bluuebunny/crossref_metadata_2025 huggingface dataset:
Recent advances in the diagnosis of intestinal tuberculosis
Authors: Maulahela Hasan , Simadibrata Marcellus , Nelwan Erni Juwita , Rahadiani Nur , Renesteen Editha , Suwarti S. W. T. , Anggraini Yunita Windi
Published: March 2022

Background

Intestinal tuberculosis still has a high incidence, especially in developing countries. The biggest challenge of this disease is the establishment of the diagnosis because the clinical features are not typical. Investigations such as culture, acid-fast bacilli (AFB) staining, and histopathology have low sensitivity, so other investigations are needed. Latest molecular-based diagnostic modalities such as GeneXpert, interferon-gamma (IFN-γ) release assays (IGRA), polymerase chain reaction (PCR), multiplex-PCR, and immunological markers are expected to help diagnose intestinal tuberculosis. This article review will examine the latest diagnostic modalities that can be used as a tool in establishing the diagnosis of intestinal tuberculosis.

Results

Through a literature search, we were able to review the diagnostic values of various available diagnostic modalities as the appropriate additional test in intestinal tuberculosis. Culture as a gold standard has a sensitivity and specificity value of 9.3% and 100% with the MGIT BACTEC system as the most recommended medium. The sensitivity values of AFB staining, histopathology examination, GeneXpert, IGRA, PCR, multiplex-PCR and, immunological markers were ranged between 17.3 and 31%; 68%; 81–95.7%; 74–88%; 21.6–65%; 75.7–93.1%; and 52–87%, respectively. Meanwhile the specificity values were 100%; 77.1%; 91–100%; 74–87%; 93–100%; 96.4–100%; and 70–95%, respectively.

Conclusion

The combination of clinical examination, conventional examination, and the latest molecular-based examination is the best choice for establishing the diagnosis of intestinal tuberculosis. Most recent modalities such as multiplex PCR and immunological marker examinations are diagnostic tools that deserve to be used in diagnosing intestinal tuberculosis as their sensitivity and specificity values are quite high and more evidences are expected to support the application of these examinations shortly soon.
Point-of-care urine Gram stain led to narrower-spectrum antimicrobial selection for febrile urinary tract infection in adolescents and adults
Authors: Taniguchi Tomohiro , Tsuha Sanefumi , Shiiki Soichi , Narita Masashi
Published: March 2022

Background

Febrile urinary tract infections (fUTIs), which include pyelonephritis, prostatitis, and urosepsis, are the most common cause of sepsis. However, the treatment has become more complex because of the worldwide increase in antimicrobial resistance (AMR). The objective of this study was to clarify whether point-of-care Gram stain (PCGS) of urine contributed to fUTI diagnosis and treatment in adults.

Methods

This hospital-based observational study was undertaken between January 2013 and March 2015 in Okinawa, Japan. All enrolled patients were adults who had been admitted to the Division of Infectious Diseases with suspected fUTI. The usefulness of PCGS results were compared for urinalysis (U/A) and urine cultures (U/Cs). The targeted therapy type and its susceptibility based on PCGS were analyzed, and each was investigated in two groups: the uncomplicated pyelonephritis group and the complicated pyelonephritis/prostatitis group.

Results

Two hundred and sixty-six patients were enrolled. The results of PCGS were closely correlated with those of U/A for pyuria and bacteriuria, and moderately correlated with the results of U/C for bacterial types. In the uncomplicated group, narrow-spectrum antimicrobials such as cefotiam were initially selected in 97.9% (47/48) of patients, and their susceptibility was 97.9% (47/48). In the complicated group, the susceptibility was 84.2% (186/221) (p = 0.009) despite frequent AMRs (14.7%; 32/218) and low use of broad-spectrum antimicrobials such as carbapenems (7.7%; 17/221).

Conclusion

Urine PCGS led to a more precise fUTI diagnosis and prompted clinicians to select narrower-spectrum antibiotics with high susceptibility.
A novel adaptive momentum method for medical image classification using convolutional neural network
Authors: Aytaç Utku Can , Güneş Ali , Ajlouni Naim
Published: March 2022

Background

AI for medical diagnosis has made a tremendous impact by applying convolutional neural networks (CNNs) to medical image classification and momentum plays an essential role in stochastic gradient optimization algorithms for accelerating or improving training convolutional neural networks. In traditional optimizers in CNNs, the momentum is usually weighted by a constant. However, tuning hyperparameters for momentum can be computationally complex. In this paper, we propose a novel adaptive momentum for fast and stable convergence.

Method

Applying adaptive momentum rate proposes increasing or decreasing based on every epoch's error changes, and it eliminates the need for momentum hyperparameter optimization. We tested the proposed method with 3 different datasets: REMBRANDT Brain Cancer, NIH Chest X-ray, COVID-19 CT scan. We compared the performance of a novel adaptive momentum optimizer with Stochastic gradient descent (SGD) and other adaptive optimizers such as Adam and RMSprop.

Results

Proposed method improves SGD performance by reducing classification error from 6.12 to 5.44%, and it achieved the lowest error and highest accuracy compared with other optimizers. To strengthen the outcomes of this study, we investigated the performance comparison for the state-of-the-art CNN architectures with adaptive momentum. The results shows that the proposed method achieved the highest with 95% compared to state-of-the-art CNN architectures while using the same dataset. The proposed method improves convergence performance by reducing classification error and achieves high accuracy compared with other optimizers.
Adherence to treatment for hypothyroidism in pregnancy and relationship with thyrotropin control: a retrospective observational cohort study
Authors: Siscart Júlia , Orós Míriam , Serna M. Catalina , Perejón Dani , Galván Leonardo , Ortega Marta
Published: March 2022

Background

Hypothyroidism is the second most common endocrinological disease during pregnancy, with percentages that can range between 3.2 and 5.5%. A good maternal and foetal health outcome depends on thyroid hormone replacement therapy. The goal of such therapy is to maintain thyrotropin (TSH) in a range that is specific for pregnant women and varies between the trimesters of pregnancy. In our study, we wanted to analyse the adherence to hypothyroidism treatment among pregnant women and to evaluate the degree of control of the disease.

Methods

We performed a retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Therapeutic adherence was analysed by the proportion of days covered (PDC). The relationship with other variables was assessed using the regression coefficients and their 95% confidence interval (CI).

Results

We examined a sample of 17,281 women, representing more than 92% of the pregnant women in the Lleida health region in the period analysed. Among this sample, the mean prevalence of hypothyroidism was 6.52% (0.07% clinical and 6.45% subclinical). 3.3% of the 17,281 pregnant women were treated. Among them, the mean adherence score was 79.6 ± 22.2. Of these, 54% presented high adherence. The latter had a higher mean age and better TSH control, in comparison to the ones showing low adherence.

Conclusions

Half of the treated patients had good adherence to treatment and a better TSH control, in comparison to the others. Most of them achieved a good control at the third trimester of pregnancy.
Measurement invariance of the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) across four European countries during the COVID-19 pandemic
Authors: Shevlin Mark , Butter Sarah , McBride Orla , Murphy Jamie , Gibson-Miller Jilly , Hartman Todd K. , Levita Liat , Mason Liam , Martinez Anton P. , McKay Ryan , Stocks Thomas VA , Bennett Kate M , Hyland Philip , Vallieres Frédérique , Valiente Carmen , Vazquez Carmelo , Contreras Alba , Peinado Vanesa , Trucharte Almudena , Bertamini Marco , Panzeri Anna , Bruno Giovanni , Granziol Umberto , Mignemi Giuseppe , Spoto Andrea , Vidotto Giulio , Bentall Richard P.
Published: March 2022

Background

The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) are self-report measures of major depressive disorder and generalised anxiety disorder. The primary aim of this study was to test for differential item functioning (DIF) on the PHQ-9 and GAD-7 items based on age, sex (males and females), and country.

Method

Data from nationally representative surveys in UK, Ireland, Spain, and Italy (combined N = 6,054) were used to fit confirmatory factor analytic and multiple-indictor multiple-causes models.

Results

Spain and Italy had higher latent variable means than the UK and Ireland for both anxiety and depression, but there was no evidence for differential items functioning.

Conclusions

The PHQ-9 and GAD-7 scores were found to be unidimensional, reliable, and largely free of DIF in data from four large nationally representative samples of the general population in the UK, Ireland, Italy and Spain.
Suicide rate and social environment characteristics in South Korea: the roles of socioeconomic, demographic, urbanicity, general health behaviors, and other environmental factors on suicide rate
Authors: Jang Hyemin , Lee Whanhee , Kim Yong-ook , Kim Ho
Published: March 2022

Background

Suicide is a serious worldwide public health concern, and South Korea has shown the highest suicide rate among Organisation for Economic Co-operation and Development (OECD) countries since 2003. Nevertheless, most previous Korean studies on suicide had limitations in investigating various social environment factors using long-term nationwide data. Thus, this study examined how various social environment characteristics are related to the suicide rate at the district-level, using nationwide longitudinal data over 11 years.

Methods

We used the district-level age-standardized suicide rate and a total of 12 annual social environment characteristics that represented socioeconomic, demographic, urbanicity, general health behaviors, and other environmental characteristics from 229 administrative districts in South Korea. A Bayesian hierarchical model with integrated Laplace approximations (INLA) was used to examine the spatiotemporal association between the rate of suicide and the social environment indicators selected for the study.

Results

In the total population, the indicators “% of population aged 65 and older eligible for the basic pension”, “% vacant houses in the area”, “% divorce”, “% single elderly households”, “% detached houses”, “% current smokers”, and “% of population with obesity” showed positive associations with the suicide rate. In contrast, “% of people who regularly participated in religious activities” showed negative associations with suicide rate. The associations between these social environment characteristics and suicide rate were generally more statistically significant in males and more urbanized areas, than in females and less urbanized areas; however, associations differed amongst age groups, depending on the social environment characteristic variable under study.

Conclusions

This study investigated the complex role of social environments on suicide rate in South Korea and revealed that higher suicide rates were associated with lower values of socioeconomic status, physical exercise, and religious activities, and with higher social isolation and smoking practice. Our results can be used in the development of targeted suicide prevention policies.
“It’s okay to not know …” a qualitative exploration of faculty approaches to working with uncertainty
Authors: Moffett Jenny , Armitage-Chan Elizabeth , Hammond Jennifer , Kelly Síle , Pawlikowska Teresa
Published: March 2022

Background

Whilst it is recognised that a capacity to manage uncertainty is an essential aspect of working as a healthcare professional, there is little clear guidance on how to facilitate student learning in this domain. A lack of faculty development opportunities also suggests that health professions’ educators may feel ill-equipped to assist students in developing effective approaches to uncertainty. The purpose of this study was to explore a faculty development intervention designed to help educators unpack students’ experiences of uncertainty, and identify attributes which may help students to manage uncertain situations.

Methods

This qualitative study was informed by a constructivist methodological approach, where participants were encouraged to share meaning around the nature of uncertainty in health professions’ education. Two 90-min faculty development sessions were held. These sessions invited participants to apply Han et al.’s taxonomy of uncertainty to role-played scenarios of student uncertainty within a focus group setting. Focus group data were collected, and examined using a two-stage, hybrid approach of deductive and inductive thematic analysis.

Results

Han et al.’s taxonomy helped participants to identify multiple sources and issues of uncertainty in the role played scenarios, thus unveiling the extent of uncertainties encountered by health professions’ learners. Data analysis revealed four themes overall: “Sources of uncertainty”, “Issues of uncertainty”, “Uncertainty attributes”, and “Learning environment.” Participants also contributed to a list of attributes which they considered helpful to undergraduate health professions’ students in managing uncertain situations. These included an awareness of the nature of uncertainty within healthcare practice, an ability to recognise uncertainty, and adopting attitudes of adaptability, positivity, and resilience.

Conclusions

This study highlights the successful use of Han et al.’s taxonomy of uncertainty within a faculty development setting. Our findings suggest that the taxonomy is a practical and versatile tool that health professions’ educators can use in shared reflections and conversations around uncertainty with students or colleagues.
Designing and conducting initial application of a performance assessment model for in-hospital trauma care
Authors: Mousazadeh Yalda , Sadeghi-Bazargani Homayoun , Janati Ali , Pouraghaei Mahboub , Rahmani Farzad , sokhanvar Mobin
Published: March 2022

Background

Trauma is a major cause of death worldwide, especially in Low and Middle-Income Countries (LMIC). The increase in health care costs and the differences in the quality of provided services indicates the need for trauma care evaluation. This study was done to develop and use a performance assessment model for in-hospital trauma care focusing on traffic injures.

Methods

This multi-method study was conducted in three main phases of determining indicators, model development, and model application. Trauma care performance indicators were extracted through literature review and confirmed using a two-round Delphi survey and experts’ perspectives. Two focus group discussions and 16 semi-structured interviews were conducted to design the prototype. In the next step, components and the final form of the model were confirmed following pre-determined factors, including importance and necessity, simplicity, clarity, and relevance. Finally, the model was tested by applying it in a trauma center.

Results

A total of 50 trauma care indicators were approved after reviewing the literature and obtaining the experts’ views. The final model consisted of six components of assessment level, teams, methods, scheduling, frequency, and data source. The model application revealed problems of a selected trauma center in terms of information recording, patient deposition, some clinical services, waiting time for deposit, recording medical errors and complications, patient follow-up, and patient satisfaction.

Conclusion

Performance assessment with an appropriate model can identify deficiencies and failures of services provided in trauma centers. Understanding the current situation is one of the main requirements for designing any quality improvement programs.
Mobile-Health based physical activities co-production policies towards cardiovascular diseases prevention: findings from a mixed-method systematic review
Authors: Palozzi Gabriele , Antonucci Gianluca
Published: March 2022

Background

Cardiovascular disease (CVD) is the first cause of death globally, with huge costs worldwide. Most cases of CVD could be prevented by addressing behavioural risk factors. Among these factors, there is physical and amateur sports activity (PASA), which has a linear negative correlation with the risk of CVD. Nevertheless, attempts to encourage PASA, as exercise prescription programmes, achieved little impact at the community-wide level. A new frontier to promote PASA is represented by mobile health tools, such as exergaming, mobile device apps, health wearables, GPS/GIS and virtual reality. Nevertheless, there has not yet been any evident turnabout in patient active involvement towards CVD prevention, and inactivity rates are even increasing. This study aims at framing the state of the art of the literature about the use of m-health in supporting PASA, as a user-centric innovation strategy, to promote co-production health policies aiming at CVD prevention.

Methods

A mixed-method systematic literature review was conducted in the fields of health and healthcare management to highlight the intersections between PASA promotion and m-health tools in fostering co-produced services focused on CVD prevention. The literature has been extracted by the PRISMA logic application. The resulting sample has been first statistically described by a bibliometric approach and then further investigated with a conceptual analysis of the most relevant contributions, which have been qualitatively analysed.

Results

We identified 2,295 studies, on which we ran the bibliometric analysis. After narrowing the research around the co-production field, we found 10 papers relevant for the concept analysis of contents. The interest about the theme has increased in the last two decades, with a high prevalence of contributions from higher income countries and those with higher CVD incidence. The field of research is highly multi-disciplinary; most of documents belong to the medical field, with only a few interconnections with the technology and health policy spheres. Although the involvement of patients is recognized as fundamental for CVD prevention through PASA, co-design schemes are still lacking at the public management level.

Conclusions

While the link between the subjects of motor activity, medicine and technology is clear, the involvement of citizens in the service delivery process is still underinvestigated, especially the issue concerning how “value co-creation” could effectively be applied by public agencies. In synthesis, the analysis of the role of co-production as a system coordination method, which is so important in designing and implementing preventive care, is still lacking.
Preliminary development of recommendations for the inclusion of patient-reported outcome measures in clinical quality registries
Authors: Ruseckaite Rasa , Maharaj Ashika D. , Dean Joanne , Krysinska Karolina , Ackerman Ilana N. , Brennan Angela L. , Busija Ljoudmila , Carter Helen , Earnest Arul , Forrest Christopher B. , Harris Ian A. , Sansoni Janet , Ahern Susannah
Published: March 2022

Background

Clinical quality registries (CQRs) monitor compliance against optimal practice and provide feedback to the clinical community and wider stakeholder groups. Despite a number of CQRs having incorporated the patient perspective to support the evaluation of healthcare delivery, no recommendations for inclusion of patient-reported outcome measures (PROMs) in CQRs exist. The aim of this study was to develop a core set of recommendations for PROMs inclusion of in CQRs.

Method

An online two-round Delphi survey was performed among CQR data custodians, quality of life researchers, biostatisticians and clinicians largely recruited in Australia. A list of statements for the recommendations was identified from a literature and survey of the Australian registries conducted in 2019. The statements were grouped into the following domains: rationale, setting, ethics, instrument, administration, data management, statistical methods, and feedback and reporting. Eighteen experts were invited to participate, 11 agreed to undertake the first online survey (round 1). Of these, nine experts completed the online survey for round 2.

Results

From 117 statements presented to the Delphi panel in round 1, a total of 72 recommendations (55 from round 1 and 17 from round 2) with median importance (MI) ≥ 7 and disagreement index (DI) < 1 were proposed for inclusion into the final draft set and were reviewed by the project team. Recommendations were refined for clarity and to read as stand-alone statements. Ten overlapped conceptually and, therefore, were merged to reduce repetition. The final 62 recommendations were sent for review to the panel members for their feedback, which was incorporated into the final set.

Conclusion

This is the first study to develop preliminary recommendations for PROMs inclusion in CQRs. Recommendations for PROMs implementation are critically important for registries to assure meaningful PROMs data capture, use, interpretation, and reporting to improve health outcomes and healthcare value.
GWAS in people of Middle Eastern descent reveals a locus protective of kidney function—a cross-sectional study
Authors: Mohamed Siham A. , Fernadez-Tajes Juan , Franks Paul W. , Bennet Louise
Published: March 2022

Background

Type 2 diabetes is one of the leading causes of chronic kidney failure, which increases globally and represents a significant threat to public health. People from the Middle East represent one of the largest immigrant groups in Europe today. Despite poor glucose regulation and high risk for early-onset insulin-deficient type 2 diabetes, they have better kidney function and lower rates of all-cause and cardiovascular-specific mortality compared with people of European ancestry. Here, we assessed the genetic basis of estimated glomerular filtration rate (eGFR) and other metabolic traits in people of Iraqi ancestry living in southern Sweden.

Methods

Genome-wide association study (GWAS) analyses were performed in 1201 Iraqi-born residents of the city of Malmö for eGFR and ten other metabolic traits using linear mixed-models to account for family structure.

Results

The strongest association signal was detected for eGFR in CST9 (rs13037490; P value = 2.4 × 10−13), a locus previously associated with cystatin C-based eGFR; importantly, the effect (major) allele here contrasts the effect (minor) allele in other populations, suggesting favorable selection at this locus. Additional novel genome-wide significant loci for eGFR (ERBB4), fasting glucose (CAMTA1, NDUFA10, TRIO, WWC1, TRAPPC9, SH3GL2, ABCC11), quantitative insulin-sensitivity check index (METTL16), and HbA1C (CAMTA1, ME1, PAK1, RORA) were identified.

Conclusions

The genetic effects discovered here may help explain why people from the Middle East have better kidney function than those of European descent. Genetic predisposition to preserved kidney function may also underlie the observed survival benefits in Middle Eastern immigrants with type 2 diabetes.
Outbreak of neuropathogenic equid herpesvirus 1 causing abortions in Yili horses of Zhaosu, North Xinjiang, China
Authors: Tong Panpan , Duan Ruli , Palidan Nuerlan , Deng Haifeng , Duan Liya , Ren Meiling , Song Xiaozhen , Jia Chenyang , Tian Shuyao , Yang Enhui , Kuang Ling , Xie Jinxin
Published: March 2022

Background

EHV-1 is one of the most serious viral pathogens that frequently cause abortion in horses around the world. However, so far, relatively little information is available on EHV-1 infections as they occur in China. In January 2021, during an abortion storm which occurred in Yili horses at the Chinese State Studs of Zhaosu (North Xinjiang, China), 43 out of 800 pregnant mares aborted.

Results

PCR detection revealed the presence of EHV-1 in all samples as the possible cause of all abortions, although EHV-4, EHV-2 and EHV-5 were also found to circulate in the aborted fetuses. Furthermore, the partial ORF33 sequences of the 43 EHV-1 shared 99.3–100% and 99.0–100% similarity in nucleotide and amino acid sequences respectively. These sequences not only indicated a highly conserved region but also allowed the strains to group into six clusters. In addition, based on the predicted ORF30 nucleotide sequence, it was found that all the strains carried a guanine at the 2254 nucleotide position (aspartic acid at position 752 of the viral DNA polymerase) and were, therefore, identified as neuropathogenic strains.

Conclusion

This study is the first one that establishes EHV-1 as the cause of abortions in Yili horses, of China. Further characterization of the ORF30 sequences revealed that all the EHV-1 strains from the study carried the neuropathogenic genotype. Totally, neuropathogenic EHV-1 infection in China’s horse population should be concerned although the virus only detected in Yili horse abortions.
Comprehensive analysis of ferroptosis-related genes and prognosis of cutaneous melanoma
Authors: Liu Changjiang , Liu Yuhang , Yu Yifeng , Zhao Yong , Yu Aixi
Published: March 2022

Background

Cutaneous Melanoma (CM) is a malignant disease with increasing incidence and high mortality. Ferroptosis is a new kind of cell death and related to tumor blood and lymphatic metastasis. This study aims at using bioinformatics technology to construct a prognostic signature and identify ferroptosis-related biomarkers to improve the prognosis and treatment of cutaneous melanoma.

Methods

We used bioinformatics tools to analyze RNA sequencing expression data with clinical information from multiple databases, utilized varieties of statistical methods to construct a ferroptosis-related prognostic signature of cutaneous melanoma and screened out specific genes with independent prognostic ability.

Results

We obtained 22 ferroptosis-related (P < 0.05) prognostic DEGs in the uniCox regression analysis, among which 10 high-expressed genes (ATG5, CHAC1, FANCD2, FBXL5, HMOX2, HSPB1, NQO1, PEBP1, PRNP, SLC3A2) were screened out by LASSO regression analysis to establish a predictive model. Meanwhile, the ferroptosis-related signature and the nomogram we drew performed an excellent performance based on Kaplan–Meier (K–M), Receiver operating characteristic (ROC) and calibration curves. Univariate and multivariable cox analyses displayed that our model was greater than other prognostic features. GO and KEGG analyses revealed that 10-biomarker signature was mainly related to epidermis differentiation and immunity. ssGSEA analysis indicated that the immune status between the two risk groups was highly different. Besides, we found that two genes (CP, ZEB1) had independent prognostic ability and can be applied for drug research. Both genes were highly related to immunity. GSEA illustrated that ZEB1 may be involved in cellular functions such as proliferation, apoptosis, and migration, while CP was closely connected to immune cell related functions.

Conclusion

The present study suggested a 10-biomarker signature can be clinically used to predict the prognosis of cutaneous melanoma, which was better than conventional factors. CP and ZEB1 were independent prognostic genes and can be applied to guide treatment. In addition, ZEB1 mutation was highly related to overall survival in cutaneous melanoma, while CP may be associated with tumor progression. Our study comprehensively analyzed the relationship between iron metabolism, ferroptosis-related genes, and the prognosis of cutaneous melanoma, provided new insight for molecular mechanisms and treatment of ferroptosis and cutaneous melanoma.
Epidemiological trends and sociodemographic factors associated with acute hemorrhagic conjunctivitis in mainland China from 2004 to 2018
Authors: Liu Rong , Chen Yuxing , Liu Hao , Huang Xihui , Zhou Fang
Published: March 2022

Background

Acute hemorrhagic conjunctivitis (AHC) is classified as a class C notifiable infectious disease in China and poses a great threat to public health. This study aimed to investigate the epidemiological trends and hotspots of AHC in mainland China. Sociodemographic factors that could contribute to early warning of AHC were further explored.

Methods

Yearly and monthly incidences of acute hemorrhagic conjunctivitis by date and region from 2004 to 2018 were extracted from the Data Center of China Public Health Science. Joinpoint regression and spatial autocorrelation analysis were performed to explore the epidemiological trends and hotspots of AHC. A generalized linear model was then applied to explore the relationship between sociodemographic factors and AHC incidence.

Results

The average annual AHC incidence was 3.58/100,000 in mainland China. The first-level spatial and temporal aggregation areas were distributed in Guangxi, Hainan, Guangdong, Guizhou, Hunan, Jiangxi, Fujian, Chongqing, Hubei, Anhui, and Zhejiang, with gathering times from 2010/1/1 to 2010/12/31 (RR = 20.13, LLR = 474,522.89, P < 0.01). After 2010, the AHC incidence was stable (APC = − 8.37, 95% CI: − 23.02–9.06). However, it was significantly increased in low- and middle-income provinces (AAPC = 10.65, 95% CI: 0.62–21.68, AAPC = 11.94, 95% CI: 0.62–24.53). The peak of AHC occurred during the August to October period. Children who age 0–3 years are identified as high-risk group with AHC incidence significantly increased (APC = 31.54, 95% CI: 0.27–72.56). Birth rate, population ages 0–14 (% of total population), passenger traffic, and urban population (% of total population) were positively associated with the AHC incidence, while per capita gross domestic product was negatively associated with the AHC incidence.

Conclusion

Overall, the AHC incidence was stable after 2010 in China, but it was significantly increased in low- and middle-income provinces. Regions with a high birth rate, population ages 0–14 (% of the total population), passenger traffic, urban population (% of the total population) and low per capita gross domestic product are at high risk of incidences of AHC. In the future, public health policy and resource priority for AHC in regions with these characteristics are necessary.
Association between perinatal factors and future risk for gout—a nested case-control study
Authors: Dehlin Mats , Jacobsson Lennart T. H.
Published: March 2022

Background

Increased level of urate is the strongest risk factor for gout development but since only a minority of hyperuricemics are affected by gout, other pathogenic factors must be considered. Low birth weight is associated with future morbidities causing hyperuricemia, such as diabetes and renal disease. The purpose of this study was to investigate if, and to what extent, maternal and perinatal factors, including birth weight, are associated with future risk of being diagnosed with gout.

Methods

A population-based retrospective nested case-control registry study based on regional and national health care registers in Sweden. All incident cases of gout born in 1973 and onward who had received ≥1 diagnosis of gout from 2000 through 2019 in the region of western Sweden were included. Up to 5 non-gout controls were matched to each case by age, sex, and county at the year of first gout diagnosis. A range of maternal, gestational, and perinatal factors were analyzed for their potential association to future gout development. This included the health of the mother, gestational length, birth weight, number of siblings, and congenital malformations.

Results

Maternal diabetes, any congenital malformation, and being small for gestational age were factors that significantly increased the risk for future gout development, odds ratio (95% CI) 3.1 (1.3 to 7.4) (p=0.01), 1.33 (1.04 to 1.7) (p=0.02), and 1.75 (1.3 to 2.3) (p<.0001), respectively.

Conclusions

In this study, maternal diabetes and being small for gestational age increased the risk for future gout development in young adults. As of today, these conditions are becoming more prevalent and may contribute to the ongoing gout epidemic. These results require both confirmation and further delineation of underlying mechanisms.
Pulmonary arterial hypertension in hereditary hemorrhagic telangiectasia associated with ACVRL1 mutation: a case report
Authors: Walsh L. J. , Collins C. , Ibrahim H. , Kerins D. M. , Brady A. P. , O Connor T. M.
Published: March 2022

Introduction

Hereditary hemorrhagic telangiectasia is an autosomal dominant condition with an estimated prevalence of 1 in 5000. It is characterized by the presence of abnormalities of vascular structures, and may affect many organ systems, including the lungs, brain, spinal cord, gastrointestinal tract, and liver. A causative mutation is identified in approximately 97% of patients with definite hereditary hemorrhagic telangiectasia in one of three genes including a mutation in endoglin, a mutation in a locus mapped to chromosome 5, and an activin receptor-like kinase-1 (ACVRL1) mutation that is associated with an increased incidence of primary pulmonary hypertension. Pulmonary arterial hypertension is a rare (15–25 cases per million people) but severe vascular disorder. Heritable pulmonary arterial hypertension is associated with several gene mutations, with 75% having a mutation in the bone morphogenetic protein receptor 2 (BMPR2). However, the remaining 25% of patients have other associated genetic mutations including ACVLR1, which is also associated with hereditary hemorrhagic telangiectasia. Pulmonary arterial hypertension is a rare complication in patients with hereditary hemorrhagic telangiectasia (< 1% of the hereditary hemorrhagic telangiectasia population). We describe a case report with this rare occurrence.

Case presentation

A 70-year-old white/caucasian Irish male presented for screening for hereditary hemorrhagic telangiectasia due to a history of recurrent epistaxis (once/week) and a family history suggestive of pulmonary hypertension. Genetic testing confirmed an ACVRL1 mutation, while an echocardiogram and right heart catheterization confirmed pulmonary arterial hypertension. On examination, he had several mucocutaneous telangiectasia across his face. He was commenced on tadalafil and macitentan. However, this led to increased iron deficiency anemia and pedal edema. Selexipag was also added to his drug regime. He continues to require intermittent admissions for diuresis and blood transfusions.

Conclusion

The association of hereditary hemorrhagic telangiectasia and pulmonary arterial hypertension is rare (< 1%). Here we describe a case of hereditary hemorrhagic telangiectasia complicated with pulmonary arterial hypertension as a result of an ACVRL1 mutation. We also describe the clinical challenges of treating these two conditions together, as treatment options for pulmonary arterial hypertension tend to worsen hereditary hemorrhagic telangiectasia symptoms.
Rectus sheath hematoma associated with commencement of therapeutic low molecular weight heparin injections: a case report
Authors: Zhou Yuxuan , Logan Kingsley
Published: March 2022

Background

Subcutaneous low molecular weight heparin is a commonly used anticoagulant. Catastrophic hemorrhage is a known adverse outcome associated with anticoagulant use. Of all potential bleeding sites, hemorrhage into the rectus sheath is a rare and unusual complication. In this case report, we document a patient who developed rectus sheath hematoma following new commencement of therapeutic low molecular weight heparin.

Case presentation

A 71-year-old New Zealand European woman presented to a peripheral hospital with suspected unstable angina. She was started on therapeutic subcutaneous low molecular weight heparin. While awaiting inpatient transfer to a tertiary hospital for coronary angiography, she developed a large rectus sheath hematoma associated with hemodynamic instability. She required an urgent laparotomy to decompress the hematoma and achieve hemostasis. Postoperatively, her anticoagulation therapy was stopped, and she made a full recovery.

Conclusion

Rectus sheath hematoma is a condition that is difficult to diagnose. The risk of adverse events must always be considered against the indication and potential benefits of new medications, especially with high-risk medications such as anticoagulants.
Regulatory requirements and labeling of commercially available prescription (oral) medicines in Sri Lanka: there is room for improvement
Authors: Jayasinghe Manori , Srilal Thotawaththage Loshadhi Indunika , Prasadi Deweni Guruge Pathmila , Madushika Wickramasinghe Senanayakege Sachini , Silva Samanda Marakkala Dileka Udyani , Subasinghe Sewwandi
Published: March 2022

Background

The consistency and the quality of medicine labels are sought through the regulatory frameworks. This study aims at investigating the secondary labels of medicines based on the labeling regulations and guidelines issued by the National Medicines Regulatory Authority (NMRA), Sri Lanka.

Methods

A descriptive cross-sectional study was conducted on 53 commonly used prescription-only oral medicines selected using the price regulations published for most commonly used drugs. High-resolution images of 216 brands/branded generics/generic products’ secondary labels were collected in April 2021 from six community pharmacies in six districts chosen as a convenience sample. Each label was manually assessed using a checklist prepared based on the regulatory requirements by four trained investigators. The status of registration of each product was assessed using the NMRA website. Descriptive statistics were performed.

Results

There was a variation observed in labeling regulations and information present on packages. Among the 216 products evaluated, only 148 (68%) products appeared as registered medicines on the NMRA website, and 2.3% of medicines fulfilled all stipulated labeling parameters set out by the NMRA, 3% of products abided by the general labeling requirements, and 76% of the products complied with labeling requirements for API. Major deficiencies were observed in the presentation of registration numbers and the details of the local agent, which were unaccounted for in 210 (97%) and 131 (61%) products, respectively. The highest consistency (100%) of information was noted with the dosage form, date of manufacture, date of expiry, and batch numbers. Among the restricted information, attractive pictures (2%), web addresses (6%), and over-stickers (34%) were found.

Conclusions

The results highlighted a gap between regulatory requirements and practice in medicine labeling information. Regular post-market examination of medicinal labels is highly advised in a country that relies largely on imports. Similarly, careful adherence to the labeling regulations is required. Furthermore, suppliers and local agents should be held accountable for ensuring accurate medicine labeling through increased awareness, education, and sanctions.
Atypical chest radiological features in Covid 19: Case based review
Authors: Vishnu Sharma M. , Anupama N.
Published: March 2022

Chest imaging plays an important role in the diagnosis and management of patients with COVID-19. Some patients may have atypical lesions on chest image. Awareness about the atypical imaging features is essential to avoid misdiagnosis/delayed diagnosis. Atypical chest imaging features in COVID-19 include central involvement, peribronchovascular involvement, isolated upper lobe involvement, nodular involvement, lobar consolidation, solitary involvement, unilateral lung involvement, interstitial emphysema, pneumomediastinum, subcutaneous emphysema, pneumothorax, hydropneumothorax, mediastinal adenopathy, cavitory lesions, bulls eye sign, necrotizing pneumonia with abscess, empyema, pleural and pericardial effusion, and subpleural sparing. In patients with atypical chest imaging features, when RT-PCR test results are positive diagnosis is certain. Diagnostic difficulty may arise when RT-PCR test results are negative. In such cases a proper epidemiologic history, typical clinical features, and exclusion of other causes for a similar chest imaging features may help in diagnosis. Causes for atypical chest imaging features include early stage of the disease when lesion can be unilateral or focal or single, late stage of the disease when lesions regress, coexisting diseases/conditions, preexisting lung parenchymal diseases, fluid overload, complications like other bacterial/ fungal infection/tuberculosis/barotrauma or involvement of other organs like kidney, heart, or liver which may lead to pleural effusion. Iatrogenic trauma, barotrauma, or drug-induced immunosuppression leading to opportunistic infections can also lead to chest imaging features. Some of the CT features like cavitory lesion, mediastinal adenopathy, and pleural and pericardial effusion may be due to complications during the course of the disease or coexistent diseases. In this pictorial essay we discuss some atypical chest images with salient learning points from each case. Awareness about the atypical chest imaging features is essential to avoid misdiagnosis/delayed diagnosis. Some of the atypical features may require further evaluation/follow up and management.
Time-lapse seismic integrated with surface microseismic for SRV characterization in the Vaca Muerta Formation
Authors: Chao Gabriel , Achilli Federico , Fachal José Luis , Sainz-Trápaga Mariana , Rojas-Arce Diego , Lafram Abderhaim , Vinchon Matthieu , Fantín Manuel , Bergery Guillaume , Brosille Eddy
Published: March 2022

Time-lapse (4D) seismic acquisitions were performed in the unconventional play of the Vaca Muerta Formation to monitor hydraulic stimulation efficiency and characterize the stimulated rock volume (SRV) in horizontal drains. Two 4D pilots were carried out by acquiring 3D surveys before and after hydraulic stimulation. The pilots targeted different stratigraphic landings characterized by distinct lithological and geomechanical properties. The 4D pilots were performed in synergy with surface microseismic acquisitions. The combined acquisition enabled joint interpretation of the results. Time-lapse acoustic inversions were performed to identify changes in acoustic impedance. They revealed the vertical dimension of the SRV more precisely than the analysis of the envelope of the wet microseismic events. These wet events are interpreted as hydraulically connected to the well. The 4D signal is interpreted as the envelope of the induced hydraulic fractures, defined here as the fractured rock volume. This volume refers to where the rock frame has been directly affected by the stimulation job. The image provided by 4D seismic represents the most direct and accurate measurement of the volume encircling the flow pathways created by the fracture network generated by the hydraulic stimulation. This information is key to assessing ultimate hydrocarbon recovery and optimizing the development of unconventional reservoirs. The added value of the microseismic is the mapping of subtle events associated with the reactivation of critically stressed faults/lineaments. These provide preferential pathways that could connect to the well. They also help in the understanding of hydraulic interactions between the wells and their individual SRVs. The findings of these studies indicate that the optimal lateral and vertical well spacing should be designed based on 4D monitoring for drainage optimization and on microseismic for the analysis of interwell structural interferences.
Integrated velocity and attenuation model building: Sakhalin case study
Authors: Tan Sirui , Ayeni Gboyega , Park Jaewoo , Aharchaou Mehdi , Traynin Peter , Burnett William , Baumstein Anatoly , Marcinkovich Carey , Lee Sunwoong , Srinivasan Arjun , Bansal Rishi , Wildermuth Eric , Lory Robert , Bishop JJ , Nell Mark
Published: March 2022

Shallow gas accumulations with varied spatial distribution and scales cause amplitude loss and phase distortion in seismic images in underlying reservoir intervals. We present an integrated velocity and attenuation (defined by the quality factor Q) model-building workflow to address the imaging challenges in a shallow-water data set acquired offshore Sakhalin Island, Russia. As part of the workflow, we use full-waveform inversion (FWI) to capture fine details of the velocity and Q models. We achieve a step change in image quality improvement and amplitude fidelity enhancement by leveraging the workflow. This image enhancement improves subsurface interpretation and influences well placement, subsurface model building, and depletion plan optimization. Key to this success is not only the advanced model-building tool kit, which includes FWI and tomography, but also the optimal integration of the tools specifically tailored for the geologic setting and imaging challenges offshore Sakhalin Island.
Two birds with one stone: can [68Ga]Ga-DOTANOC PET/CT image quality be improved through BMI-adjusted injected activity without increasing acquisition times?
Authors: Zanoni Lucia , Calabrò Diletta , Fortunati Emilia , Argalia Giulia , Malizia Claudio , Allegri Vincenzo , Civollani Simona , Fanti Stefano , Ambrosini Valentina
Published: March 2022

Objectives:

To assess how patients’ dependent parameters may affect [68Ga]Ga-DOTANOC image quality and to propose a theoretical body mass index (BMI)-adjusted injected activity (IA) scheme, to improve imaging of high weight patients.

Methods:

Among patients prospectively enrolled (June-2019 and May-2020) in an Institutional Ethical Committee-approved electronic archive, we included those affected by primary gastro-entero-pancreatic (GEP) or lung neuroendocrine tumour and referred by our Institutional clinicians (excluding even minimal radiopharmaceutical extravasation, movement artefacts, renal insufficiency). All PET/CT images were acquired following EANM guidelines and rated for visual quality (1 = non-diagnostic, 2 = poor, 3 = moderate, 4 = good). Collected data included patient’s body mass, height, BMI, age, IA (injected activity), IA/Kg (IAkg), IA/BMI (IABMI), liver SUVmean, liver SUVmax standard deviation, liver-signal-to-noise (LSNR), normalised_LSNR (LSNR_norm) and contrast-to-noise ratio (CNR) for positive scans and were compared to image rating (poor vs moderate/good).

Results:

Overall, 77 patients were included. Rating concordance was high (agreement = 81.8%, Fleiss k score = 0.806). All patients’ dependent parameters resulted significantly different between poor-rated and moderate/good-rated scans (IA: p = 0.006, IAkg: p =< 0.001, body weight: p =< 0.001, BMI: p =< 0.001, IABMI: p =< 0.001). Factors significantly associated with moderate/good rating were BMI (p =< 0.001), body weight (p =< 0.001), IABMI (p =< 0.001), IAkg (p = 0.001), IA (p = 0.003), LSNR_norm (p = 0.01). The BMI-based model presented the best predictive efficiency (81.82%). IABMI performance to differentiate moderate/good from poor rating resulted statistically significant (IA-AUC = 0.78; 95% CI: 0.68–0.89; cut-off value of 4.17 MBq*m2/kg, sensitivity = 81.1%, specificity = 66.7%). If BMI-adjusted IA (=4.17*BMI) would have been applied in this population, the median IA would have slightly inferior (−4.8%), despite a different IA in each patient.

Advances in knowledge:

BMI resulted the best predictor of image quality. The proposed theoretical BMI-adjusted IA scheme (4.17*BMI) should yield images of better quality (especially in high-BMI patients) maintaining practical scanning times (3 min/bed).