bluuebunny/crossref_metadata_2025 huggingface dataset:
Autologous hematopoietic stem-cell transplant in small-sized and peripheral centers: a 10-year experiment
Authors: Choufi Bachra , Alsuliman Tamim
Published: October 2019

Background:

Along with continuing changes in therapeutic modalities, indications of autologous hematopoietic stem-cell transplantation (ASCT) have been emerging and changing considerably, especially in the era of targeted therapy and small molecule inhibitors. Patients treated with novel agents tend to have a longer survival period, thus eventually reaching higher ages at ASCT. Herein, and to address the question of ASCT outcomes in small, community-based, peripheral French centers, we report the 10-year follow-up results of 136 patients who received ASCT in our eight-bed ASCT unit, situated in an urban area.

Methods:

We retrospectively analyzed a cohort of 136 patients treated between 2008 and 2017 at the Duchenne Hospital Center. Of these 136 patients, 75 underwent ASCT for myeloma, while 61 underwent ASCT for lymphoma, amongst which 57 patients were treated for B-cell lymphoma. The median age was 65 years (range, 27–72) for myeloma patients, and 62 years (range, 27–71) for patients with lymphoma.

Results:

The cohort median follow up was estimated at 33 months; 10-year overall survival (OS) and progression-free survival (PFS) were 71% and 64% for B-cell non-Hodgkin lymphoma, and 75% and 45% for myeloma, respectively. No statistically significant differences were found for OS or 1-year PFS between patients who received ASCT from 2008 to 2012, and those who received it from 2013 to 2017.

Conclusions:

In the absence of randomized trials studying the role of center size, experience, and standardization procedure for ASCT outcome, these results may suggest that ASCT in peripheral accredited small-sized centers could be a viable option to facilitate follow up and enable access to this treatment, especially for elderly patients, in comparison with referring the patient to central large hospitals to undergo ASCT.
The updated PIM-Taiwan criteria: a list of potentially inappropriate medications in older people
Authors: Chang Chirn-Bin , Lai Hsiu-Yun , Hwang Shinn-Jang , Yang Shu-Yu , Wu Ru-Shu , Chang Lo-Yu , Lee I-Shan , Liu Hsing-Cheng , Chan Ding-Cheng
Published: October 2019

Background:

Explicit criteria for potentially inappropriate medications (PIMs) developed for other countries are difficult to apply to a specific territory. This study aimed to update the PIM-Taiwan criteria from a qualitative review of several published PIM criteria, followed by consensus among regional experts in Taiwan.

Methods:

After a review of the literature, we selected four sets of published PIM criteria to construct preliminary core PIMs. The Beers criteria, Fit fOR The Aged (FORTA), and Japan criteria were used for PIMs, without consideration of chronic diseases. The Beers criteria, Screening Tool of Older Persons’ Prescriptions (STOPP) criteria, and Japan criteria were used for PIMs with respect to chronic diseases. We asked experts ( n = 24) to rate their agreement with each statement, including in the final PIM criteria, after two rounds of modified Delphi methods. The intraclass coefficient (ICC) was used to examine the reliability of the modified Delphi method.

Results:

Overall, two categories of PIMs were established: 131 individual drugs and 9 drugs with combinations that should generally be avoided; and 9 chronic diseases with their corresponding PIMs that have drug–disease interactions. The ICC estimates for PIMs to be avoided generally were 0.634 and 0.557 (round 1 and 2) and those for PIMs with respect to chronic diseases were 0.866 and 0.775 (round 1 and 2) of the Delphi method, respectively.

Conclusions:

The 2018 version of PIM-Taiwan criteria was established and several modifications were made to keep the criteria updated and relevant. Clinicians can use them to reduce polypharmacy and PIMs among older patients.
Contributors, risk associates, and complications of frailty in patients with chronic kidney disease: a scoping review
Authors: Wu Patrick Yihong , Chao Chia-Ter , Chan Ding-Cheng , Huang Jenq-Wen , Hung Kuan-Yu
Published: October 2019

Frailty exhibits diverse influences on health-related outcomes and represents a surrogate of increased susceptibility to harmful injuries. Patients with chronic kidney disease (CKD) are at a higher risk of accelerated biologic aging, and, in this population, the concept of frailty emerges as an instrumental measurement of physiologic reserves. However, a comprehensive description of known independent contributors to, and risk associates of, frailty in these patients remain unavailable. In the present review, original studies up to 28 February 2019 that assessed frailty in patients with all stages of CKD were retrieved and reviewed, with results extracted and summarized. By pooling 62 original investigations, 58.1% and 49.1% used cohort and cross-sectional designs, respectively. Dialysis-dependent end-stage renal disease patients ( n = 39; 62.9%) were the most commonly examined population, followed by those with nondialysis CKD ( n = 12; 19.4%) and those receiving renal transplantation ( n = 11; 17.7%). Contributors to frailty in CKD patients included sociodemographic factors, smoking, CKD severity, organ-specific comorbidities, depression, hypoalbuminemia, and low testosterone levels. Conversely, the development of frailty was potentially associated with the emergence of cardiometabolic, musculoskeletal, and cerebral complications; mental distress; and a higher risk of subsequent functional and quality-of-life impairment. Moreover, frailty in CKD patients increased healthcare utilization and consistently elevated mortality among affected ones. Based on the multitude of contributors to frailty and its diverse health influences, a multifaceted approach to manage CKD patients with frailty is needed, and its potential influences on outcomes besides mortality need to be considered.
A Commentary on the Use of Simulated Settings in Business Communication Research
Authors: Du-Babcock Bertha , Chan Angela C. K.
Published: October 2019

Although there are different views toward the use of simulations for research purposes, interactional data produced in a simulated setting (simulated data) is still common in the field of business communication research. However, little research has been conducted to investigate the extent to which simulated interactional data can be used as an alternative to authentic business communication data. In this commentary, we review the controversy over the use of simulated data and discuss some contextual factors that may influence the authenticity of simulated data. We also provide suggestions for improving the compatibility of simulated data when researching business communication.
Preschool Mathematics Intervention Can Significantly Improve Student Learning Trajectories Through Elementary School
Authors: Dumas Denis , McNeish Daniel , Sarama Julie , Clements Douglas
Published: October 2019

Perhaps more than at any other time in history, the development of mathematical skill is critical for the long-term success of students. Unfortunately, on average, U.S. students lag behind their peers in other developed countries on mathematics outcomes, and within the United States, an entrenched mathematics achievement gap exists between students from more highly resourced and socially dominant groups, and minority students. To begin to remedy this situation, educational researchers have created instructional interventions designed to support the mathematical learning of young students, some of which have demonstrated efficacy at improving student mathematical skills in preschool, as compared with a business-as-usual control group. However, the degree to which these effects last or fade out in elementary school has been the subject of substantial research and debate, and differences in scholarly viewpoints have prevented researchers from making clear and consistent policy recommendations to educational decision makers and stakeholders. In this article, we use a relatively novel statistical framework, Dynamic Measurement Modeling, that takes both intra- and interindividual student differences across time into account, to demonstrate that while students who receive a short-term intervention in preschool may not differ from a control group in terms of their long-term mathematics outcomes at the end of elementary school, they do exhibit significantly steeper growth curves as they approach their eventual skill level. In addition, this significant improvement of learning rate in elementary school benefited minority (i.e., Black or Latinx) students most, highlighting the critical societal need for research-based mathematics curricula in preschool.
Developmental divergence: motor trajectories in children with fragile X syndrome with and without co-occurring autism
Authors: Will Elizabeth A. , Bishop Somer L. , Roberts Jane E.
Published: October 2019

Background

Autism spectrum disorder (ASD) is highly prevalent in fragile X syndrome (FXS), affecting 50–70% of males. Motor impairments are a shared feature across autism and FXS that may help to better characterize autism in FXS. As motor skills provide a critical foundation for various language, cognitive, and social outcomes, they may serve an important mechanistic role for autism in FXS. As such, this study aimed to identify differences in motor trajectories across direct assessment and parent-report measures of fine and gross motor development between FXS with and without autism, and typical development, while controlling for cognitive functioning.

Methods

This prospective longitudinal study included 42 children with FXS, 24 of whom also had ASD (FXS + ASD), as well as 40 typically developing children. The Mullen Scales of Early Learning provided a direct measure of fine and gross motor skills, and the Vineland Adaptive Behavior Scales provided a measure of parent-reported fine and gross motor skills. Random slopes and random intercepts multilevel models were tested to determine divergence in developmental motor trajectories between groups when controlling for cognitive level.

Results

Model results indicated the children with FXS + ASD diverged from TD children by 9-months on all measures of gross and fine motor skills, even when controlling for cognitive level. Results also indicated an early divergence in motor trajectories of fine and gross motor skills between the FXS + ASD and FXS groups when controlling for cognitive level. This divergence was statistically significant by 18 months, with the FXS + ASD showing decelerated growth in motor skills across direct observation and parent-report measures.

Conclusions

This study is the first to examine longitudinal trends in motor development in children with FXS with and without comorbid ASD using both direct assessment and parent-report measures of fine and gross motor. Furthermore, it is among the first to account for nonverbal cognitive delays, a step towards elucidating the isolated role of motor impairments in FXS with and without ASD. Findings underscore the role of motor impairments as a possible signal representing greater underlying genetic liability, or as a potential catalyst or consequence, of co-occurring autism in FXS.
Behavioural and psychological characteristics in Pitt-Hopkins syndrome: a comparison with Angelman and Cornelia de Lange syndromes
Authors: Watkins Alice , Bissell Stacey , Moss Jo , Oliver Chris , Clayton-Smith Jill , Haye Lorraine , Heald Mary , Welham Alice
Published: October 2019

Background

Pitt-Hopkins syndrome (PTHS) is a genetic neurodevelopmental disorder associated with intellectual disability. Although the genetic mechanisms underlying the disorder have been identified, description of its behavioural phenotype is in its infancy. In this study, reported behavioural and psychological characteristics of individuals with PTHS were investigated in comparison with the reported behaviour of age-matched individuals with Angelman syndrome (AS) and Cornelia de Lange syndrome (CdLS).

Methods

Questionnaire data were collected from parents/caregivers of individuals with PTHS (n = 24), assessing behaviours associated with autism spectrum disorder (ASD), sociability, mood, repetitive behaviour, sensory processing, challenging behaviours and overactivity and impulsivity. For most measures, data were compared to data for people with AS (n = 24) and CdLS (n = 24) individually matched by adaptive ability, age and sex.

Results

Individuals with PTHS evidenced significantly higher levels of difficulties with social communication and reciprocal social interaction than individuals with AS, with 21 of 22 participants with PTHS meeting criteria indicative of ASD on a screening instrument. Individuals with PTHS were reported to be less sociable with familiar and unfamiliar people than individuals with AS, but more sociable with unfamiliar people than individuals with CdLS. Data also suggested areas of atypicality in sensory experiences. Challenging behaviours were reported frequently in PTHS, with self-injury (70.8%) occurring at significantly higher rates than in AS (41.7%) and aggression (54.2%) occurring at significantly higher rates than in CdLS (25%). Individuals with PTHS also evidenced lower reported mood than individuals with AS.

Conclusions

Behaviours which may be characteristic of PTHS include those associated with ASD, including deficits in social communication and reciprocal social interaction. High rates of aggression and self-injurious behaviour compared to other genetic syndrome groups are of potential clinical significance and warrant further investigation. An atypical sensory profile may also be evident in PTHS. The specific aetiology of and relationships between different behavioural and psychological atypicalities in PTHS, and effective clinical management of these, present potential topics for future research.
Greater glucagon-like peptide-1 responses to oral glucose are associated with lower central and peripheral blood pressures
Authors: Lundgren Julie R. , Færch Kristine , Witte Daniel R. , Jonsson Anna E. , Pedersen Oluf , Hansen Torben , Lauritzen Torsten , Holst Jens J. , Vistisen Dorte , Jørgensen Marit E. , Torekov Signe S. , Johansen Nanna B.
Published: October 2019

Background and aim

Cardiovascular diseases (CVDs) are globally the leading cause of death and hypertension is a significant risk factor. Treatment with glucagon-like peptide-1 (GLP-1) receptor agonists has been associated with decreases in blood pressure and CVD risk. Our aim was to investigate the association between endogenous GLP-1 responses to oral glucose and peripheral and central haemodynamic measures in a population at risk of diabetes and CVD.

Methods

This cross-sectional study included 837 Danish individuals from the ADDITION-PRO cohort (52% men, median (interquartile range) age 65.5 (59.8 to 70.7) years, BMI 26.1 (23.4 to 28.5) kg/m2, without antihypertensive treatment and known diabetes). All participants received an oral glucose tolerance test with measurements of GLP-1 at 0, 30 and 120 min. Aortic stiffness was assessed by pulse wave velocity (PWV). The associations between GLP-1 response and central and brachial blood pressure (BP) and PWV were assessed in linear regression models adjusting for age and sex.

Results

A greater GLP-1 response was associated with lower central systolic and diastolic BP of − 1.17 mmHg (95% confidence interval (CI) − 2.07 to − 0.27 mmHg, P = 0.011) and − 0.74 mmHg (95% CI − 1.29 to − 0.18 mmHg, P = 0.009), respectively, as well as lower brachial systolic and diastolic BP of − 1.27 mmHg (95% CI − 2.20 to − 0.33 mmHg, P = 0.008) and − 1.00 (95% CI − 1.56 to − 0.44 mmHg, P = 0.001), respectively. PWV was not associated with GLP-1 release (P = 0.3). Individuals with the greatest quartile of GLP-1 response had clinically relevant lower BP measures compared to individuals with the lowest quartile of GLP-1 response (central systolic BP: − 4.94 (95% CI − 8.56 to − 1.31) mmHg, central diastolic BP: − 3.05 (95% CI − 5.29 to − 0.80) mmHg, brachial systolic BP: − 5.18 (95% CI − 8.94 to − 1.42) mmHg, and brachial diastolic BP: − 2.96 (95% CI − 5.26 to − 0.67) mmHg).

Conclusion

Greater glucose-stimulated GLP-1 responses were associated with clinically relevant lower central and peripheral blood pressures, consistent with beneficial effects on the cardiovascular system and reduced risk of CVD and mortality.

Trial registration ClinicalTrials.gov Identifier: NCT00237549. Retrospectively registered 10 October 2005
Event-specific multiplex PCR method for four genetically modified cotton varieties, and its application
Authors: Eum Soon-Jae , Kim Il Ryong , Lim Hye Song , Lee Jung Ro , Choi Wonkyun
Published: October 2019

Multiplex polymerase chain reaction (PCR) methods have been developed and validated for screening, tracing, and regulating genetically modified (GM) crops in quarantine and environmental monitoring. In this study, we aimed to develop a method to simultaneously detect four GM cotton varieties in order to establish a screening system for cotton volunteers. Based on the sequence of DNA in the junction between introduced gene and flanking genomic DNA of four GM cotton events, herbicide-tolerant MON88701 and DAS-81910-7 and insect-resistant COT102 and T304-40, event-specific primers were designed and a multiplex detection method was developed. The simplex PCR results supported the multiplex PCR results; the amplification efficiency of the novel multiplex PCR method was increased compared with that of the Joint Research Centre (JRC) method. Based on the accuracy and efficiency, the method can be applied to detect and identify randomly mixed reference materials and suspected cotton volunteers. To apply this multiplex PCR method to living modified (LM) environmental monitoring samples, we performed additional PCR analysis to identify whether the volunteers were the four LM cotton varieties. As a result, 66 cotton volunteers were identified with stack event, comprising one or two of the four LM cotton events, and all stacks have been approved in South Korea for food, feed, and processing. These results indicated that our novel multiplex method is suitable for LMO identification.
A sliding mode contact electrification based triboelectric-electromagnetic hybrid generator for small-scale biomechanical energy harvesting
Authors: Vivekananthan Venkateswaran , Kim Woo Joong , Alluri Nagamalleswara Rao , Purusothaman Yuvasree , Abisegapriyan K. S. , Kim Sang-Jae
Published: October 2019

The present work describes the hybridization of two different energy harvesters works simultaneously in a single package. By applying simultaneous mechanical force, two components such as triboelectric nanogenerator (TENG) and electromagnetic generator (EMG) independently produce power. The hybrid device was made with a polymeric cylinder composed of Kapton in the inner wall; a copper coil wound outside the cylinder and neodymium magnet and small bits of paper housed inside it. The paper flakes having the dimension of 5 mm × 5 mm, which are triboelectric positive slides over the negative triboelectric layer Kapton. The potential difference between the two different triboelectric material leads to the generation of electric power. The triboelectric component generates the maximum output with the voltage of ≈ 20 V and the current of 300 nA. The magnet inside the cylinder moves simultaneously along with the paper made the production of electric flux in the coil. The alternating magnetic flux induces the current in the outer coil as per the Lenz’s law. The maximum output generated from the EMG component with the obtained voltage of 2 V and the maximum current of 10 mA. Further, to analyze the actual working behavior of the device, commercial capacitor charging behavior was analyzed. The TENG component runs the consistent charging behavior, whereas the EMG component offers a rapid charging behavior, under hybrid mode both the merits can be utilized. The device has had placed in a backpack, and the biomechanical energy from human motions such as walking, running and jumping had been demonstrated. This study confirms that the proposed hybrid generator is capable of powering small electronic devices such as global positioning system (GPS), flashlights and potentially be able to use as an active MEMS/NEMS-based self-powered sensor.
Big data analysis and distributed deep learning for next-generation intrusion detection system optimization
Authors: Al Jallad Khloud , Aljnidi Mohamad , Desouki Mohammad Said
Published: October 2019

With the growing use of information technology in all life domains, hacking has become more negatively effective than ever before. Also with developing technologies, attacks numbers are growing exponentially every few months and become more sophisticated so that traditional IDS becomes inefficient detecting them. This paper proposes a solution to detect not only new threats with higher detection rate and lower false positive than already used IDS, but also it could detect collective and contextual security attacks. We achieve those results by using Networking Chatbot, a deep recurrent neural network: Long Short Term Memory (LSTM) on top of Apache Spark Framework that has an input of flow traffic and traffic aggregation and the output is a language of two words, normal or abnormal. We propose merging the concepts of language processing, contextual analysis, distributed deep learning, big data, anomaly detection of flow analysis. We propose a model that describes the network abstract normal behavior from a sequence of millions of packets within their context and analyzes them in near real-time to detect point, collective and contextual anomalies. Experiments are done on MAWI dataset, and it shows better detection rate not only than signature IDS, but also better than traditional anomaly IDS. The experiment shows lower false positive, higher detection rate and better point anomalies detection. As for prove of contextual and collective anomalies detection, we discuss our claim and the reason behind our hypothesis. But the experiment is done on random small subsets of the dataset because of hardware limitations, so we share experiment and our future vision thoughts as we wish that full prove will be done in future by other interested researchers who have better hardware infrastructure than ours.
Diffraction separation and imaging using multichannel singular-spectrum analysis
Authors: Lin Peng , Peng Suping , Zhao Jingtao , Cui Xiaoqin
Published: October 2019

Seismic diffractions are the responses of small-scale discontinuous structures. They contain subwavelength geologic information. Thus, diffractions can be used for high-resolution imaging. The energy of diffractions is generally much weaker than that of reflections. Therefore, diffracted energy is typically masked by specular reflected energy. Diffraction/reflection separation is a crucial preprocessing step for diffraction imaging. To resolve the diffraction-separation problem, we have developed a method based on the multichannel singular-spectrum analysis (MSSA) algorithm for diffraction separation by reflection suppression. The MSSA algorithm uses the differences in the kinematic and dynamic properties between reflections and diffractions to suppress time-linear signals (reflections) and separate weaker time-nonlinear signals (diffractions) in the common-offset or poststack domain. For the time-linear signals, the magnitudes of the singular values are proportional to the energy strength of the signals. The stronger the energy of a component of the linear signals is, the larger the corresponding singular values will be. The singular values of reflections and diffractions have dissimilar spatial distributions in the singular-value spectrum because of the differences in their linear properties and energy. Only the singular values representing diffractions are selected to reconstruct seismic signals. Synthetic data and field data are used to test our method. The results reveal the good performance of the MSSA algorithm in enhancing diffractions and suppressing reflections.
Improved well-log classification using semisupervised label propagation and self-training, with comparisons to popular supervised algorithms
Authors: Dunham Michael W. , Malcolm Alison , Kim Welford J.
Published: October 2019

Machine-learning techniques allow geoscientists to extract meaningful information from data in an automated fashion, and they are also an efficient alternative to traditional manual interpretation methods. Many geophysical problems have an abundance of unlabeled data and a paucity of labeled data, and the lithology classification of wireline data reflects this situation. Training supervised algorithms on small labeled data sets can lead to overtraining, and subsequent predictions for the numerous unlabeled data may be unstable. However, semisupervised algorithms are designed for classification problems with limited amounts of labeled data, and they are theoretically able to achieve better accuracies than supervised algorithms in these situations. We explore this hypothesis by applying two semisupervised techniques, label propagation (LP) and self-training, to a well-log data set and compare their performance to three popular supervised algorithms. LP is an established method, but our self-training method is a unique adaptation of existing implementations. The well-log data were made public through an SEG competition held in 2016. We simulate a semisupervised scenario with these data by assuming that only one of the 10 wells has labels (i.e., core samples), and our objective is to predict the labels for the remaining nine wells. We generate results from these data in two stages. The first stage is applying all the algorithms in question to the data as is (i.e., the global data), and the results from this motivate the second stage, which is applying all algorithms to the data when they are decomposed into two separate data sets. Overall, our findings suggest that LP does not outperform the supervised methods, but our self-training method coupled with LP can outperform the supervised methods by a notable margin if the assumptions of LP are met.
The Efficacy of Mitotane in Human Primary Adrenocortical Carcinoma Cultures
Authors: van Koetsveld Peter M , Creemers Sara G , Dogan Fadime , Franssen Gaston J H , de Herder Wouter W , Feelders Richard A , Hofland Leo J
Published: October 2019

Context

Patients with adrenocortical carcinoma (ACC) often fail mitotane treatment and deal with severe toxicity, marking the relevance of predictive parameters for treatment outcome.

Objective

Determine the effects of mitotane in primary ACC cultures, and correlate sensitivity with patient and tumor characteristics.

Methods

In 32 primary ACC cultures, the effects of mitotane on cell growth and cortisol production were determined. RRM1, SOAT1, and CYP2W1 expression were assessed using reverse transcription-polymerase chain reaction and immunohistochemistry.

Results

The median percentage cell amount inhibition in primary ACC cultures at 50 µM mitotane was 57%. Seven patients were classified as nonresponders, 14 as partial responders, and 11 as responders. The mean median effective concentration (EC50) value of mitotane for inhibition of cell amount in responders was 14.2 µM (95% CI, 11.3–17.9), in partial responders 41.6 µM (95% CI, 33.5–51.8), and could not be calculated in nonresponders. The percentage cortisol-producing ACC was 14%, 43%, and 73% for nonresponders, partial responders, and responders (P = 0.068). Mitotane inhibited cortisol production with a mean EC50 of 1.4 µM (95% CI, 0.9–2.1), which was considerably lower than the EC50 on cell growth. RRM1, SOAT1, and CYP2W1 expression levels were not predictive for mitotane sensitivity in vitro.

Conclusion

Direct antitumor effects of mitotane on human primary ACC cultures are highly variable between patients, reflecting heterogeneous responses in patients. Cortisol was inhibited at lower concentrations, compared with its effect on cell amount. Cortisol secretion by ACC might be associated with enhanced mitotane sensitivity due to increased direct antitumor effects of mitotane.
Progress and prospects of medical education research in Asian Countries
Authors: Meo Sultan Ayoub , Sattar Kamran , Habib ullah Chaudhary , Alnassar Sami , Hajjar Waseem , Hajjar Waseem , Usmani Adnan Mahmood
Published: October 2019

Background and Objectives: Medical education has a profound impact on health care system. Progress in achieving medical education research goals varies over time and across countries. This study aimed to investigate the medical education research ambience in Asia during the period 1965-2015.

Methods: We investigated the bibliometric indicators of 49 Asian states in medical education research from 1965-2015. The data about Asian countries, their per capita GDP, expenditure on R&D, universities and indexed scientific journals were collected. We recorded medical education related research documents published in Institute of Scientific Information (ISI) Web of Science, Thomson Reuters during the period 1965-2015.

Results: Asian countries collectively published 12721799 research articles, among them 40628 (0.31%) publications were in medical education. China contributed total of 3351565 articles among which 5414 (0.16%) research articles were in medical education; India added 1328725 papers with 4563 (0.34%) in medical education; Japan produced 3080257 papers with 4199 (0.13%) in medical education; Israel 561531 with 3848 (0.68%) in medical education; and lastly, Georgia contributed a total of 296532 research articles with 2565 (0.86%) in medical education.

Conclusions: In Asia, the top five countries in medical education research are China, Georgia, Israel, Japan and India. The countries at low ranking are Yemen, Palestine, Myanmar, Kazakhstan, Syria and Armenia. In Asian states, the overall performance in medical science research needs policies to enhance its impact globally. Medical universities should offer research programs for learning and understanding the challengeable issues in medical education research.

doi: https://doi.org/10.12669/pjms.35.6.1147

How to cite this:Meo SA, Sattar K, Habib-Ullah C, Alnassar S, Hajjar W, Usmani AM. Progress and prospects of medical education research in Asian Countries. Pak J Med Sci. 2019;35(6):1475-1481. doi: https://doi.org/10.12669/pjms.35.6.1147

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Can hematological parameters in type 2 diabetes predict microvascular complication development?
Authors: Onalan Erhan , Gozel Nevzat , Donder Emir
Published: October 2019

Objective: To examine potential associations between neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, mean platelet volume (MPV), HbA1c and microvascular complications in diabetic patients from a cost-effectiveness perspective.

Methods: One hundred patients with type 2 diabetes attending our outpatient unit between May 2018 and October 2018 were included, and 100 healthy individuals served as the control group. A retrospective file search was performed to collect information on hemoglobin, mean platelet volume (MPV), glycosylated haemoglobin (HbA1c), hematocrit (Hct), neutrophil and lymphocyte count, neutrophil/lymphocyte ratio (NLR), platelets (Plt), platelet/lymphocyte ratio (PLR), and microvascular complications (neuropathy, retinopathy, nephropathy).

Results: Demographic and laboratory data were retrospectively controlled between diabetes (n=100) and healthy control (n=100) groups. The mean age in diabetic patients and healthy controls was 56.34 and 36.68 years, respectively. The mean NLR in diabetics and healthy controls was 2.48 and 2.11, the difference in NLR being significant (p=0.002). MPV in diabetics and controls was 8.54 and 8.53, respectively, and the difference was not significant (p=0.93). PLR was also similar, i.e. 149.7 and 145.3 in diabetics and healthy controls (p=0.067). With respect to microvascular complications, retinopathy was found to be significantly associated with MPV and NLR (p=0.015, and p=0.051), and nephropathy showed a significant association with NLR (p=0.027) among diabetics. In contrast with the two other microvascular complications, no significant association between neuropathy and NLR could be detected, while PLR and neuropathy was significantly associated (p=0.003).

Conclusion: Microvascular complications may be associated with certain hematologic parameters, as suggested by comparisons both between diabetics and healthy individuals and within the group of diabetic individuals. We believe that hematologic parameters such as hematocrit, MPV, NLR, and PLR, which can be obtained through a simple complete blood count, may be utilized as cost-effective predictors of diabetic microvascular complications. Further prospective studies with larger sample size are required to better delineate these associations.

doi: https://doi.org/10.12669/pjms.35.6.1150

How to cite this:Onalan E, Gozel N, Donder E. Can hematological parameters in type 2 diabetes predict microvascular complication development? Pak J Med Sci. 2019;35(6):1511-1515. doi: https://doi.org/10.12669/pjms.35.6.1150

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conbercept and Retinal Photocoagulation in the treatment of Diabetic Macular Edema
Authors: Meng Weizhe , Li Ronghua , Xie Xiufen
Published: October 2019

Objective: To explore the clinical efficacy of intravitreal injection of conbercept in combination with retinal laser photocoagulation in the treatment of diabetic macular edema.

Methods: Ninety patients with diabetic macular edema were selected and grouped into an observation group and a control group using random number table, 45 patients (45 eyes) each group. The control group was given retinal laser photocoagulation, while the observation group was given intravitreal injection of Conbercept on the basis of panretinal photocoagulation. The Best Corrected Visual Acuity (BCVA), thickness of retinal nerve fibre layer (RNFL) and macular thickness were measured through relevant examinations before and after treatment. The intraocular pressures of patients in the two groups were evaluated, and moreover the complications were recorded.

Results: The RNFL thickness and macular thickness of the two groups had no statistically significant differences before treatment (P>0.05) and decreased significantly after treatment; the decrease amplitude of the observation group was significantly larger than that of the control group (P<0.05). The BCVA of both groups significantly increased in the 1st, 2nd and 4th week after treatment (P<0.05); the increase amplitude of BCVA of the observation group was more significant than that of the control group at different time points after treatment (P<0.05). The intraocular pressure of the observation group was not significantly different with that of the control group in the 1st, 2nd and 4th week after treatment (P>0.05). There were no severe eye complications and systemic adverse reactions in both groups in the process of follow up.

Conclusion: Intravitreal injection of conbercept in combination with retinal laser photocoagulation performs better in improving the BCVA and central macular thickness of patients with diabetic macular edema compared to retinal laser photocoagulation and has high safety.

doi: https://doi.org/10.12669/pjms.35.6.512

How to cite this:Meng W, Li R, Xie X. Conbercept and Retinal Photocoagulation in the treatment of Diabetic Macular Edema. Pak J Med Sci. 2019;35(6):1493-1498. doi: https://doi.org10.12669/pjms.35.6.512

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Clinical efficacy and tolerability of Gabapentinoids with current prescription patterns in patients with Neuropathic pain
Authors: Shaheen Abida , Alam Syed Mahboob , Ahmad Arsalan , Khan Moosa
Published: October 2019

Objective: To investigate the current dosing regimens of gabapentinoids in Pakistani patients with neuropathic pain and to compare their clinical efficacy and tolerability in terms of pain relief and adverse effects using difference in pain score as a treatment outcome.

Methods: This observational, prospective study was conducted in 320 patients with neuropathic pain from August 2016 to March 2018 at Basic Medical Sciences Institute (BMSI), Karachi in collaboration with Shifa International Hospital and Benazir Bhutto Hospital, Islamabad. Demographic data, treatment-related adverse effects and pain intensity was documented at recruitment and follow up visits at two, four and eight weeks. Discontinuation due to adverse effects and lack of efficacy were also recorded. Data was entered and analyzed using SPSS version 22.

Results: Mean age of patients was 52.57±12.47 and the most common ethnicity were Punjabi speaking population (66%). Diabetic neuropathy (51%) was the most common etiology followed by radicular pain (25%). Mean dosages of pregabalin and gabapentin were 114mg and 470mg respectively. Mean pain score was significantly reduced by gabapentinoids (<0.001). Dizziness, drowsiness and somnolence were frequent adverse effects. Common dosages for pregabalin and gabapentin were 75 mg/day and 300 mg/day respectively.

Conclusion: Current dosing regimens of gabapentinoids in Pakistani patients with neuropathic pain were found to be efficacious at low dosages in comparison to international recommended dosages. Gabapentin and pregabalin were both similar in terms of reducing pain score but onset of pain relief was relatively faster with pregabalin. Dizziness, drowsiness and somnolence were frequently reported with both gabapentinoids; however, visual blurring, ataxia and weight gain were observed only with the use of pregabalin. Adverse effects are frequently observed with gabapentinoids which necessitates reverting back to low dosages or switching to other drugs for pain relief.

doi: https://doi.org/10.12669/pjms.35.6.652

How to cite this:Shaheen A, Alam SM, Ahmad A, Khan M. Clinical efficacy and tolerability of Gabapentinoids with current prescription patterns in patients with Neuropathic pain. Pak J Med Sci. 2019;35(6):1505-1510. doi: https://doi.org/10.12669/pjms.35.6.652

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Performance of Pediatrics’ residents as clinical teachers: A student-based assessment
Authors: Afzal Muhammad Faheem , Ashraf Ali Abrar , Hanif Asif
Published: October 2019

Objective: To assess the clinical teaching skills of Pediatrics’ residents as rated by final year MBBS students by using augmented Stanford Faculty Development Program questionnaire (SFDPQ) in a teaching hospital, Lahore.

Methods: This cross- sectional survey was conducted in the Department of Pediatrics, King Edward Medical University, Lahore in six months in 2016. Total of 265 students of final year MBBS, attending the teaching sessions organized by residents during their four weeks rotation in Pediatrics were included by non-probability purposive sampling. The augmented SFDPQ was emailed to the study participants after the completion of the clinical rotation, following several encounters with the resident. The data was entered in SPSS 22 for statistical analysis. Scores for each domain (learning climate, control of session, communication of goals, promoting understanding and retention, evaluation, promoting self-directed learning, teacher’s knowledge and teacher’s attitude) were also presented as mean and standard deviation. One-sample Kolmogorov-Smirnov test was applied to observe the normality of data. Where normality of data was observed, independent sample t-test was applied and where normality of data was not observed, Mann-Whitney U test was applied to compare the score between genders. Score of four was considered as cut off score for satisfactory results.

Results: Out of 265 students, 250 responded with response rate of 94.3%. Out of 250 medical students, 105 (42.0%) were male and 145(58.0%) were female. The internal consistency (Cronbach’s alpha) of this score was excellent (0.973). The mean score for all SFDPQ domains was also sub-optimal (2.90±0.611). The mean total score was sub-optimal for learning climate (3.39±0.69), control of session (3.25±0.77), communication of goals (3.26±0.86), promoting understanding and retention (3.26±0.77), evaluation (2.25±0.67), promoting self-directed learning (3.17±0.90), teacher’s knowledge (3.14±0.93) and teacher’s attitude (3.31±0.89), while it was good only for feedback (4.03±0.11). The mean total score for all SFDPQ domains in males and females was 3.05±0.54 and 2.79±0.64 respectively. Although sub-optimal in both the genders, the score was significantly higher in males with p-value 0.001.

Conclusion: We found suboptimal clinical teaching skills of Pediatrics’ residents as rated by final year MBBS medical students.

doi: https://doi.org/10.12669/pjms.35.6.830

How to cite this:Afzal MF, Ali AA, Hanif A. Performance of Pediatrics’ residents as clinical teachers: A student-based assessment. Pak J Med Sci. 2019;35(6):1499-1504. doi: https://doi.org/10.12669/pjms.35.6.830

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Outcome of early use of non-invasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease
Authors: Ishfaq Nadia , Gul Naheed , Zaka Neelum
Published: October 2019

Objective: To determine the outcome of early use of non-invasive positive pressure ventilation (NIPPV) in Pakistani patients with acute exacerbation of chronic obstructive pulmonary disease.

Methods: This descriptive study was conducted at Shifa International Hospital Islamabad from April 2015 to January 2017. A total of 120 patients with acute exacerbation of chronic obstructive pulmonary disease receiving NIPPV alongside standard therapy were included in the study. The patients were clinically assessed before starting on NIPPV. The parameters of respiratory rate, pH and paCO2 were monitored and NIPPV was given for six hours to evaluate clinical outcomes and analyze the factors predicting failure (requirement of mechanical ventilation and mortality). Frequency and percentages were calculated for qualitative variables while Mean and Standard Deviation for quantitative variables. Chi-square and t-test were used to see differences in pre and post NIPPV arterial blood gases.

Results: Patients’ mean age was 58.88±10.09 years. Males were 88 (73.3%) and females were 32 (26.7%). The mean respiratory rate was 24±1.45 per minute before and 17.96±1.35 per minute after NIPPV (p < 0.00001). The mean pH before NIPPV was 7.27±0.04 and afterwards 7.38±0.02 (p < 0.00001). The mean pCO2 was 61.87±9.60 mm of Hg before and 57.46±6.79 mm of Hg after NIPPV (P < 0.0003). Twenty Four (20%) patients required invasive ventilation of which 19 (15.8%) patients could not survive.

Conclusions: There was remarkable improvement in the arterial blood gases after NIPPV. However, the high mortality rate and significant number of COPD patients requiring mechanical ventilation necessitates further investigation into our population.

doi: https://doi.org/10.12669/pjms.35.6.857

How to cite this:Ishfaq N, Gul N, Zaka N. Outcome of early use of non-invasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease. Pak J Med Sci. 2019;35(6):1488-1492. doi: https://doi.org/10.12669/pjms.35.6.857

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Postpartum contraception utilization and its impact on inter pregnancy interval among mothers accessing maternity services in the public sector hospital of Hyderabad Sindh
Authors: Qureshi Prof. Seema Bibi , Shoukat Dr Anila , Maroof Dr Pir , Mushraf Sara
Published: October 2019

Objective: To find out the particulars regarding contraceptive practices in the postpartum period and to see its impact on prolonging interpregnancy interval (IPI).

Methods: A cross sectional observational study was conducted in the Department of Obstetrics & Gynecology Unit 3, Liaquat University Hospital Hyderabad from 1st July to 31st December 2018. Out of 2100 total deliveries, 398 postpartum women with second or higher order births were included. Pregnant women, primiparas and those who were not willing to participate were excluded. They were interviewed face to face by principal investigator and her team members and required information was collected on predesigned Performa. Outcome variable was interpregnancy interval in months. Chi-square test was used to see association

Results: Postpartum contraception utilization (PPC) was 24.6%(n=398). Most of the women choose condoms as contraceptive method (n=41, 10.3%) followed by oral contraceptive pills (n=18, 4.5%) and intra uterine contraceptive device (n=16,4%). Method related issues were the chief reasons for discontinuation while desire to have another child soon and spouse/family disapproval were among the reasons mentioned largely by non-utilizers of modern methods of family planning. The average interpregnancy interval was 16.4±1.45. Significant association was observed between interpregnancy interval and postpartum contraception use, particularly in the users of long acting reversible contraceptive methods (P-Value 0.0001).

Conclusion: Uptake and continuation of modern methods of contraception was low after last birth culminating in short interpregnancy interval. Optimal IPI was observed in those utilizing modern methods of family planning, with marked effect in users of long acting reversible contraceptive methods.

doi: https://doi.org/10.12669/pjms.35.6.914

How to cite this:Bibi S, Shoukat A, Maroof P, Mushraf S. Postpartum contraception utilization and its impact on inter pregnancy interval among mothers accessing maternity services in the public sector hospital of Hyderabad Sindh. Pak J Med Sci. 2019;35(6):1482-1487.  doi: https://doi.org/10.12669/pjms.35.6.914

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.