bluuebunny/crossref_metadata_2025 huggingface dataset:
MTHFR and F5 genetic variations have association with preeclampsia in Pakistani patients: a case control study
Authors: Khidri Feriha Fatima , Waryah Yar Muhammad , Ali Faiza Kamran , Shaikh Hina , Ujjan Ikram Din , Waryah Ali Muhammad
Published: October 2019

Background

To study the role of single nucleotide variants (SNVs) of genes related to preeclampsia in Pakistani pregnant women.

Methods

After ethical approval and getting informed consent; 250 pregnant women were enrolled and equally divided into two groups (125 preeclamptic cases and 125 normotensive pregnant women). Demographic details and medical history were recorded, and 10 ml blood sample was obtained for DNA extraction. The tetra-primer amplification refractory mutation system (ARMS) assays were developed for assessing the variants of three preeclampsia related genes;F5,MTHFRandVEGFA. An association of six SNVs;F5:c.1601G > A (rs6025),F5:c.6665A > G (rs6027),MTHFR: c.665C > T (rs1801133),MTHFR: c.1286A > C (rs1801131),VEGFA: c.-2055A > C (rs699947) andVEGFA: c.*237C > T (rs3025039) with preeclampsia was determined by using different genetic models.

Results

Genotyping of the SNVs revealed that patients withMTHFR:c.665C > T, have increased susceptibility to preeclampsia (CT versus CC/TT: OR = 2.79, 95% CI = 1.18–6.59;P* = 0.046 and CT/TT vs CC: OR = 2.91, 95% CI = 1.29–6.57;P* = 0.0497, in overdominant and dominant models, respectively), whereasF5:c.6665A > G, (A/G vs AA/GG: OR = 0.42, 95% CI = 0.21–0.84;P* = 0.038 in overdominant model) andMTHFR:c.1286A > C, (CC versus AA: OR = 0.36, 95% CI = 0.18–0.72;P* = 0.0392 in codominant model) have significantly decreased risk for preeclampsia.F5:c.1601G > A,VEGFA: c.-2055A > CandVEGFA: c.*237C > T variants revealed no relationship with the disease.

Conclusion

This is the first case control study describing the protective role ofF5:c.6665A > G against preeclampsia in any world population. In addition, the present study confirmed the association and role ofMTHFRgene variations in the development of preeclampsia in Pakistani patients. Further genetic studies may be required to better understand the complex genetic mechanism of SNVs in preeclampsia related genes in pregnant women.
The association of dialysis adequacy, body mass index, and mortality among hemodialysis patients
Authors: Hong Woong-pyo , Lee Yu-Ji
Published: October 2019

Background

Although hemodialysis (HD) adequacy, single-pool Kt/Vurea(spKt/V), is inversely correlated with body size, each is known to affect patient survival in the same direction. Therefore, we sought to examine the relationship between HD adequacy and mortality according to body mass index (BMI) in HD patients and explore a combination effect of BMI and HD adequacy on mortality risk.

Methods

We retrospectively reviewed patient data from the Korean Society of Nephrology registry, a nationwide database of medical records of HD patients, from January 2001 to June 2017. We included patients ≥18 years old who were receiving maintenance HD. Patients were categorized into three groups according to baseline BMI (< 20 (low), 20 to < 23 (normal), and ≥ 23 (high) kg/m2). Baseline spKt/V was divided into six categories.

Results

Among 18,242 patients on HD, the median follow-up duration was 5.2 (IQR, 1.9–8.9) years. Cox regression analysis showed that, compared to the reference (spKt/V 1.2–1.4), lower and higher baseline spKt/V were associated with greater and lower risks for all-cause mortality, respectively. However, among patients with high BMI (n = 5588), the association between higher spKt/V and lower all-cause mortality was attenuated in all adjusted models (Pinteraction < 0.001). Compared to patients with normal BMI and spKt/V within the target range (1.2–1.4), those with low BMI had a higher risk for all-cause mortality at all spKt/V levels. However, the gap in mortality risk became narrower for higher values of spKt/V. Compared to patients with normal BMI and spKt/V in the target range, those with high BMI and spKt/V < 1.2 were not at increased risk for mortality despite low dialysis adequacy.

Conclusions

The association between spKt/V and mortality in HD patients may be modified by BMI.
Multiple cerebral metastases and metastatic aneurysms in patients with left atrial Myxoma: a case report
Authors: Wan Yan , Du Hai , Zhang Lei , Guo Shuang , Xu Li , Li Yuanyuan , He Hui , Zhou Lian , Chen Yunping , Mao Ling , Jin Huijuan , Hu Bo
Published: October 2019

Background

Cardiac myxoma is the most common benign cardiac tumor. Brain metastases or multiple cerebral aneurysms are extremely rare, especially for the case of both complications. Brain metastases are usually found at the same time or few months after the diagnosis or surgical removal of cardiac myxoma

Case presentation

We describe a case of patient, operated for a cardiac myxoma, who presented multiple central nervous system metastases associated, cerebral aneurysms and subsequent intracerebral hemorrhage

Conclusions

The long-term follow-up of the patients with atrial myxoma even after complete surgical excision is recommended, especially for the patient with central nervous system manifestations before atrial myxoma excision
Disrespect and abuse during facility-based childbirth in southern Mozambique: a cross-sectional study
Authors: Galle Anna , Manaharlal Helma , Cumbane Emidio , Picardo Joelma , Griffin Sally , Osman Nafissa , Roelens Kristien , Degomme Olivier
Published: October 2019

Background

Evidence suggests that many women experience mistreatment during childbirth in health facilities across the world, but the magnitude of the problem is unknown. The occurrence of disrespect and abuse (D&A) in maternity care services affects the overall quality of care and may undermine women’s trust in the health system. Studies about the occurrence of disrespect and abuse in Mozambican health facilities are scarce. The aim of this study was to explore the experience of women giving birth in hospital in different settings in Maputo City and Province, Mozambique.

Methods

A cross sectional descriptive survey was conducted between April and June 2018 in the Central Hospital of Maputo (HCM) and district hospitals of Manhiça and Marracuene, Maputo Province, Mozambique. Five hundred seventy-two exit interviews were conducted with women leaving the hospital after delivery. The questionnaire consisted of the following components: socio-demographic characteristics, the occurrence of disrespect and abuse, male involvement during labor and childbirth and intrapartum family planning counselling and provision.

Results

Prevalence of disrespect and abuse ranged from 24% in the central hospital to 80% in the district hospitals. The main types of D&A reported were lack of confidentiality/privacy, being left alone, being shouted at/scolded, and being given a treatment without permission. While very few women’s partners attended the births, the majority of women (73-80%) were in favor of involving their partner as a birth companion. Intrapartum counseling of family planning was very low (9-17%).

Conclusion

The occurrence of disrespect and abuse was much higher in the district hospitals compared to the central hospital, emphasizing the high need for interventions outside Maputo City. Allowing male partners as birth companions should be explored further, as women seem in favor of involving their partners. Investing in intrapartum counselling for family planning is currently a missed opportunity for improving the uptake of contraception in the country.
Fast-track multidisciplinary treatment versus conventional treatment for colorectal cancer: a multicenter, open-label randomized controlled study
Authors: Li Jun , Kong Xiang-Xing , Zhou Jiao-Jiao , Song Yong-Mao , Huang Xue-Feng , Li Gen-Hai , Ying Xiao-Jiang , Dai Xiao-Yu , Lu Min , Jiang Kai , Fu Dong-Liang , Li Xin-Lin , He Jin-Jie , Wang Jian-Wei , Sun Li-Feng , Xu Dong , Xu Jing-Yan , Chen Min , Tian Yu , Li Jing-Song , Yan Min , Yuan Ying , Ding Ke-Feng
Published: October 2019

Background

Laparoscopic surgery, fast-track perioperative treatment and XELOX chemotherapy are effective strategies for shortening the duration of hospital stay for cancer patients. This trial aimed to clarify the safety and efficacy of the fast-track multidisciplinary treatment (FTMDT) model compared to conventional surgery combined with chemotherapy in Chinese colorectal cancer patients.

Methods

This trial was a prospective randomized controlled study with a 2 × 2 balanced factorial design and was conducted at six hospitals. Patients in group 1 (FTMDT) received fast-track perioperative treatment and XELOX adjuvant chemotherapy. Patients in group 2 (conventional treatment) received conventional perioperative treatment and mFOLFOX6 adjuvant chemotherapy. Subgroups 1a and 2a had laparoscopic surgery and subgroups 1b and 2b had open surgery. The primary endpoint was total length of hospital stay during treatment.

Results

A total of 374 patients were randomly assigned to the four subgroups, and 342 patients were finally analyzed, including 87 patients in subgroup 1a, 85 in subgroup 1b, 86 in subgroup 2a, and 84 in subgroup 2b. The total hospital stay of group 1 was shorter than that of group 2 [13 days, (IQR, 11–17 days) vs. 23.5 days (IQR, 15–42 days), P = 0.0001]. Compared to group 2, group 1 had lower surgical costs, fewer in-hospital complications and faster recovery (all P < 0.05). Subgroup 1a showed faster surgical recovery than that of subgroup 1b (all P < 0.05). There was no difference in 5-year overall survival between groups 1 and 2 [87.1% (95% CI, 80.7–91.5%) vs. 87.1% (95% CI, 80.8–91.4%), P = 0.7420].

Conclusions

The FTMDT model, which integrates laparoscopic surgery, fast-track treatment, and XELOX chemotherapy, was the superior model for enhancing the recovery of Chinese patients with colorectal cancer.

Trial registration

ClinicalTrials.gov: NCT01080547, registered on March 4, 2010.
Lymphocyte-sparing effect of stereotactic body radiation therapy compared to conventional fractionated radiation therapy in patients with locally advanced pancreatic cancer
Authors: Wu Guangyin , Baine Michael J. , Zhao Nan , Li Sicong , Li Xiaobo , Lin Chi
Published: October 2019

Background

Conventionally fractionated (CF) radiation therapy (RT) has been associated with lymphopenia, leading to compromised overall survival (OS) in cancer patients. It currently remains unknown if stereotactic body (SB) RT induces lymphopenia to the same degree. The aim of this study is to determine if SBRT with either chemotherapy (CMT) (Fluorouracil (5FU) or capecitabine) or Nelfinavir (NFV) to pancreatic adenocarcinoma induces lymphopenia to the same degree as CFRT with 5FU or capecitabine and how any associated difference affects patient survival outcomes.

Methods

Medical records of pancreatic adenocarcinoma patients treated with induction CMT followed by RT with concurrent CMT or NFV were reviewed. Patients with total lymphocyte counts (TLCs) available both prior to and following initiation of RT were included. Three groups were identified: CFRT/CMT, SBRT/CMT, and SBRT/NFV. Median delivered RT doses for CFRT and SBRT were 50.4 Gy in 1.8 Gy fractions and 35 Gy in 7 Gy fractions, respectively. TLCs from day 0 (the first day of RT) to 40 were recorded and analyzed using the Kruskal-Wallis test with p-values adjusted with Bonferroni’s method. Linear regressions were utilized to estimate the slope of TLCs as it changes with time and survival analysis was performed via Kaplan-Meier plots.

Results

One hundred patients were identified (28 CFRT/CMT, 27 SBRT/CMT, 45 SBRT/NFV). Median pre-RT TLCs were not different among groups. Median lowest TLCs were significantly lower (p <  0.0001) and median TLCs reduction over time were significantly greater (p <  0.0001) in the CFRT group than SBRT groups. There was no difference in lowest TLCs or TLCs reduction over time between SBRT groups. Across all groups, the median time to lowest TLCs was similar. Survival analysis revealed no significant difference in median OS between SBRT and CFRT groups. However, in patients with surgery, Median OS for patients with SBRT/CMT was significantly higher than in those with SBRT/NFV (p = 0.03).

Conclusions

Compared to CFRT, SBRT is associated with less lymphopenia. Further study of the effect of radiation technique on immune status is warranted.
Inherited FGFR2 mutation in a Chinese patient with Crouzon syndrome and luxation of bulbus oculi provoked by trauma: a case report
Authors: Yang Ji , Tao Tao , Liu Hai , Hu Zhu-Lin
Published: October 2019

Background

Crouzon syndrome (CS), which results from fibroblast growth factor receptor 2 mutations, is associated with craniosynostosis, exophthalmos, and other symptoms. Herein, we report the genetic abnormalities detected in a Chinese family with autosomal dominant CS, combined with luxation of the eyeball. This luxation was a consequence of the trauma to the shallow orbits.

Case presentation

The proband was a 4-year-old boy. He accidentally fell, following which luxation of the bulbus oculi occurred immediately. Computed tomography and magnetic resonance imaging clearly revealed ocular proptosis. Upon physical examination, the proband, his father, and grandfather had ocular proptosis, shallow orbits, and mid-face hypoplasia. However, their hands and feet were clinically normal. Genomic DNA was extracted from the peripheral blood through a polymerase chain reaction performed for the target sequence. Genetic assessments revealed a heterozygous missense mutation (c.1012G > C, p.G338R) in exon 10 of the human FGFR2, cosegregated with the disease phenotype in this family. These findings confirmed the diagnosis of CS.

Discussion

CS is usually caused by FGFR2 mutations. While there are a few reports of luxation of the bulbus oculi in Chinese families with CS, the ocular proptosis, shallow orbits, combined with luxation of eyeball after trauma observed in this patient were particularly interesting. Our findings enhance the current knowledge of traumatic luxation concomitant with CS.
Immunoreactive trypsinogen levels in newborn screened infants with an inconclusive diagnosis of cystic fibrosis
Authors: Ooi Chee Y. , Sutherland Rosie , Castellani Carlo , Keenan Katherine , Boland Margaret , Reisman Joe , Bjornson Candice , Chilvers Mark A. , van Wylick Richard , Kent Steven , Price April , Mateos-Corral Dimas , Hughes Daniel , Solomon Melinda , Zuberbuhler Peter , Brusky Janna , Durie Peter R. , Ratjen Felix , Gonska Tanja
Published: October 2019

Background

Newborn screening (NBS) for cystic fibrosis (CF) not only identifies infants with a diagnosis of CF, but also those with an uncertain diagnosis of cystic fibrosis (CF), i.e. CF transmembrane conductance regulator (CFTR)-related metabolic syndrome (CRMS) or CF screen positive inconclusive diagnosis (CFSPID). These infants have an uncertain long-term outcome and it is currently unclear around time of diagnosis, which infants are at higher risk of later fulfilling a CF diagnosis. In this study, we hypothesised that immunoreactive trypsinogen (IRT) levels, used in NBS as a marker of pancreatic disease and function, may reflect the degree of CFTR dysfunction in each individual and therefore would help to identify those with CRMS/CSPID who are later at risk for meeting the criteria of CF.

Methods

In this longitudinal, prospective study, infants with CRMS/CFSPID and CF were recruited and followed in 9 CF clinics (Canada and Italy). We compared NBS IRT levels between CF and CRMS/CFSPID, and between children with CRMS/CFSPID→CF and CRMS/CFSPID→CRMS/CFSPID during the period of June 2007 to April 2016.

Results

Ninety eight CRMS/CFSPID and 120 CF subjects were enrolled. During the study period, 14 (14.3%) CRMS/CFSPID subjects fulfilled the diagnostic criteria for CF (CRMS/CFSPID→CF), while the diagnosis remained uncertain (CRMS/CFSPID→ CRMS/CFSPID) in 84 (85.7%) subjects. Significantly higher NBS IRT concentrations (ng/ml) were present in CF than CRMS/CFPSID (median (interquartile range): 143.8 (99.8–206.2) vs. 75.0 (61.0–105.9); P < 0.0001). Infants with CRMS/CFSPID→CF (n = 14) had significantly higher NBS IRT concentrations (ng/ml) than CRMS/CFSPID→ CRMS/CFSPID (n = 83) (median (interquartile range): 108.9 (72.3–126.8) vs. 73.7(60.0–96.0); P = 0.02).

Conclusions

Amongst infants who tested positive on NBS for CF, there is a gradation of elevated NBS IRT concentrations. Infants with CF have higher NBS IRT levels than CRMS/CFPSID, and higher NBS IRT concentrations were present in infants with CRMS/CFSPID→CF than CRMS/CFSPID→ CRMS/CFSPID. NBS IRT concentrations, in concert with other factors, may have the potential to predict the likelihood of CF amongst infants with CRMS/CFSPID.
Growth of HIV-uninfected children born to HIV-infected mothers in Guangdong, China: an 18-month longitudinal follow-up study
Authors: Li Bing , Tang Liu-ying , Wang Zhi-qiang , Gao Shuang , Wu Yun-tao , Xu Hao-li , Ma Yuan-zhu
Published: October 2019

Background

To evaluate the early growth (weight and length) of HIV-exposed uninfected (HEU) children from the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) program in Guangdong Province, China.

Methods

A total of 731 HEU children were longitudinally followed up at 7 time points, with anthropometric measurement conducted of weight and length (supine) in the first 18 months. Z scores were calculated, with and without adjustment for gestational age.

Results

A total of 708 HEU children were included in the final follow-up cohort, and 105 (14.83%) children completed all 7 follow-up visits. The mean of adjusted weight-for-age Z scores in these children was above zero and showed a decreasing trend in 18 months. The mean of adjusted length-for-age Z scores showed a decreasing trend and was above zero in the first 12 months; this declined to under zero at age 18 months. The proportion of underweight was 0.28–2.19% and that of stunting was 0.71–4.63% at each follow-up month-age. Slower growth in HEU children was associated with no sustained food subside after 6 month, mothers’ hemoglobin content less than 100 g/L during pregnancy, preterm birth, and low birth weight (p < 0.05).

Conclusions

HEU children could catch up to WHO growth standards in first 18 months in Guangdong; however, growth declined after 12 months, and these children need sustained nutritional support.
Surgical treatment of awn aspiration causing bronchopleural fistula and bronchiectasis: case reports
Authors: Rieth Anna , Kovács Tamás , Novák Zoltán , Kapus Katalin , Ottlakán Aurél , Németh Tibor , Furák József
Published: October 2019

Background

Aspiration of grass inflorescences is an extremely rare phenomenon with potential diagnostic difficulties. Due to its special shape, each coughing and respiratory action helps its migration towards the periphery of lung, resulting late-onset, life-threatening complications. The diagnosis has some difficulties for the reason that soon after the aspiration initial symptoms, such as coughing, wheezing or vomiting disappear and bronchoscopy is mostly negative. At least serious complications such as tension pneumothorax, bronchopleurocutaneous fistula or even spontaneous percutan elimination may develope.

Case presentation

We present two cases of pleuropneumonia resulting from aspiration of the head of barley grass. Soon after the accidents initial symptoms diminished, inflammatory markers improved and bronchoscopy was unable to confirm the presence of awn. Despite of conservative treatment (antibiotics, physiotherapy, bronchodilators, expectorants, and inhalation) localized pulmonary inflammation developed after 1 and 9 months showed up on chest computed tomography. After ineffective conservative treatment, surgical resections became inevitable in order to remove chronically inflamed parts (lobectomy, segmentectomy) and foreign bodies. Both patients recovered and were discharged home after successful interventions.

Conclusions

Due to its peculiar shape and behaviour, awn inhalation is a special and atypical form of aspiration, thus great care and awareness is needed in its treatment. Negative bronchoscopic result does not exclude the presence of bronchial grass head. Symptomless child with negative bronchoscopy and improved inflammatory markers should be followed up thoroughly to recognize late complications in time. Regular diagnostic steps (chest ultrasound/X-ray) should be performed to localize potential chronic lung inflammation. Chest computed tomography is a valuable diagnostic tool for identifying and localising the foreign body. In cases with localized inflammation and peripheric localisation, segmentectomy can be a successful and safe alternative of lobectomy.
Socio-demographic characteristics and co-occurrence of depressive symptoms with chronic diseases among older adults in China: the China longitudinal ageing social survey
Authors: Wang Zhenjie , Yang Hanmo , Guo Zhanyuan , Liu Bei , Geng Shen
Published: October 2019

Background

The aim of the current study is to assess the cross-sectional association of chronic non-communicable diseases (hypertension, diabetes mellitus, arthritis, and cerebrovascular) with depressive symptoms among older adults in China.

Methods

Data was obtained from the China Longitudinal Ageing Social Survey (CLASS) conducted in 2014. A total of 7505 participants were included. Depressive symptoms status was assessed by 9-item Center for Epidemiological Studies Depression Scale (CES-D) Associations between depressive symptoms and chronic diseases, adjusting for so, demographics and chronic diseases risk factors were assessed by using logistic regression model.

Results

We found negative associations between depressive symptoms and several socioeconomic factors, including education attainment and economic level. Widowed/divorced/ unmarried individuals are more likely to suffer from depressive symptoms. Hypertension (Odds ratio:1.29 [95%CI:1.16, 1.42]), diabetes (1.41 [95%CI:1.19,1.67]), arthritis (1.72 [1.52, 1.96]), and cerebrovascular disease (1.69 [1.41, 2.02]) were found to be associated with depressive symptoms.

Conclusions

Most depressive symptoms cases were found to be significantly associated with chronic diseases. Our findings have provided evidence for understanding co-morbid depressive symptoms with chronic diseases, which could help clinicians to evaluate, diagnose and manage depression promptly.
Physical exercise and body-mass index in young adults: a national survey of Norwegian university students
Authors: Grasdalsmoen Michael , Eriksen Hege Randi , Lønning Kari Jussie , Sivertsen Børge
Published: October 2019

Background

Physical inactivity and obesity pose a major public health challenge. The aim of this study was to describe the level of physical exercise and body-mass index in college and university students, as well as to examine potential changes from 2010 to 2018.

Methods

Data stem from the SHoT study, a national student health survey for higher education in Norway, conducted at 4-year intervals. The SHOT studies conducted so far in 2010, 2014 and 2018, included 6053, 13,525 and 50,054 fulltime students (aged 18–35), respectively. Exercise frequency (average number of times exercising each week) was assessed in all three waves, and was used for the trend analysis. The last wave in 2018 also assessed the average intensity and duration of the exercise.

Results

Overall, students exercised less in 2018 compared to 2014, but comparable to level in 2010. The prevalence of overweight increased substantially from 2010 to 2018, but especially in the last 4 years and among older female students. Less than one of four male, and one of five female students, met the recommended criteria for both exercise frequency, intensity and duration. As expected, the associations between exercise and overweight/obesity were in a dose-response manner, and strong across all three waves.

Conclusions

Our findings show that the large majority of young adults fail to meet international recommendations on exercise, and that the proportion of overweight is increasing in both genders and across all age groups. We conclude that there is an urgent need for a broad approach to achieve a paradigm shift in supporting our college and university students to become more active.
‘Teach-back’ is a simple communication tool that improves disease knowledge in people with chronic hepatitis B – a pilot randomized controlled study
Authors: Tran Sophie , Bennett Gabrielle , Richmond Jacqui , Nguyen Tin , Ryan Marno , Hong Thai , Howell Jessica , Demediuk Barbara , Desmond Paul , Bell Sally , Thompson Alexander
Published: October 2019

Background

The low diagnosis rate and poor access to clinical care among people with CHB is a major barrier to reducing HBV-related morbidity and mortality in Australia. One explanation for this is a lack of disease-specific knowledge among people living with CHB. Health literacy has been shown to be important for maximising engagement with medical care and adherence to recommended management. The ‘teach-back’ communication strategy has been shown to improve patient understanding in other clinical areas. This study aims to assess disease-specific knowledge; and evaluate the efficacy of the teach-back strategy for improving HBV knowledge, compared to a standard medical consultation.

Method

A randomized pilot study was conducted between February and June 2017. Participants were recruited from the liver clinic at an inner-city tertiary hospital. English-speaking patients aged ≥18 years and diagnosed with CHB were eligible for the study. Participants were randomised to a control group (medical specialist appointment) and intervention group (teach-back). Knowledge was assessed at baseline, immediately post-intervention and at one month using a validated questionnaire. Participants in the intervention group received a one-on-one teach-back session about CHB. The main outcome measure was a combined knowledge score of the domains assessed – transmission, natural history, epidemiology and prevention and clinical management.

Results

Seventy participants were recruited (control n = 32, teach-back n = 38). Mean baseline knowledge score was 19.1 out of 23 with 55 (79%) participants scoring ≥17.3 (defined as high knowledge) (7). Sub-analysis of CHB knowledge domains identified focal deficits concerning transmission and whether HBV is curable. Knowledge scores were found to be positively associated with English proficiency and antiviral treatment experience (p < 0.05). Teach-back was associated with a significant increase in CHB knowledge at early recall (22.5 vs 18.7, p < 0.001) and at 1-month follow-up (21.9 vs 18.7, p < 0.001); there was no improvement in CHB knowledge associated with standard clinical consultant (early recall: 19.6 vs 19.4, p = 0.49, one-month follow-up: 19.5 vs 19.4, p = 0.94).

Conclusion

In a tertiary hospital liver clinic population, baseline knowledge about CHB was good, but there were focal deficits concerning transmission and potential for cure. Teach-back was associated with improvement in CHB knowledge and it is a simple communication tool suitable for incorporation into a standard medical consultation.
Prevalence and incidence of Parkinson’s disease and drug-induced parkinsonism in Korea
Authors: Han Sola , Kim Siin , Kim Hyungtae , Shin Hae-Won , Na Kyoung-Sae , Suh Hae Sun
Published: October 2019

Background

Parkinson’s disease (PD) and drug-induced parkinsonism (DIP) are the major diseases of parkinsonism. To better understand parkinsonism, we aimed to assess the prevalence and incidence of PD and DIP in Korea from 2012 to 2015.

Methods

We used the Health Insurance Review and Assessment Service database, which covers the entire population in Korea. We used claims during 2011–2015 to assess epidemiology of PD and DIP during 2012–2015. Retrospective cross-sectional study design was employed to assess prevalence, whereas retrospective cohort study design was used to determine incidence. Patients with at least one claim with ICD-10 G20 and who received antiparkinsonian drugs for at least 60 days were classified as having PD. We excluded patients with antiparkinsonian drugs that can be used for indications other than PD. Patients with at least one claim with ICD-10 G211 or G251 during the prescription period of drugs that are frequently related with DIP were classified as having DIP. Incident cases had a disease-free period of 1 year before diagnosis. To evaluate the significance of changes in the prevalence or incidence over time, Poisson regression was used to determine p for trend.

Results

The prevalence of PD increased from 156.9 per 100,000 persons in 2012 to 181.3 per 100,000 persons in 2015 (p for trend< 0.0001). The incidence of PD decreased steadily from 35.4 per 100,000 person-years in 2012 to 33.3 per 100,000 person-years in 2015 (p for trend< 0.0001). The prevalence of DIP increased from 7.3 per 100,000 persons in 2012 to 15.4 per 100,000 persons in 2015 (p for trend< 0.0001) and the incidence of DIP increased from 7.1 per 100,000 person-years in 2012 to 13.9 per 100,000 person-years in 2015 (p for trend< 0.0001).

Conclusions

Our study suggests that the incidence of PD has gradually decreased whereas, the incidence of DIP increased from 2012 to 2015. Further studies are warranted to examine possible causes of increased DIP incidence in order to develop management strategy for parkinsonism.
Sekentei and objectively-measured physical activity among older Japanese people: a cross-sectional analysis from the NEIGE study
Authors: Murayama Hiroshi , Amagasa Shiho , Inoue Shigeru , Fujiwara Takeo , Shobugawa Yugo
Published: October 2019

Background

The concept of sekentei (social appearance), defined as sensitivity about one’s reputation, reflects Japanese behavioral principles and involves pressure to conform to social norms, particularly among people living in rural areas. However, data regarding the relationship between sekentei and health behaviors are sparse. In this study, we examined the relationship between sekentei and objectively-measured physical activity among community-dwelling older people in Japan.

Methods

We used data from the Neuron to Environmental Impact across Generations Study (NEIGE Study), which is a prospective cohort study of randomly-sampled community-dwelling individuals aged 65–84 years living in Tokamachi City, Niigata Prefecture, Japan. The baseline survey was conducted in 2017 and included 527 independent older people. We analyzed the baseline data cross-sectionally. To measure activity behaviors, participants wore a tri-axial accelerometer for seven consecutive days. Physically active individuals were defined based on the World Health Organization recommendation guidelines on physical activity. Sekentei was measured using the 12-item Sekentei Scale (score range: 12–60).

Results

After excluding 15 people for whom we had three or fewer days of valid accelerometer-assessed activity data, we used data from 512 participants in our analysis (average 73.4 years old; 46.9% men). Physically active individuals made up 22.3% of the sample, and the proportion of physically active men was higher than that of women. A logistic regression analysis showed that higher levels of sekentei were inversely associated with physical activity after adjusting for demographic factors, socioeconomic status, and health conditions (odds ratio [95% confidence interval]: 0.58 [0.36–0.91] for every 10-point increase in the Sekentei Scale score). This association was stronger in women than in men (0.66 [0.34–1.26] for men and 0.51 [0.26–1.00] for women).

Conclusions

Our findings indicate that an individual’s sense of sekentei may be an important socio-cultural factor affecting their level of physical activity. Culturally appropriate approaches may be beneficial in addressing insufficient physical activity in older adults.
Incidence and etiology of infectious diarrhea from a facility-based surveillance system in Guatemala, 2008–2012
Authors: Arvelo Wences , Hall Aron J. , Henao Olga , Lopez Beatriz , Bernart Chris , Moir Juan C. , Reyes Lissette , Montgomery Susan P. , Morgan Oliver , Estevez Alejandra , Parsons Michele B. , Lopez Maria R. , Gomez Gerry , Vinje Jan , Gregoricus Nicole , Parashar Umesh , Mintz Eric D. , McCracken John , Bryan Joe P. , Lindblade Kim A.
Published: October 2019

Background

Diarrhea is a major cause of morbidity and mortality, yet incidence and etiology data are limited. We conducted laboratory-based diarrhea surveillance in Guatemala.

Methods

A diarrhea case was defined as ≥3 loose stools in a 24-h period in a person presenting to the surveillance facilities. Epidemiologic data and stool specimens were collected. Specimens were tested for bacterial, parasitic, and viral pathogens. Yearly incidence was adjusted for healthcare seeking behaviors determined from a household survey conducted in the surveillance catchment area.

Results

From November 2008 to December 2012, the surveillance system captured 5331 diarrhea cases; among these 1381 (26%) had specimens tested for all enteric pathogens of interest. The adjusted incidence averaged 659 diarrhea cases per 10,000 persons per year, and was highest among children aged < 5 years, averaging 1584 cases per 10,000 children per year. Among 1381 (26%) specimens tested for all the pathogens of interest, 235 (17%) had a viral etiology, 275 (20%) had a bacterial, 50 (4%) had parasites, and 86 (6%) had co-infections. Among 827 (60%) specimens from children aged < 5 years, a virus was identified in 196 (23%) patients; 165 (20%) had norovirus and 99 (12%) rotavirus, including co-infections. Among 554 patients aged ≥5 years, 103 (19%) had a bacterial etiology, including diarrheagenic Escherichia coli in 94 (17%) cases, Shigella spp. in 31 (6%), Campylobacter spp. in 5 (1%), and Salmonella spp. in 4 (1%) cases. Detection of Giardia and Cryptosporidium was infrequent (73 cases; 5%).

Conclusions

There was a substantial burden of viral and bacterial diarrheal diseases in Guatemala, highlighting the importance of strengthening laboratory capacity for rapid detection and control and for evaluation of public health interventions.
Management and outcome of pelvic fracture associated with vaginal injuries: a retrospective study of 25 cases
Authors: Li Pengyu , Zhou Dongsheng , Fu Baisheng , Song Wenhao , Dong Jinlei
Published: October 2019

Background

Pelvic ring fractures associated with vaginal injuries were rarely reported due to low incidence. The displaced segments of pelvic ring may increase the risk of vaginal injury. The aim of this retrospective study was to evaluate the correlation between pelvic fracture and vaginal injury.

Methods

We conducted a retrospective review of 25 patients with pelvic fractures associated with vaginal injury treated at our institution. The medical records of these patients were collected and 24 patients were followed-up for 10–36 months.

Results

All patients suffered anterior pelvic ring fracture. Young-Burgess fracture classification and compromised pubic symphysis were related to severity of vaginal injury. Gauze packing was done in 6 patients and 18 patients received surgical repair. Infection occurred in 6 patients, among them 4 were due to delayed diagnosis. Factors associated with pelvic outcome were age, urethral injury, and infection. Four patients suffered pain in sexual intercourse but no influence factor found correlated to sexual function.

Conclusion

VS type pelvic fracture and compromised pubic symphysis were related to higher severity of vaginal injury. Disruption of anterior ring and an unstable pelvic ring caused by forces on coronary and axial plane may increase the risk of vaginal injury.

Trial registration

ChiCTR1900020540. Registered 28 January 2019. Retrospectively registered. Trial registry: Chinese Clinical Trial Registry.
Dual graft living donor liver transplantation – a case report
Authors: Vinayak Nikam , Ravi Mohanka , Ankush Golhar , Rashmi Bhade , Prashantha Rao , Parul Gadre , Anurag Shrimal
Published: October 2019

Background

Living donor liver transplantation (LDLT) has emerged as an equally viable option to deceased donor liver transplant for treating end stage liver disease patients. Optimising the recipient outcome without compromising donor safety is the primary goal of LDLT. Achieving the adequate graft to recipient weight ratio (GRWR) is important to prevent small for size syndrome which is an uncommon but potentially lethal complication of LDLT.

Case presentation

Here we describe a case of successful dual lobe liver transplant for a 32 years old patient with ethanol related end stage liver disease. A right lobe graft without middle hepatic vein and another left lateral sector graft were transplanted successfully. Recipient and both donors recovered uneventfully.

Conclusion

Dual lobe liver transplant is a feasible strategy to achieve adequate GRWR without compromising donor safety.
Surgical management of pyelo-ureteral junction syndrome in a resource-limited setting: case of Zinder National Hospital, Niger
Authors: Adamou Harissou , Amadou Magagi Ibrahim , Halidou Maazou , Diongolé Hassane , Doutchi Mahamadou , Habou Oumarou , Ganiou Kabirou , Soumana Amadou , Sani Rachid
Published: October 2019

Background

Pyelo-ureteral junction syndrome (PUJS) is a frequent congenital malformation. We report the surgical management of PUJS by pyeloplasty according to Anderson-Hyne-Kuss’s procedure at the Zinder National Hospital..

Methods

This was a retrospective study from January 2013 to December 2016 (4 years), including patients who have undergone surgery for PUJS.

Results

Twelve (12) cases of PUJS had a surgery among which 66.7% were men with an average age of 32.5 ± 7.6 years. The clinical symptomatology was lumbar pain or renal colic in 92.3% of cases. This pain had evolved for more than 2 years for 58.3% of the cases. Ultrasound coupled with intravenous urography or CT-scan was performed to confirm the diagnosis of PUJS in 58.3 and 41.7% of cases. The average serum creatinine level at admission was 181.25 ± 67.3 μmol/L [Lab reference range: 53–97 μmol/L]. The Anderson-Hynes non dismembered pyeloplasty is used for all the patients. The release of a crossing lower pole vessel was performed in 25%, pyelolithotomy in 16.7%. The average surgery time was 118.3 ± 20.7 min. The average hospital length of stay was 10.8 ± 3 days. Immediate postoperative complications were recorded in 33.3% (n = 4). Postoperative outcomes were considered good by disappearance of clinical, biological and radiological signs.

Conclusion

The Anderson-Hynes non dismembered pyeloplasty gives good results and provides a successful alternative in an environment where laparoscopy and robotic surgery are not developed.
Laparoscopically excised retroperitoneal presacral Schwannoma: atypical pre and postoperative manifestations – case report
Authors: Carvalho Bárbara Justo , de Almeida Medeiros Kayo Augusto , Martines Diego Ramos , Nii Fernanda , Pipek Leonardo Zumerkorn , de Mesquita Gustavo Heluani Antunes , D’Albuquerque Luiz Augusto Carneiro , Meyer Alberto , Andraus Wellington
Published: October 2019

Background

We are a reporting a rare case of retroperitoneal schwanomma with atypical pre and postoperative manifestations. Retroperitoneal schwannomas are rare tumors that are difficult to preoperatively diagnose.

Case presentation

This is a case report of a male patient, 41 years old, with symptoms of hipogastric and lower right member pain, as well as a history of a papilliferous thyroid tumor. Computerized tomography exams were inconclusive, showing a mass in the presacral region with dimensions of 4.4 × 3.9 × 3.4 cm. Removal was carried out by laparoscopic surgery, with self-limited postoperative complications. Diagnosis was carried out by anatomopathological examination, and syndromic hypotheses were discarded.

Conclusions

The postoperative complications of schwanomma are little reported in the literature. In the simultaneous occurrence of schwanomma and other endocrine tumors, further studies are warranted to better differentiate the cases that need investigation of syndromic causes.
Safety and efficacy of Holmium laser enucleation of the prostate (HoLEP) in patients with previous transperineal biopsy (TPB): outcomes from a dual-centre case-control study
Authors: Bell Chris , Moore Sacha L. , Gill Amarit , Obi-Njoku Obinna , Hughes Stephen F. , Saleemi Asad , Ellis Gidon , Khan Farooq , Shergill Iqbal S.
Published: October 2019

Background

We investigated the surgical feasibility, safety and effectiveness of 50 W (low power) Holmium Laser enucleation of the prostate (HoLEP) in patients who have undergone previous template biopsy of the prostate (TPB).

Methods

Data encompassing pre-operative baseline characteristics, intra-operative measures and post-operative outcomes was collected for 109 patients undergoing HoLEP across two UK centres. Patients were stratified into two groups; group 1 (n = 24) had undergone previous TPB were compared with ‘controls’ (no previous TPB) in group 2 (n = 85). The primary outcome was successful HoLEP.

Results

There were no statistically significant differences in either key baseline characteristics or mass of prostate enucleated between groups 1 and 2. There was no statistically significant difference in enucleation or morcellation times parameters between the two groups other than enucleation efficiency in favour of group 1 (p = 0.024). Functional outcomes improved, without any statistically significant difference, in both groups.

Conclusions

In patients with a previous TPB, HoLEP is surgically feasible, safe and effective. TPB should not be considered a contraindication to HoLEP. Our work provides a strong foundation for further research in this area.
Barriers and facilitators to weight management in overweight and obese women living in Australia with PCOS: a qualitative study
Authors: Lim Siew , Smith Caroline A. , Costello Michael F. , MacMillan Freya , Moran Lisa , Ee Carolyn
Published: October 2019

Background

Lifestyle modification targeting weight management is the first-line treatment for women with Polycystic Ovary Syndrome (PCOS) regardless of presenting symptoms. Women with PCOS are more likely to gain more weight compared with women without PCOS, which may be related to barriers in engaging in lifestyle modification. The aim of this study is to explore the experience of women with PCOS in weight management and to determine the facilitators and barriers to lifestyle modifications in women with PCOS.

Methods

Ten women with PCOS participated in focus groups and semi-structured telephone interviews on lifestyle and weight management in PCOS. Discussions were audio-recorded and transcribed verbatim. Thematic analysis of the transcripts was conducted. Thematic analysis of the transcripts were conducted using the method of constant comparison.

Results

Women in the current study attempted a wide range of weight loss interventions, but had difficulties losing weight and preventing weight regain. Women felt that having PCOS affected their ability to lose weight and to keep it off. Facilitators to lifestyle modification for weight management were reported as structured approaches such as having balanced meals and support by health professionals, peers, friends or family. Barriers to lifestyle changes in women with PCOS included logistical barriers such as time and cost, motivational barriers including tiredness or feeling unrewarded, environmental barriers such as not having access to safe places to exercise, emotional barriers such as having depressive and defeating thoughts, and relational barriers such as having unsupportive partner or prioritising children’s meal preferences.

Conclusions

Women with PCOS face a number of personal, environmental and social facilitators and barriers to lifestyle modification for weight loss. While many of these are also experienced by women without PCOS, women with PCOS face additional barriers in having low sense of self-confidence and high prevalence of negative thoughts which may impair their ability to maintain efforts in lifestyle modification over the long term. Future research should further explore the impact of the emotional and mental burden of PCOS on the management of weight and other aspects of PCOS. Future lifestyle intervention should also address the psychosocial aspect of PCOS.
Image quality to estimate ventricular ejection fraction by last year medical students improves after short courses of training
Authors: Hüppe Tobias , Groesdonk Heinrich Volker , Volk Thomas , Wagenpfeil Stefan , Wallrich Benedict
Published: October 2019

Background

Transthoracic echocardiography is the primary imaging modality for diagnosing cardiac conditions but medical education in this field is limited. We tested the hypothesis that a structured theoretical and supervised practical course of training in focused echocardiography in last year medical students results in a more accurate assessment and more precise calculation of left ventricular ejection fraction after ten patient examinations.

Methods

After a theoretical introduction course 25 last year medical students performed ten transthoracic echocardiographic examination blocks in postsurgical patients. Left ventricular function was evaluated both with an eye-balling method and with the calculated ejection fraction using diameter and area of left ventricles. Each examination block was controlled by a certified and blinded tutor. Bias and precision of measurements were assessed with Bland and Altman method.

Results

Using the eye-balling method students agreed with the tutor’s findings both at the beginning (88%) but more at the end of the course (95.7%). The variation between student and tutor for calculation of area, diameter and ejection fraction, respectively, was significantly lower in examination block 10 than in examination block 1 (each p < 0.001). Students underestimated both the length and the area of the left ventricle at the outset, as complete imaging of the left heart in the ultrasound sector was initially unsuccessful.

Conclusions

A structured theoretical and practical transthoracic echocardiography course of training for last year medical students provides a clear and measurable learning experience in assessing and measuring left ventricular function. At least 14 examination blocks are necessary to achieve 90% agreement of correct determination of the ejection fraction.