessa, ovvero di forme di relazioni sentimentali che vanno oltre il duale e dunque oltre la coppia.
Pial arteriovenous fistula: A clinical and neuro-interventional experience of outcomes in a rare entity
Authors: Medhi Gorky , Gupta Arun K , Saini Jitender , Ramalingaiah Arvinda H , Pendharkar Hima , Parida Subhendu
Published: October 2020

Purpose: Pial arteriovenous fistulae (PAVF) are rare intracranial vascular malformations, predominantly seen in children and distinct from arteriovenous malformations and dural arteriovenous fistulae. PAVF often leads to high morbidity and mortality. The aim of our study was to describe the clinical features and endovascular management of PAVF at various intracranial locations; to analyze the use of liquid embolic agents and coils alone or in combination in the treatment of PAVF and to analyze the outcome of embolization. Materials and Methods: Retrospective review of diagnostic angiography and neurointerventional database of our institution identified a cohort of 15 patients with non-galenic PAVF from 2008 to 2014 out of 6750 patients. Fourteen patients were treated endovascularly with coils and liquid embolic materials in combination or alone. Patients were followed up for evaluation of prognosis. Results: Age of the patients ranged from 3 to 37 years. Most patients were male and most common presentation was headache followed by seizure. Most common location of fistula was frontal lobe. The most common type was single artery single hole fistula with venous varix. Satisfactory obliteration was seen in all cases. One patient developed intraparenchymal hematoma on the first post procedural day and outcome was poor. Conclusions: PAVF are rare intracranial vascular malformations which can effectively be managed endovascularly with liquid embolic, coils alone, or in combination. Complete occlusion of the fistula can be achieved in most cases in a single sitting with a reasonable morbidity related to the procedure, compared with the natural history of this disease.
Unusual case of persistent primitive hypoglossal artery with anterior choroidal artery aneurysm in Chiari type I malformation
Authors: Haryu Shinya , Shida Naoki , Tominaga Teiji
Published: October 2020

Persistent primitive hypoglossal artery (PPHA) is a rare form of persistent embryonic carotid-basilar anastomosis. We present an unusual case of PPHA and an anterior choroidal artery (AChoA) aneurysm associated with Chiari type I malformation. A 45-year-old woman presented with transient dizziness. Magnetic resonance imaging revealed Chiari type I malformation and a left AChoA aneurysm. Digital subtraction angiography incidentally revealed a left PPHA. To the best of our knowledge, this is the first reported case of Chiari malformation in conjunction with PPHA and aneurysms. In this case, the perfusion of the posterior circulation is completely dependent on PPHA. It is very important to identify such variant vessels and complex angioarchitecture before planning neuroendovascular or surgical intervention to prevent possible risks.
Technical and patient-related sources of error and artifacts in bone mineral densitometry using dual-energy X-ray absorptiometry: A pictorial review
Authors: Qutbi Mohsen , Soltanshahi Mehdi , Shiravand Yaser , Gorzi Saba Karami , Shafiei Babak , Asli Isa Neshandar
Published: October 2020

Dual-energy X-ray absorptiometry is currently the standard and validated tool for measurement of bone mineral density and for the evaluation of osteoporosis. Current densitometry scanners based on dual-energy X-ray absorptiometry method produce two X-ray beams with different energies to differentiate the overlapped soft tissue and bony structures, by creating two different attenuation profiles. Procedural guidelines are available to technicians and physicians to guarantee the best practice, including consistent positioning during scanning and standard reporting. However, similar to other imaging modalities, dual-energy X-ray absorptiometry may be influenced by technical errors, and thus, imaging artifacts may arise and accuracy and precision of the results may be influenced. This issue may, in turn, affect the final result and interpretation. Hence, the article is arranged with the intention of presenting some less common and rare technical and patient-related sources of error and resultant artifacts, from poor patient preparation to acquisition and data processing. Where appropriate, the corresponding tables of densitometric results (bone mineral density) and statistical parameters (T- and Z-scores) are provided.
Inflammatory myofibroblastic tumours of the thorax: Radiologic and clinicopathological correlation
Authors: Irodi Aparna , Chacko Binita R , Prajapati Anand , Prabhu Anne J , Vimala Leena R , Christopher Devasahayam J , Gnanamuthu Birla R
Published: October 2020

Context and Aims: Inflammatory myofibroblastic tumour (IMT) is a rare mesenchymal neoplasm with intermediate malignant potential. The aim of this study is to describe and compare the clinical presentation, computed tomography (CT) findings and anaplastic lymphoma kinase -1 (ALK-1) expression of IMT of the thorax in children and adults. We also sought to study the tumour behaviour after treatment on the follow-up imaging. Materials and Method: This is a retrospective observational study of 22 histopathologically proven cases of IMT in the thorax. The clinical parameters, CT findings, biopsy results, treatment received and follow-up were recorded. Statistical analysis was performed using Fisher’s exact test. Results: IMT of the thorax had diverse imaging appearances, presenting either as large invasive lung masses with or without calcifications or as smaller endobronchial lesions. Children commonly presented with long duration fever (P = 0.02) and large invasive lung masses (P = 0.026), whereas adults presented with long duration haemoptysis (P = 0.001) and endobronchial lesions or smaller lung parenchymal lesions. Calcifications were more common in children (P = 0.007). ALK-1 was positive in 40% of children and 18.2% of adults (P = 0.547). Endobronchial lesions showed a trend for ALK-1 negativity. Patients with bronchoscopic excision had local recurrence and patients with surgical wedge resection had metastatic brain lesions as compared to those with lobectomy and pneumonectomy (P = 0.0152). A patient with unresectable lung mass had malignant transformation to spindle cell sarcoma after 9.5 years. Conclusions: Thoracic IMT presents with some distinct clinical and CT findings in adults and children. The CT findings and management options have implications for prognosis. If resectable, lobectomy is a better option than wedge resection or bronchoscopic excision for preventing local recurrence and metastasis. IMT can undergo malignant transformation.
Everolimus-induced somatostatin receptor overexpression in a rectal neuroendocrine tumor patient may promote somatostatin receptor-guided radionuclide therapy (peptide receptor radiotherapy) as an additional treatment option
Authors: Mileva Magdalena , Wimana Zéna , Flamen Patrick , Karfis Ioannis
Published: October 2020

We present a case of Grade II, well-differentiated rectal neuroendocrine tumor in a 39-year-old patient. Following different sequential treatment modalities, the disease progressed both on metabolic (18F-fluorodeoxyglucose positron emission tomography-computed tomography [18F-FDG PET/CT]) and somatostatin receptor (SSTR)-imaging (68Ga-DOTA-Tyr3-octreotate [68Ga-DOTATATE] PET/CT), and the patient received three cycles of peptide receptor radiotherapy (PRRT). Two years later, upon new progression due to the appearance of metabolically active, 68Ga-DOTATATE PET/CT-negative liver lesions, targeted treatment with everolimus was introduced. Further morphologic and metabolic progression occurred 4 months after everolimus initiation, however, this time liver lesions demonstrated increased SSTR-expression on68Ga-DOTATATE PET/CT. Thus, the patient became eligible for a second PRRT course.
Graves' disease: A rare fate of Hashimoto's thyroiditis
Authors: Jadhav Rahul , Alberawi Mohammad , Gupta Khushboo
Published: October 2020

Hashimoto's thyroiditis is a known autoimmune disorder that leads to chronic inflammation of the thyroid gland, with a gradual decline in function and eventual hypothyroidism. Conversion of Hashimoto's thyroiditis to Graves' disease is unusual clinically and has been occasionally reported in the literature. Awareness of such a rare phenomenon is important for the physicians evaluating patients with autoimmune thyroid disorders. Close investigation of the patient's symptoms and biochemical status is crucial in the implementation of appropriate treatment.
Lung cancer metastasis mimicking fingertip osteomyelitis: An 18F-fluorodeoxyglucose positron emission tomography-computed tomography study
Authors: Cottignoli Chiara , Romagnolo Cinzia , Fringuelli Fabio , Burroni Luca
Published: October 2020

Lung cancer commonly metastasizes to ipsilateral and contralateral lungs, to mediastinal lymph nodes, to skeletal level, to brain, and to adrenal gland. It is indeed very rare to find skeletal metastases at the extremities, especially at the onset of the disease. We share the case of a 53-year-old man with dyspnea and pain at the level of the first finger of the left hand under antibiotic treatment for suspected osteomyelitis. 18F-fluorodeoxyglucose positron emission tomography–computed tomography showed the presence of a left lung lesion with multiple localizations at muscles and bones.
Quantifying the survival benefit of completing all the six cycles of radium-223 therapy in patients with castrate-resistant prostate cancer with predominant bone metastases
Authors: Buscombe John , Gillett Daniel , Bird Nick , Powell Anne , Heard Sarah , Aloj Luigi
Published: October 2020

A retrospective analysis was performed of epidemiological data assessing the survival of patients who had received radium-223 for castrate-resistant metastatic prostate cancer treated at a regional tertiary referral center over a 5-year period. The patients' age, date of first treatment, and the number of cycles of radium-223 given were obtained from the patients' electronic patient record (EPR). Data on the date of death were provided by national death registrations which update the EPR via a unique national health service number. A total of 187 patients (mean age on the date of first treatment: 73 years; range: 56–93) were treated from April 1, 2014, to June 30, 2019. The median overall survival of the 119 patients (71%) who had died by December 31, 2019, was 15 months. There was no significant age difference between those who had died and survivors (72 vs. 74 years). On a further analysis, it was found that the median overall survival of the 107 patients who had received all the six cycles of radium-223 was 31 months, significantly longer than the median overall survival of only 6 months for those eighty patients who had received less than the full course of six cycles of radium-223 (P = 0.001). Of those who received all the six cycles of treatment, 58 patients had died (58%) and the 1-year survival was 87%. This was compared to the group of patients receiving <6 cycles of radium-223 where 61 patients (76%) had died and the 1-year survival was 30%. Therefore, the hazard ratio of dying before 1 year if the patient did not receive all the six cycles of treatment was 2.9. Where the reason for stopping treatment was recorded on the EPR the most common cause for the cessation of treatment was because of the side effects caused by the treatment itself. Other causes were hospitalization with comorbidities, disease progression, or patient choice. Given the survival advantage of receiving the full course of all the six cycles of treatment, this should be administered if possible and the patients should be managed in such a way as to allow the complete treatment course to be given.
Barriers to Medication Adherence among Hypertensive Patients in Deprived Rural Areas
Authors: Ebrahim Aliafsari Mamaghani  , Edris Hasanpoor  , Esmaiel Maghsoodi  , Farzaneh Soleimani
Published: October 2020

BACKGROUND: Poor adherence to medication regimen leads to poor health outcomes, increased medical costs and increased death rate due to hypertension. The aim of this study was to evaluate baseline barriers to medication adherence among hypertensive patients in deprived rural areas.METHODS: A cross-sectional study was conducted on 238 hypertensive patients living in deprived rural areas of Iran. Data were collected using a questionnaire consisting of demographic information, Morisky medication adherence scale and the barriers to medication adherence that were reliable and valid.RESULTS: The results of the study showed that medication adherence was significantly decreased and had a significant positive correlation with gender and economic status, while it had a negative correlation with age. Medication Adherence had a positive correlation with the duration of hypertension, while it had a negative correlation with the number of medications used and concurrently with other diseases.CONCLUSIONS: Based on the present study it can be concluded that enhanced knowledge about illness and treatment in rural communities is improves the medical adherence. Financial supports along with the reduced number of prescribed drugs are also found to be the determining factors in the medical adherence.
Patterns of Surgically Treated Thyroid Disease: A Two Years Review at St. Paul Hospital Millennium medical Collage, Addis Ababa, Ethiopia
Authors: Suga Yisihak , Abebe Engida
Published: October 2020

BACKGROUND: Thyroid disease is a common disorder of the endocrine system worldwide. It is a common problem in developing countries, including Ethiopia. The aim of this study was to determine the burden and the pattern of thyroid disease in St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.METHODS: A retrospective review of patients’ medical records over a two-year period, January 2013-december 2014, was done. OR log books, and individual patient medical records was used for the review. Data was analyzed with SPSS version 20.RESULTS: A total of 2201 general surgical operations were done in a two-year period. Of these, 250(11%) were for thyroid surgery. Records of 222(88.8%) patients were found and used for analysis. Females accounted for 91.4% with F: M ratio of 10.7:1. The common mode of presentations were anterior neck swelling (91.4%) and toxic (29.7%) and pressure symptoms(19.4%). The common physical findings identified were multi nodular goiter (57.2%), diffuse goiter (23.9%) and solitary nodule (5.8%). FNAC showed that Nodular colloid goiter was common diagnosis (68.5%). Neoplasms accounted for 15.9% of the diagnosis; of this follicular neoplasm make (54%) and papillary cancer (20%). Functionally, hyperthyroid goiter 28.8% and euthyroid goiters (64 %). Transient hypocalcaemia (3.2%) and hoarseness of voice (1.8%) were the commonest complications. There was no postoperative mortality.CONCLUSION: Hyperthyroidism and neoplasms make significant proportions of the patients. Follicular neoplasm is the commonest tumor. Morbidity and mortality rates are comparable to the literature.
Therapeutic Characteristics, Chemotherapy-Related Toxicities and Survivorship in Colorectal Cancer Patients
Authors: Zineb Aoullay  , Meriem Slaoui  , Rachid Razine  , Abdelouahed Er-Raki  , Bouchra Meddah  , Yahia Cherrah
Published: October 2020

BACKGROUND: Colorectal Cancer (CRC) is a major health problem around the globe. In Morocco, the disease ranks third after breast and lung cancers. This study is the first in Morocco to investigate epidemiological, clinical and therapeutic features while exhaustively describing toxic side-effects to chemotherapy of CRC and studying the 3-years survivorship.METHODS: This is a descriptive and analytical retrospective study of about 290 patients with CRC enrolled during the period of January-December 2013. Statistical analysis was performed to correlate clinicopathological data with chemotherapy toxicity and survivorship in patients, by Chi2 test. Overall Survival (OS) rate has been calculated by the Kaplan-Meier method and compared using Log-rank test.RESULTS: Fifty-five percent had a tumor localized in rectum, and 42,8% in colon. Mean age of these patients at diagnosis was 56,16 ±14,6. incidence rate of adverse events (grade I to IV) was 85,6%. Diarrhea was the predominant toxicity (4.6%) occurring at a high grade (grade III-IV). The 3-years OS rate of patients with CRC was 71%. OS decreased by age, and patients with age subgroup between 40 to 59 years had a better OS than the other age subgroups (60 to 79 years and >80 years) with a p-value of 0.0001. Occurence of toxicity (all grades and types) was linked to a higher survival rates compared to the group who had no toxicity noticed (p-value of 0.001).CONCLUSION: Our study shows that patients who had a polychemotherapy had a better OS than those who had monotherapy (p-value of 0.002).
Patient Education and Medication Adherence among Hypertensives in a Tertiary Hospital, South Western Nigeria
Authors: Ayodapo AO  , Elegbede OT  , Omosanya OE  , Monsudi KF
Published: October 2020

BACKGROUND: Hypertension is a global health issue among the adult population with high morbidity and mortality rates. Poor adherence to medication is associated with bad outcome of the disease and wastage of health resources. Therefore, this study aims to determine the role of patient education in medication adherence among hypertensives attending tertiary hospitals in Ekiti State, South Western, Nigeria.METHODS: This is a descriptive cross-sectional study involving 420 participants attending Family Medicine Department Clinic of Federal Medical Centre (FMC), Ido-Ekiti. Relevant data were collected using semi-structured questionnaire.RESULTS: The mean age of respondents was 60.97 ± 11.28 years, and a slight female preponderance (male: female = 1:1.7 over male). Three hundred and forty nine (83.1%) were married, 273(65.0%) were from a monogamous family and 375(89.2%) had family sizes of more than 4. Ninety four (22.4%) had good knowledge about hypertension, and 257(61.2%) were adherent to their medication. Increased medication adherence proportion was observed as knowledge about hypertension improves. The odds of adherence to treatment among subjects with good knowledge is 2 times (OR = 2.320, 95%CI = 1.164, 4.626) higher than among subjects with poor knowledge.CONCLUSION: The proportion of respondents with good knowledge about hypertension is low. However, the adherence among them to medication is higher and statistically significant. Patient education about the disease and its treatment by primary care physicians can help to improve adherence to medication.
A Literature Review of Placenta Accreta Spectrum Disorder: The Place of Expectant Management in Ethiopian Setup
Authors: Yifru Berhan  , Tadesse Urgie
Published: October 2020

In the last three to four decades, the increasing caesarean delivery rate has contributed to several fold increment in the incidence of placenta accreta spectrum disorders globally. Placenta accreta spectrum with its subtypes (accreta, increta and percreta) is one of the devastating obstetric complications. As a result, it is the commonest indication for peripartum hysterectomy and common cause of severe maternal morbidity. However, in recent years, there is a growing interest in and practice of expectant management either to minimize emergency hysterectomy related maternal complications or to preserve the fertility potential of a woman with an intact uterus. A large body of observational research findings has demonstrated the success rate of expectant management in many of well selected cases. Similarly, the experience on delayed hysterectomy was encouraging in order to have less hemorrhage. For the best success of placenta accreta spectrum management, multidisciplinary team approach, antenatal diagnosis and managing such cases in a hospital with center of excellence has been strongly recommended. This literature review provides a robust synthesis of up-to-date knowledge and practice on the challenges and successes of placenta accreta spectrum disorders management. The currently practiced management options in the high and middle income countries are also summarized under seven categories. Therefore, the purpose of this review was to shed light on the applicability of the PAS disorder management modalities in our setup.
Spurring the Uptake of Maternal Healthcare Services in Culturally Endowed Communities in Elgeyo Marakwet, Kenya
Authors: Cheboi Solomon Kemoi  , Kimeu Anastasiah Nyamilu Mailu  , Rucha Kenneth Kibaara
Published: October 2020

BACKGROUND: Enhancing the well-being of the mother and newborn is an explicit goal in health. Of the most legendary neglected influencer is patient centered requirement. The hope for people-oriented maternal health interventions in societies is hinged on cultural differentials therefore, contextualizing beliefs, values and expectations is important. A study to identify maternal healthcare services needs amongst women in Marakwet communities was undertaken.MATERIALS AND METHODS: This was an explorative qualitative study. A stratified list of cultural subgroups was developed and used to purposively select study participants. Twelve focus group discussions (FGDs) and fourteen key informant interviews (KIIs) were undertaken. Data was collected using semi-structured FGD and KII guides. The data was analyzed using five steps of conventional content analysis.RESULTS: The finding of the study revealed that support and care during pregnancy, labour, childbirth and postpartum are systematic defined informational, instrumental and emotional processes pivoted by individual and society pathways. Social-cultural needs include continuous pregnancy and labor care, companionship, elective delivery methods, placenta interpretation, placenta disposal, newborn celebration, privacy and mother-child welfare services. Choice of delivery assistant is a dynamic social construct informed by cultural values such as initiation, age, gender and experience. Health behavior dynamics is therefore context-dependent, embodied by social network and social support as well as psychological and physiological expectation.CONCLUSION: Women maternity needs are multiple and diverse. Adapting care to meet the contextualized individual and community needs may spur positive maternal health seeking behaviour among women and assist healthcare workers to provide culturally competent care to improve health outcomes. Educational outreach and behaviour change communications to demystify and tackle retrogressive cultural practices should be increased.
Seroprevalence and Trend of HBV, HCV, and HIV Infections among Blood Donors of Fars Province, Iran (2006-2018)
Authors: Mojtaba Azadbakht  , Masoud Torabi Ardakani  , Marziyeh Delirakbariazar  , Leila Kasraian  , Azad Khaledi  , Hossein Foruozandeh  , Alireza Salah  , Fahimeh Maleki  , Mohsen Eshraghi
Published: October 2020

BACKGROUND: Blood transfusion is a life-saving procedure; millions of lives are saved each year. However, blood transfusions are associated with certain risks that can lead to adverse consequences. This study aimed to survey the prevalence and trend of hepatitis B virus (HBV), hepatitis C virus (HCV), and Human immunodeficiency virus (HIV) among blood donors of Fars province, Iran (2006-2018).METHODS: This retrospective cross-sectional study was conducted by reviewing the records of the blood transfusion organization of Fars province. A total of 1952478 blood units were screened for transfusion-transmitted infections (TTIs). Then, data were entered into SPSS software (Negare. version 25). Chi-square test was used to compare the sof TTIs among blood donors. Chisquare test for trend was used to analyze the variations in trends of TTIs during this period. Finally, p-values less than 0.05 were considered statistically significant. GraphPad Prism software was used for the depiction of the graphs.RESULTS: Among the 1952478 blood donations within the 13-years, 4479(0.229 %) of donors were HBsAg, HCV Ab, and HIV Ag-Ab positive. The seroprevalence of HBV, HCV, and HIV was 2684(0.137%), 1703(0.087 %), and 92(0.0047%), respectively.CONCLUSION: The current study showed that the overall prevalence of TTIs among blood donors was low and had a descending trend over the years of study.
The Relationship between Patient Safety Climate and Medical Error Reporting Rate among Iranian Hospitals Using a Structural Equation Modeling
Authors: Mostefa Shahabinejad  , Hadi Khoshab  , Kazem Najafi  , Aboutalem Haghshenas
Published: October 2020

BACKGROUND: Improving patient safety is a global health imperative, and patient safety climate is one of the components one that plays an important role in promoting patient safety. Medical error reporting is a way through which it can be evaluated and prevented in the future. The aim of this study was to assess the relationship between patient safety climate and medical error reporting in military and civilian hospitals.METHODS: This research was conducted by using structural equation modeling in the selected hospitals of Iran in 2018. The study community consisted of 200 nurses in the military and 400 nurses in the civilian hospitals. By using Structural Equation Modeling, the relationship between patient safety climate and the rate of medical error reporting in the hospitals was measured by a questionnaire. Data was analyzed using SPSS 17 and LISREL 8.8 software.RESULTS: The mean score of patient safety climate was moderate in the hospitals. There was no significant relationship between the rate of medical error reporting and patient safety climate, while a significant difference was found between patient safety climate score and age, sex, job category, and type of hospital (P < 0.05).CONCLUSION: The results suggested that patient safety climate and the rate of reporting errors were not favorable in the studied hospitals, while there was a difference between safety climate dimensions.
Thyroid Hormone Tests Ordering Practice and Cost-Effectiveness in Samples Referred to International Clinical Laboratories from Addis Ababa Health Facilities
Authors: Kifle Tilahun  , Meaza Demissie  , Tamrat Bekele  , Mesfin Nigussie  , Damen H/Mariam
Published: October 2020

BACKGROUND: Thyroid dysfunction accounts for majority of endocrine disorders. In sub-Saharan Africa Graves’ disease and hypothyroidism have accounted for 13.1% and 8.8% while the burden of thyroid disorder has ranged from 6.18 to47.34% among countries in the Arab world. The cost for a primary thyroid test done to evaluate the gland function constituted a large proportion of the public health budget. For instance, 10 million thyroid functions have been done each year by laboratories which cost 30 million UK pounds, and they represent 8% of laboratory charge in the US. When a TSH-only protocol (guideline) was used, 95% of the requests were sufficient for diagnosis without requiring further tests, thereby resulting in 50% savings on FT4 reagent and reducing the annual TFT reagent cost by 25%. This is an original study, and its objective was to assess the ordering pattern of TSH tests and their cost-effectiveness in patients’ samples referred to ICL from Addis Ababa health facilities between July2015 to June 2016METHOD: An institution-based cross-sectional study design was utilized to study the ordering pattern of thyroid function tests using one-year retrospective data from ICL.RESULTS: Thyroid profiles were ordered more frequently (49.5%) compared to TSH only (24.3%). An additional 2625.70 USD was paid by patients for individual components in the profile tests that turned out normal.CONCLUSION: Guidelines advocate TSH as the initial test for thyroid dysfunction, but the use of a combination of tests is more common.
Risk Factors that Affect Morbidity and Mortality in Patients with Perforated Peptic Ulcer Diseases in a Teaching Hospital
Authors: Nebyou Seyoum  , Daba Ethicha  , Zelalem Assefa  , Berhanu Nega
Published: October 2020

Background: This study was done to identify risk factors that affect the morbidity and mortality of patients operated for a perforated peptic ulcer in a resource-limited setting.Methods: A two years (January 1, 2016 - December 30, 2018) retrospective cross- sectional study was done on patients admitted and operated for PPU at Yekatit 12 Hospital, Addis Ababa,Ethiopia.Results: A total of 93 patients were operated. The median age affected was 29 years (Range 15-75 years). Male to female ratio was 7.5:1. Chewing chat, smoking and alcohol use were seen in 22 (23.6%), 35(37.6%), and 34(36.5%), cases respectively. Only 23.6% gave previous history of dyspepsia. The median duration of illness was 48hours and the duodenal to gastric ulcer perforation ratio was 6.5:1. In majority of the cases (63.3%) the perforation diameter was <10mm (63.3%). Cellan-Jones repair of the perforations was done in 92.5% of cases. A total of 47 complications were seen in 25 cases. The total complications and mortality rates were 25(26.8%) and 6(6.5%) respectively. The most common postoperative complication was pneumonia (13.97%) followed by superficial surgical site infection (10.8%). Mortality rate was highest among patients >50yrs [AOR (95%CI) =2.4(2-30)]. Delayed presentation of >24 hours [AOR (95%CI) =4.3(1.4-13.5)] and a SBP <90mmhg [AOR (95%CI) =4.8(1-24)] were found to be significantly related with higher complication rate.Conclusions: Patients who presented early and immediate corrective measures were instituted had better outcomes while those seen late developed unfavorable out-come with significantly higher complications. Therefore, early detection and treatment of PPU is essential.
Community Perception and Attitude towards people with Depression among Adults Residing in Arba Minch Health and Demographic Surveillance Site (AM-HDSS), Southern Ethiopia
Authors: Negussie Boti  , Sultan Hussen  , Gistane Ayele  , Abera Mersha  , Selamawit Gebeyehu  , Mekidm Kassa  , Tesfaye Feleke  , Bilcha Oumer
Published: October 2020

BACKGROUND: Negative perception and attitude of community prevents many people with depression and their caregivers from seeking help and receiving adequate treatment due to fear of social reaction and may try to hide the illness. The reasons for negative attitudes are not consistent across communities or cultures. Therefore, understanding the level of community perception and attitude towards people with depression is important to develop an intervention to reduce the impact of mental illness.METHODS: A community-based cross-sectional study was conducted among 617 randomly selected adults. The data was collected using structured, pre-tested, and interviewer-administered questionnaires. Descriptive statistics like frequency, mean, and median were performed. Bi-variable and multivariable logistic regression analyses were performed to identify the factors that affect the community attitude towards people with depression.RESULTS: Of the study population, 325(52.7%) had a good perception and 246(39.9%) had a positive attitude towards people with depression. The majority of study participants frequently identified as the perceived cause of depression was substance misuse, loss of loved one, and conflict within a family. In addition, psychosocial treatment was the most preferred treatment for people with depression in the study area. Marital status and educational status were significantly associated with the community attitude towards people with depressionCONCLUSION: Giving special attention to people with substance misuse, loss of loved one, and conflict within a family is very vital for the prevention of depression. In addition, future mental health promotion activities should focus on cause and common manifestation of depression to improve the attitude toward people with depression.