bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of vulvovaginal candidiasis among pregnant women in the Ho municipality, Ghana: species identification and antifungal susceptibility of Candida isolates
Authors: Waikhom Sayanika Devi , Afeke Innocent , Kwawu Grace Sefakor , Mbroh Hintermann Kobina , Osei George Yiadom , Louis Bengyella , Deku John Gameli , Kasu Emmanuel Senyo , Mensah Prosper , Agede Charles Yao , Dodoo Cornelius , Asiamah Emmanuel Akomanin , Tampuori John , Korbuvi John , Opintan Japheth Awuletey
Published: May 2020

Background

Candida is the leading cause of vaginitis, and 75% of women have at least one episode of infection in their lives, with pregnancy being a predisposing factor. If left untreated, vulvovaginal candidiasis (VVC) can lead to chorioamnionitis with subsequent abortion, prematurity and congenital infection of the neonate. We aimed to determine the prevalence of VVC, identify the recent and most frequently occurring species of Candida in pregnant women, and determine the most effective antifungal drug of choice for treatment.

Method

A prospective cross-sectional study in which 176 high vaginal swab samples of consented pregnant women visiting the antenatal clinic from February 2018 to April 2018 were subjected to direct gram smear and culture for Candida isolation. Candida isolates were identified using a germ tube test and HiCrome Candida differential agar. Candida isolates were then subjected to a disk diffusion method using fluconazole (25 μg), nystatin (100 units), and voriconazole (1 μg) on Mueller-Hinton agar supplemented with 2% (w/v) glucose and 0.5 μg/ml methylene blue dye to determine the susceptibility pattern as per the guidelines of the Clinical Laboratory Standard Institute (CLSI). Chi-square analysis was used to ascertain the significant association of participants’ sociodemographics and clinical presentations to VVC. A univariate logistic regression model was used to identify potential risk factors of VVC.

Results

The prevalence of VVC among our study participants was 30.7%. Non-albicans Candida (NAC) and Candida albicans had a prevalence of 74.1 and 25.9%, respectively. Candida glabrata was the most common species, followed by Candida albicans, Candida krusei, and Candida parapsilosis. 50.0, 18.5 and 3.7% of Candida species were susceptible to voriconazole, fluconazole and nystatin, respectively, whereas 37.0, 48.1 and 9.3% of Candida species were resistant to voriconazole, fluconazole and nystatin, respectively. The majority of isolates were susceptible dose dependent to all three antifungal agents, with voriconazole being the most efficacious antifungal agent. There was no significant association between participants’ socio-demographic information and clinical presentations to VVC.

Conclusion

The prevalence of VVC was high in the study area. C. glabrata was found to be the most common cause of VVC among the pregnant women attending antenatal clinics, in the Ho Municipality region of Ghana. The majority of the Candida isolates were susceptible and resistant to voriconazole and fluconazole, respectively.
Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort
Authors: Bell Sarah F. , Watkins Adam , John Miriam , Macgillivray Elinore , Kitchen Thomas L. , James Donna , Scarr Cerys , Bailey Christopher M. , Kelly Kevin P. , James Kathryn , Stevens Jenna L. , Edey Tracey , Collis Rachel E. , Collins Peter W.
Published: May 2020

Background

Visual estimation of blood loss following delivery often under-reports actual bleed volume. To improve accuracy, quantitative blood loss measurement was introduced for all births in the 12 hospitals providing maternity care in Wales. This intervention was incorporated into a quality improvement programme (Obstetric Bleeding Strategy for Wales, OBS Cymru). We report the incidence of postpartum haemorrhage in Wales over a 1-year period using quantitative measurement.

Methods

This prospective, consecutive cohort included all 31,341 women giving birth in Wales in 2017. Standardised training was cascaded to maternity staff in all 12 hospitals in Wales. The training comprised mock-scenarios, a video and team drills. Uptake of quantitative blood loss measurement was audited at each centre. Data on postpartum haemorrhage of > 1000 mL were collected and analysed according to mode of delivery. Data on blood loss for all maternities was from the NHS Wales Informatics Service.

Results

Biannual audit data demonstrated an increase in quantitative measurement from 52.1 to 87.8% (P < 0.001). The incidence (95% confidence intervals, CI) of postpartum haemorrhage of > 1000 mL, > 1500 mL and > 2000 mL was 8.6% (8.3 to 8.9), 3.3% (3.1 to 3.5) and 1.3% (1.2 to 1.4), respectively compared to 5%, 2% and 0.8% in the year before OBS Cymru. The incidence (95% CI) of bleeds of > 1000 mL was similar across the 12 hospitals despite widely varied size, staffing levels and case mix, median (25th to 75th centile) 8.6% (7.8–9.6). The incidence of PPH varied with mode of delivery and was mean (95% CI) 4.9% (4.6–5.2) for unassisted vaginal deliveries, 18.4 (17.1–19.8) for instrumental vaginal deliveries, 8.5 (7.7–9.4) for elective caesarean section and 19.8 (18.6–21.0) for non-elective caesarean sections.

Conclusions

Quantitative measurement of blood loss is feasible in all hospitals providing maternity care and is associated with detection of higher rates of postpartum haemorrhage. These results have implications for the definition of abnormal blood loss after childbirth and for management and research of postpartum haemorrhage.
Long-term visual outcomes of endophthalmitis and the role of systemic steroids in addition to intravitreal dexamethasone
Authors: Conrady Christopher D. , Feist Richard M. , Vitale Albert T. , Shakoor Akbar
Published: May 2020

Background

The purpose of this study was to evaluate the role of systemic steroids in post-procedural endophthalmitis as the role of intravitreal steroids in treatment algorithms of endophthalmitis remain controversial.

Methods

This is a retrospective analysis from a single tertiary referral center of all patients older than 18 years old that developed presumed post-procedure endophthalmitis and were treated at our center from 2009 to 2018.

Results

Eighty-three patients were followed after being treated for post-procedural endophthalmitis that either received systemic steroids or did not around the time of diagnosis. Almost 30 % of all patients regained a final visual acuity of 20/40 or better, while 31.2% had poor visual outcomes of count fingers or worse. Non-clearing debris was the most significant long-term complication. Visual improvement plateaued in 67.7% by 1 month after diagnosis and initial treatment in both groups. There was no difference in visual outcomes when comparing the sixteen patients that received systemic steroids and the sixty-seven that did not; however, no enucleation or evisceration was required in patients receiving systemic steroids. Five patients that did not receive systemic steroids required an enucleation or evisceration due to a blind, painful eye.

Conclusions

The use of systemic steroids does not seem to worsen long-term outcomes of endophthalmitis compared to those patients that did not receive them and they may prove beneficial in the most severe cases by reducing the risk of losing the globe altogether.
Cognitive function and its transitions in predicting all-cause mortality among urban community-dwelling older adults
Authors: Wang Mu-Cyun , Li Tsai-Chung , Li Chia-Ing , Liu Chiu-Shong , Lin Chih-Hsueh , Lin Wen-Yuan , Yang Chuan-Wei , Yang Shing-Yu , Lin Cheng-Chieh
Published: May 2020

Background

Cognitive impairment is accompanied with high rates of comorbid conditions, leading ultimately to death. Few studies examine the relation between cognitive transition and mortality, especially in Asian population. This study evaluated baseline cognition and cognitive transition in relation to all-cause mortality among community-dwelling older adults.

Methods

We conducted a community-based prospective cohort study among 921 participants of Taichung Community Health Study for Elders in 2009. Cognitive function was evaluated by the Mini-Mental State Examination. Cognitive impairment was considered if the total score is less than 27, 24, and 21 for a participant’s educational level of more than 6 years, equal or less than 6 years, and illiteracy, respectively. One-year transition in cognitive function was obtained among 517 individuals who were assessed in both 2009 and 2010. Mortality was followed up until 2016. Cox proportional hazards models were applied to estimate the adjusted hazard ratios of mortality for baseline cognitive impairment and one-year transition in cognitive status.

Results

After a follow-up of 6.62 years, 160 deaths were recorded. The multivariate adjusted hazard ratio (95% confidence interval) for baseline cognitive impairment was 2.08 (1.43, 3.01). Significantly increased mortality risk was observed for cognitively impaired–normal and impaired–impaired subgroups over 1 year as compared with those who remained normal [2.87 (1.25, 6.56) and 3.79 (1.64, 8.73), respectively]. The area under the receiver operating characteristic curves demonstrated that baseline cognition and one-year cognitive transition had no differential predictive ability for mortality. Besides, there was an interaction of cognitive impairment and frailty, with an additive mortality risk [5.41 (3.14, 9.35)] for the elders who presented with both.

Conclusion

Baseline cognitive impairment rather than one-year progression is associated with mortality in a six-year follow-up on older adults.
Misinformation and the US Ebola communication crisis: analyzing the veracity and content of social media messages related to a fear-inducing infectious disease outbreak
Authors: Sell Tara Kirk , Hosangadi Divya , Trotochaud Marc
Published: May 2020

Background

The Ebola communication crisis of 2014 generated widespread fear and attention among Western news media, social media users, and members of the United States (US) public. Health communicators need more information on misinformation and the social media environment during a fear-inducing disease outbreak to improve communication practices. The purpose of this study was to describe the content of Ebola-related tweets with a specific focus on misinformation, political content, health related content, risk framing, and rumors.

Methods

We examined tweets from a random 1% sample of all tweets published September 30th - October 30th, 2014, filtered for English-language tweets mentioning “Ebola” in the content or hashtag, that had at least 1 retweet (N = 72,775 tweets). A randomly selected subset of 3639 (5%) tweets were evaluated for inclusion. We analyzed the 3113 tweets that meet inclusion criteria using public health trained human coders to assess tweet characteristics (joke, opinion, discord), veracity (true, false, partially false), political context, risk frame, health context, Ebola specific messages, and rumors. We assessed the proportion of tweets with specific content using descriptive statistics and chi-squared tests.

Results

Of non-joke tweets, 10% of Ebola-related tweets contained false or partially false information. Twenty-five percent were related to politics, 28% contained content that provoked reader response or promoted discord, 42% contained risk elevating messages and 72% were related to health. The most frequent rumor mentioned focused on government conspiracy. When comparing tweets with true information to tweets with misinformation, a greater percentage of tweets with misinformation were political in nature (36% vs 15%) and contained discord-inducing statements (45% vs 10%). Discord-inducing statements and political messages were both significantly more common in tweets containing misinformation compared with those without(p < 0.001).

Conclusions

Results highlight the importance of anticipating politicization of disease outbreaks, and the need for policy makers and social media companies to build partnerships and develop response frameworks in advance of an event. While each public health event is different, our findings provide insight into the possible social media environment during a future epidemic and could help optimize potential public health communication strategies.
Integrating pediatric TB services into child healthcare services in Africa: study protocol for the INPUT cluster-randomized stepped wedge trial
Authors:   the INPUT Study Group, Denoeud-Ndam Lise , Otieno-Masaba Rose , Tchounga Boris , Machekano Rhoderick , Simo Leonie , Mboya Joseph Phelix , Kose Judith , Tchendjou Patrice , Bissek Anne-Cécile Zoung-Kanyi , Okomo Gordon Odhiambo , Casenghi Martina , Cohn Jennifer , Tiam Appolinaire
Published: May 2020

Background

Tuberculosis is among the top-10 causes of mortality in children with more than 1 million children suffering from TB disease annually worldwide. The main challenge in young children is the difficulty in establishing an accurate diagnosis of active TB.

The INPUT study is a stepped-wedge cluster-randomized intervention study aiming to assess the effectiveness of integrating TB services into child healthcare services on TB diagnosis capacities in children under 5 years of age.

Methods

Two strategies will be compared: i) The standard of care, offering pediatric TB services based on national standard of care; ii) The intervention, with pediatric TB services integrated into child healthcare services: it consists of a package of training, supportive supervision, job aids, and logistical support to the integration of TB screening and diagnosis activities into pediatric services. The design is a cluster-randomized stepped-wedge of 12 study clusters in Cameroon and Kenya. The sites start enrolling participants under standard-of-care and will transition to the intervention at randomly assigned time points. We enroll children aged less than 5 years with a presumptive diagnosis of TB after obtaining caregiver written informed consent. The participants are followed through TB diagnosis and treatment, with clinical information prospectively abstracted from their medical records.

The primary outcome is the proportion of TB cases diagnosed among children < 5 years old attending the child healthcare services. Secondary outcomes include: number of children screened for presumptive active TB; diagnosed; initiated on TB treatment; and completing treatment. We will also assess the cost-effectiveness of the intervention, its acceptability among health care providers and users, and fidelity of implementation.

Discussion

Study enrolments started in May 2019, enrolments will be completed in October 2020 and follow up will be completed by June 2021. The study findings will be disseminated to national, regional and international audiences and will inform innovative approaches to integration of TB screening, diagnosis, and treatment initiation into child health care services.

Trial resistration

NCT03862261, initial release 12 February 2019.
Experiences of rural women with damages resulting from an earthquake in Iran: a qualitative study
Authors: Yoosefi Lebni Javad , Khorami Farhad , Ebadi Fard Azar Farbod , Khosravi Bahar , Safari Hossein , Ziapour Arash
Published: May 2020

Background

Women, with more vulnerabilities and less access to resources, are often seen as victims of natural disasters. Therefore, the present study aimed to investigate the experiences of rural women with damages resulting from an earthquake in Iran.

Methods

In this research, a qualitative approach, as well as the conventional content analysis was employed. The study population consisted of rural women residing in the earthquake-stricken areas of Sarpol-e Zahab and Salas-e Babajani counties in Kermanshah Province, Iran. Semi-structured interviews were used for data collection. Moreover, sampling was purposeful, theoretical saturation was achieved by conducting 22 interviews, and the data analysis process was performed according to the steps proposed by Graneheim and Lundman. For the strength and transferability of the research, Lincoln and Guba’s Evaluative Criteria were used.

Results

There were seven categories regarding the experiences of rural women after the earthquakes including neglecting the health needs; tension in the family and marital relations; gender inequality in the provision of assistance; feeling insecure; ignoring the ruling culture of the region; concealing needs for fear of stigmatization, and incoherent mourning as well as two categories regarding their reactions to and interaction with the earthquake consequences including positive and negative interactions.

Conclusions

Paying more attention to the needs of rural women, taking the culture governing the village into account at the time of service delivery, and helping them with positive adaptations are some indispensable measures that should be taken.
Relationships between health outcomes in older populations and urban green infrastructure size, quality and proximity
Authors: Dennis Matthew , Cook Penny A. , James Philip , Wheater C. Philip , Lindley Sarah J.
Published: May 2020

Background

There is a growing body of literature supporting positive associations between natural environments and better health. The type, quality and quantity of green and blue space (‘green-space’) in proximity to the home might be particularly important for less mobile populations, such as for some older people. However, considerations of measurement and definition of green-space, beyond single aggregated metrics, are rare. This constitutes a major source of uncertainty in current understanding of public health benefits derived from natural environments. We aimed to improve our understanding of how such benefits are conferred to different demographic groups through a comprehensive evaluation of the physical and spatial characteristics of urban green infrastructure.

Methods

We employed a green infrastructure (GI) approach combining a high-resolution spatial dataset of land-cover and function with area-level demographic and socio-economic data. This allowed for a comprehensive characterization of a densely populated, polycentric city-region. We produced multiple GI attributes including, for example, urban vegetation health. We used a series of step-wise multi-level regression analyses to test associations between population chronic morbidity and the functional, physical and spatial components of GI across an urban socio-demographic gradient.

Results

GI attributes demonstrated associations with health in all socio-demographic contexts even where associations between health and overall green cover were non-significant. Associations varied by urban socio-demographic group. For areas characterised by having higher proportions of older people (‘older neighbourhoods’), associations with better health were exhibited by land-cover diversity, informal greenery and patch size in high income areas and by proximity to public parks and recreation land in low income areas. Quality of GI was a significant predictor of good health in areas of low income and low GI cover. Proximity of publicly accessible GI was also significant.

Conclusions

The influence of urban GI on population health is mediated by green-space form, quantity, accessibility, and vegetation health. People in urban neighbourhoods that are characterised by lower income and older age populations are disproportionately healthy if their neighbourhoods contain accessible, good quality public green-space. This has implications for strategies to decrease health inequalities and inform international initiatives, such as the World Health Organisation’s Age-Friendly Cities programme.
Chylous ascites as a late complication of one anastomosis gastric bypass-minigastric bypass: case report
Authors: Abu Shakra Ibrahim , Bez Maxim , Bickel Amitai , Kassis Walid , Ganam Samer , Merei Fahed , Karra Nour , Kamal Khatib , Fischer Doron , Kakiashvili Eli
Published: May 2020

Background

One anastomosis gastric bypass- minigastric bypass (OAGB-MGB) is an emerging bariatric surgery that is being endorsed by surgeons worldwide. Internal herniation is a rare and dreaded complication after malabsorptive bariatric procedures, which necessitates early diagnosis and intervention.

Case presentation

We describe a 29-year-old male with chylous ascites caused by an internal hernia 8 months following laparoscopic one anastomosis gastric bypass. An abdominal CT showed enlargement of lymph nodes at the mesentery, with a moderate amount of liquid in the abdomen and pelvis. An emergent exploratory laparoscopic surgery demonstrated an internal hernia at the Petersen’s space with a moderate quantity of chylous ascites. The patient made an uneventful recovery after surgery.

Conclusions

Internal herniation can occur after OAGB-MGB and in extremely rare cases lead to chylous ascites. To our knowledge, this is the first reported case of chylous ascites following one anastomosis gastric bypass.
Robotic, laparoscopic or open hemihepatectomy for giant liver haemangiomas over 10 cm in diameter
Authors: Hu Minggen , Chen Kuang , Zhang Xuan , Li Chenggang , Song Dongda , Liu Rong
Published: May 2020

Background

To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver haemangiomas.

Methods

From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver haemangiomas were included in this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria.

Results

There were no significant differences in age, sex, tumour location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver haemangioma volume, FLR/SLV, resected normal liver volume/resected volume, hepatic disease, rates of blood transfusion, liver function after 24 h of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n = 19) and the LH group (n = 13), patients in the OH group (n = 25) had a significantly longer postoperative hospital stay (P < 0.05), time to oral intake (P < 0.05), and time to get-out-of-bed (P < 0.05); a higher VAS score after 24 h of surgery (P < 0.05); and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P>0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time in the RH group was significantly shorter than that in the LH group (P<0.05). There was no significant difference in the operative time between the RH group and the OH group (P>0.05). The amount of intraoperative blood loss in the RH group was the lowest among the three groups (P<0.05), and the amount of intraoperative blood loss in the LH group was less than that in the OH group (P<0.05).

Conclusion

Robotic and laparoscopic hemihepatectomies were associated with less intraoperative blood loss,better postoperative recovery and lower pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and a shorter operative time.
Two faces of the same coin: a qualitative study of patients’ and carers’ coexistence with chronic breathlessness associated with chronic obstructive pulmonary disease (COPD)
Authors: Ferreira Diana H. , Kochovska Slavica , Honson Aaron , Phillips Jane L. , Currow David C.
Published: May 2020

Background

Chronic breathlessness is a recognized clinical syndrome that severely impacts patients and carers, who become increasingly restricted in their daily activities. Often, patients become reliant on their carers, who are required to provide constant support. Although individual experiences of breathlessness have been previously investigated, there are few studies exploring contemporaneous experiences of breathlessness of the patient and their carer. This study aimed to understand the experience of severe chronic breathlessness in people with chronic obstructive pulmonary disease (COPD) from the perspective of the patient and carer unit.

Methods

A qualitative study embedded in a randomised, placebo-controlled effectiveness study (RCT) of regular, low-dose (≤32 mg/day), sustained-release morphine for chronic breathlessness associated with COPD. Recruitment occurred between July 2017 and November 2018 in one respiratory and palliative care services, in South Australia. Participants were community-dwelling patients with COPD and severe breathlessness (modified Medical Research Council scale 3 or 4) and their carers. Separate semi-structured interviews were conducted with patients and carers, recorded and transcribed verbatim. Analysis was informed by grounded theory using a constant comparative approach.

Results

From the 26 patients with a carer recruited for the RCT in South Australia, nine were interviewed in their homes. Six patients were men, median age 77 years. Carers were mostly women, who were their wives (n = 6), median age 70. Five themes emerged from the data: (1) shrinking world; (2) mutual adaptation; (3) co-management; (4) emotional coping; and (5) meaning in the face of death.

Conclusion

Chronic breathlessness is a systemic condition that permeates all aspects of the patient’s and carer’s lives. Working as a team, patients and carers manage chronic breathlessness to achieve maximal function and well-being. Patients and carers share many aspects of the experience of breathlessness, but the carer seems particularly susceptible to emotional distress. Future chronic breathlessness interventions should target the patient and the carer, both together and separately to address their common and individual needs.

Trial registration

The main trial is registered (registration no. NCT02720822; posted March 28, 2016).
Acupuncture techniques for COPD: a systematic review
Authors: Fernández-Jané Carles , Vilaró Jordi , Fei Yutong , Wang Congcong , Liu Jianping , Huang Na , Xia Ruyu , Tian Xia , Hu Ruixue , Wen Lingzi , Yu Mingkun , Gómara-Toldrà Natàlia , Solà-Madurell Mireia , Sitjà-Rabert Mercè
Published: May 2020

Background

This is the second part of a large spectrum systematic review which aims to identify and assess the evidence for the efficacy of non-pharmacological acupuncture techniques in the treatment of chronic obstructive pulmonary disease (COPD). The results of all techniques except for filiform needle are described in this publication.

Methods

Eleven different databases were screened for randomised controlled trials up to June 2019. Authors in pairs extracted the data and assessed the risk of bias independently. RevMan 5.3 software was used for the meta-analysis.

Results

Thirty-three trials met the inclusion criteria, which involved the follow techniques: AcuTENS (7 trials), moxibustion (11 trials), acupressure (7 trials), ear acupuncture (6 trials), acupressure and ear acupuncture combined (1 trial) and cupping (1 trial). Due to the great heterogeneity, only 7 meta-analysis could be performed (AcuTENS vs sham on quality of life and exercise capacity, acupressure vs no acupressure on quality of life and anxiety and ear acupuncture vs sham on FEV1 and FEV1/FVC) with only acupressure showing statistical differences for quality of life (SMD: -0.63 95%CI: − 0.88, − 0.39 I2 = 0%) and anxiety (HAM-A scale MD:-4.83 95%CI: − 5.71, − 3.94 I2 = 0%).

Conclusions

Overall, strong evidence in favour of any technique was not found. Acupressure could be beneficial for dyspnoea, quality of life and anxiety, but this is based on low quality trials.

Further large well-designed randomised control trials are needed to elucidate the possible role of acupuncture techniques in the treatment of COPD.

Trial registration

PROSPERO (identifier: CRD42014015074).
Community based programs to improve the oral health of Australian Indigenous adolescents: a systematic review and recommendations to guide future strategies
Authors: Gwynn Josephine , Skinner John , Dimitropoulos Yvonne , Masoe Angela , Rambaldini Boe , Christie Vita , Sohn Woosung , Gwynne Kylie
Published: May 2020

Background

To review the international literature on community-based interventions aiming to improve the oral health of Indigenous adolescents and identify which demonstrate a positive impact.

Methods

Data sources were MEDLINE, EMBASE, CINAHL, SCOPUS, the COCHRANE library and the Australian Indigenous HealthInfoNet. Articles were included where they: were published in English from 1990 onwards; described oral health outcomes for Indigenous adolescents aged 10 to 19 years; implemented a community based oral health intervention. The Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project was applied.

Results

Nine studies met inclusion criteria; two rated strong in quality; only one study was conducted with an urban community; five reported moderate community engagement. Five intervention strategies were identified, and schools were the most common setting reported. Statistically significant improvements were described in eight studies with the most frequently reported outcome being change in decayed missing or filled teeth.

Conclusions

Few good quality peer reviewed international studies of community-based oral health interventions which address the needs of Indigenous adolescents exist. Studies must include strong Indigenous community leadership and governance at all stages of the research, adopt participatory action-based research approaches, and are required in urban communities.
Epidemiology and clinico-pathological characteristics of current goat pox outbreak in North Vietnam
Authors: Pham Trang Hong , Lila Mohd Azmi Mohd , Rahaman Nor Yasmin Abd. , Lai Huong Lan Thi , Nguyen Lan Thi , Do Khien Van , Noordin Mustapha M.
Published: May 2020

Background

In view of the current swine fever outbreak and the government aspiration to increase the goat population, a need arises to control and prevent outbreaks of goat pox. Despite North Vietnam facing sporadic cases of goat pox, this most recent outbreak had the highest recorded morbidity, mortality and case fatality rate. Thus, owing to the likelihood of a widespread recurrence of goat pox infection, an analysis of that outbreak was done based on selected signalment, management and disease pattern (signs and pathology) parameters. This includes examination of animals, inspection of facilities, tissue sampling and analysis for confirmation of goatpox along with questionaires.

Results

It was found that the susceptible age group were between 3 and 6 months old kids while higher infection rate occurred in those under the free-range rearing system. The clinical signs of pyrexia, anorexia, nasal discharge and lesions of pocks were not restricted to the skin but have extended into the lung and intestine. The pathogen had been confirmed in positive cases via PCR as goat pox with prevalence of 79.69%.

Conclusions

The epidemiology of the current goat pox outbreak in North Vietnam denotes a significant prevalence which may affect the industry. This signals the importance of identifying the salient clinical signs and post mortem lesions of goat pox at the field level in order to achieve an effective control of the disease.
Optimization of a rapid one-step platelet-rich plasma preparation method using syringe centrifugation with and without carprofen
Authors: Apakupakul Jutarat , Sattasathuchana Panpicha , Chanloinapha Phongsak , Thengchaisri Naris
Published: May 2020

Background

Carprofen and platelet-rich plasma (PRP) are widely used in small animal clinical practice. Separation layers have been used during blood centrifugation to increase platelet yield. The objectives of this study were to (1) identify the optimal centrifugation force for the one-step PRP preparation, (2) determine whether there is an advantage to using carprofen in one-step PRP preparation, and (3) compare platelet morphology from one-step PRP preparation with and without carprofen. We hypothesized that injectable carprofen (emulsion formula) could be used successfully as the separation layer in PRP preparation.

Results

Samples from 14 healthy dogs were used to determine the optimal centrifugation force using one-step PRP preparation in a disposable syringe without carprofen, with forces set at 300, 500, 700, 900, 1100, 1300, and 1500 xg for 5 min. Optimum centrifugation force, plasma volume, and platelet concentrations of one-step PRP preparation were found and recovered at 900 xg, 1.9 ± 0.28 ml, and 260.50 ± 58.39 X 103cell/μl, respectively. Samples from 12 healthy dogs were used to determine the optimal force (with forces set at 300, 500, 700, and 900 xg) for 5 min using one-step PRP preparation with carprofen. Optimum centrifugation force, plasma volume, and platelet concentrations for one-step PRP preparation with carprofen were found and recovered at 500 xg, 0.62 ± 0.16 ml and 948.50 ± 261.40 X 103cell/μl, respectively. One-step PRP preparation with carprofen increased the platelet yield from baseline by 1.76 and 4.95 fold, respectively. Samples from 3 healthy dogs were used to observe platelet morphologies after centrifugation by scanning electron microscopy. Images of platelets on glass slides from both preparation methods revealed pseudopods emerging from the margins of the discoid platelets.

Conclusions

One-step PRP centrifugation both with and without carprofen increased the platelet yield, but using carprofen (emulsion formula) as a separation layer resulted in a higher platelet yield. The clinical usefulness of PRP products from these methods should be further investigated.
Rho kinase cascade activation in circulating leukocytes in patients with diabetes mellitus type 2
Authors: Ocaranza Maria Paz , Valderas Patricio , Moya Jackeline , Gabrielli Luigi , Godoy Iván , Córdova Samuel , Nab Paul Mac , García Lorena , Farías Luis , Jalil Jorge E.
Published: May 2020

Background

The intracellular ROCK signaling pathway is an important modulator of blood pressure and of cardiovascular and renal remodeling when Rho-kinase activity is increased. Besides, in preclinical models of diabetes, ROCK activation has also a role in abnormal glucose metabolism as well as in subsequent vascular and myocardial dysfunction. In humans, there are a few data assessing ROCK activation in patients with type 2 diabetes mellitus (T2D) and no studies assessing upstream/downstream components of the ROCK pathway. We assessed here levels of ROCK activation and some of the RhoA/ROCK cascade molecules in peripheral blood mononuclear cells (PBMCs) in T2D patients under current treatment.

Methods

Cross-sectional observational study comparing 28 T2D patients under current antidiabetic treatment with 31 consecutive healthy subjects, matched by age and gender. Circulating levels of malondialdehyde, angiotensin II and inflammatory cytokines IL-6 and IL-8 were determined in all subjects. ROCK activation in PMBCs, upstream and downstream cascade proteins, and levels of the proinflammatory molecules VCAM, ICAM-1 and IL-8 were determined in their PMBCs by Western blot.

Results

Compared to healthy controls, ROCK activation in T2D patients measured by 2 direct ROCK targets in PBMCs was increased by 420 and 570% (p < 0001) and it correlated significantly with serum glucose levels. p38 MAPK phosphorylation (downstream from ROCK) and JAK-2 (upstream from ROCK) were significantly higher in the T2D patients by 580% and 220%, respectively. In T2D patients, significantly increased PBMC levels of the proinflammatory molecules VCAM-1, ICAM-1 and IL-8 were observed compared to control subjects (by 180%, 360% and 260%, respectively). Circulating levels of Ang II and MDA were significantly higher in T2D patients by 29 and 63%, respectively.

Conclusions

T2D patients under treatment with glucose-lowering drugs, antihypertensive treatment as well as with statins have significantly increased ROCK activation in their circulating leukocytes along with higher phosphorylation of downstream cascade proteins despite pharmacologic treatment, along with increased plasma angiotensin II and MDA levels. ROCK inhibition might have an additional role in the prevention and treatment of T2D.
Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial
Authors: Amano Yumeko , Noma Tomokazu , Etoh Seiji , Miyata Ryuji , Kawamura Kentaro , Shimodozono Megumi
Published: May 2020

Background

Our group developed a rehabilitation robot to assist with repetitive, active reaching movement of a paretic upper extremity. The robot is equipped with a servo motor-controlled arm-weight support and works in conjunction with neuromuscular electrical stimulation and vibratory stimulation to facilitate agonist-muscle contraction. In this before-and-after pilot study, we assessed the feasibility of applying the robot to improve motor control and function of the hemiparetic upper extremity in patients who suffered chronic stroke.

Methods

We enrolled 6 patients with chronic stroke and hemiparesis who, while sitting and without assistance, could reach 10 cm both sagitally and vertically (from a starting position located 10 cm forward from the patient’s navel level) with the affected upper extremity. The patients were assigned to receive reaching exercise intervention with the robot (Yaskawa Electric Co., Ltd. Fukuoka, Japan) for 2 weeks at 15 min/day in addition to regular occupational therapy for 40 min/day. Outcomes assessed before and after 2 weeks of intervention included the upper extremity component of the Fugl-Meyer Assessment (UE-FMA), the Action Research Arm Test (ARAT), and, during reaching movement, kinematic analysis.

Results

None of the patients experienced adverse events. The mean score of UE-FMA increased from 44.8 [SD 14.4] to 48.0 [SD 14.4] (p = 0.026,r = 0.91), and both the shoulder–elbow and wrist–hand scores increased after 2-week intervention. An increase was also observed in ARAT score, from mean 29.8 [SD 16.3] to 36.2 [SD 18.1] (p = 0.042,r = 0.83). Kinematic analysis during the reaching movement revealed a significant increase in active range of motion (AROM) at the elbow, and movement time tended to decrease. Furthermore, trajectory length for the wrist (“hand path”) and the acromion (“trunk compensatory movement”) showed a decreasing trend.

Conclusions

This robot-assisted modality is feasible and our preliminary findings suggest it improved motor control and motor function of the hemiparetic upper extremity in patients with chronic stroke. Training with this robot might induce greater AROM for the elbow and decrease compensatory trunk movement, thus contributing to movement efficacy and efficiency.

Trial registrationUMIN Clinical Trial Registry, as UMIN000018132, on June 30, 2015.https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000020398
USMCA 2.0: a few improvements but far from a ‘healthy’ trade treaty
Authors: Labonté Ronald , Gleeson Deborah , McNamara Courtney L.
Published: May 2020

The USMCA (NAFTA 2.0), although signed over a year ago, went through several months of renegotiation of certain of its new rules that the Democrat-controlled US Congress wanted altered or strengthened. In December a ‘Protocol of Amendment’ was agreed upon and signed by the three Parties (the USA, Mexico, and Canada). A number of tough, new measures governing pharmaceuticals were revised or deleted, making it potentially easier for generic competition and lower drug costs in all three countries. Rules on protection of labour rights were also strengthened, lowering the threshold at which a complaint of unfair labour practices could be initiated. Procedures for investigating such a complaint or resolving a formal dispute were also improved. Similar procedural improvements were made on measures affecting environmental protection. These Protocol agreements are more health-positive than health-negative, and in the case of pharmaceuticals are of significant impact. Overall, however, these amendments are simply a political fine-tuning of the agreement. Concerns raised in our earlier health impact assessment of the USMCA, notably how the agreement’s regulatory reforms reduce public health policy flexibilities, remain. The agreement continues to subordinate known or potential health costs of many of its measures to dubious claims of aggregate economic gains. Moreover, these gains, if materialized, are likely to accrue to those atop the income/wealth hierarchies in all three nations.
Evaluation of breastfeeding care and education given to mothers with low-birthweight babies by healthcare workers at a hospital in urban Tanzania: a qualitative study
Authors: Tada Kyoko , Shimpuku Yoko , Sunguya Bruno , Horiuchi Shigeko
Published: May 2020

Background

The total neonatal mortality in Tanzania remains high reaching as much as 44,900 deaths per year, particularly among low birthweight (LBW) babies. This makes Tanzania the fourth African country with the highest number of annual neonatal deaths. Studies have shown the advantages of breast milk for LBW babies and the effectiveness of interventions from healthcare workers (HCWs) to encourage mothers to achieve exclusive breastfeeding (EBF). Although these interventions can substantially reduce mortality in this vulnerable group, they remain insufficient in practice particularly in resource-limited countries. Therefore, there is an urgent need to establish the most appropriate interventions for mothers with LBW babies, particularly in these countries. To help address this need, we evaluated the breastfeeding care and education given to mothers with LBW babies by HCWs during hospitalization in Tanzania.

Methods

A qualitative study using semi-structured interviews with mothers of LBW babies at an urban hospital in Tanzania was conducted. We assessed their understanding of breastfeeding at discharge. All the interviews were conducted in local Swahili and then translated to English. Data were analyzed using content analysis.

Results

Among the 19 mothers interviewed, only four breastfed their baby within an hour after birth. Nine mothers received no support from HCWs when they breastfeed their baby for the first time. Ten mothers received no education on EBF, and there were mothers who misunderstood the EBF definition. Eight answered that they had difficulty breastfeeding their baby at discharge. Four mothers were dissatisfied with the care and education given by HCWs, and six mothers provided suggestions for improvements. Although six mothers had a high reliance on HCWs, they had difficulty asking HCWs questions because of their authoritative attitude and behavior.

Conclusions

Mothers with LBW babies need special support to increase their ability to breastfeed and ensure EBF continuance. To address the gaps between the currently provided breastfeeding interventions and the ideal breastfeeding interventions, improvements in the quality and quantity of breastfeeding care and education are required. Training HCWs to systematize standard interventions, confirming mothers’ understanding, and ensuring a comfortable environment for mothers are absolutely needed.
A balanced score to predict survival of elderly patients newly diagnosed with glioblastoma
Authors: Straube Christoph , Kessel Kerstin A. , Antoni Stefanie , Gempt Jens , Meyer Bernhard , Schlegel Juergen , Schmidt-Graf Friederike , Combs Stephanie E.
Published: May 2020

Background

Over the past years, several treatment regimens have been recommended for elderly patients with glioblastoma (GBM), ranging from ultrahypofractionated radiotherapy (RT) over monochemotherapy (ChT) to combined radiochemotherapy (RChT). The current guidelines recommend active treatment in elderly patients in cases with a KPS of at least 60%. We established a score for selecting patients with a very poor prognosis from patients with a better prognosis.

Methods

One hundred eighty one patients ≥65 years old, histologically diagnosed with GBM, were retrospectively evaluated. Clinical characteristics were analysed for their impact on the overall survival (OS). Factors which were significant in univariate analysis (log-rank test, p < 0.05) were included in a multi-variate model (multi-variate Cox regression analysis, MVA). The 9-month OS for the significant factors after MVA (p < 0.05) was included in a prognostic score. Score sums with a median OS of < and > 6 months were summarized as Group A and B, respectively.

Results

Age, KPS, MGMT status, the extent of resection, aphasia after surgery and motor dysfunction after surgery were significantly associated with OS on univariate analysis (p < 0.05). On MVA age (p 0.002), MGMT promotor methylation (p 0.013) and Karnofsky performance status (p 0.005) remained significant and were included in the score. Patients were divided into two groups, group A (median OS of 2.7 months) and group B (median OS of 7.8 months). The score was of prognostic significance, independent of the adjuvant treatment regimen.

Conclusions

The score distinguishes patients with a poor prognosis from patients with a better prognosis. Its inclusion in future retrospective or prospective trials could help enhance the comparability of results. Before its employment on a routine basis, external validation is recommended.
Fully automated brain resection cavity delineation for radiation target volume definition in glioblastoma patients using deep learning
Authors: Ermiş Ekin , Jungo Alain , Poel Robert , Blatti-Moreno Marcela , Meier Raphael , Knecht Urspeter , Aebersold Daniel M. , Fix Michael K. , Manser Peter , Reyes Mauricio , Herrmann Evelyn
Published: May 2020

Background

Automated brain tumor segmentation methods are computational algorithms that yield tumor delineation from, in this case, multimodal magnetic resonance imaging (MRI). We present an automated segmentation method and its results for resection cavity (RC) in glioblastoma multiforme (GBM) patients using deep learning (DL) technologies.

Methods

Post-operative, T1w with and without contrast, T2w and fluid attenuated inversion recovery MRI studies of 30 GBM patients were included. Three radiation oncologists manually delineated the RC to obtain a reference segmentation. We developed a DL cavity segmentation method, which utilizes all four MRI sequences and the reference segmentation to learn to perform RC delineations. We evaluated the segmentation method in terms of Dice coefficient (DC) and estimated volume measurements.

Results

Median DC of the three radiation oncologist were 0.85 (interquartile range [IQR]: 0.08), 0.84 (IQR: 0.07), and 0.86 (IQR: 0.07). The results of the automatic segmentation compared to the three different raters were 0.83 (IQR: 0.14), 0.81 (IQR: 0.12), and 0.81 (IQR: 0.13) which was significantly lower compared to the DC among raters (chi-square = 11.63, p = 0.04). We did not detect a statistically significant difference of the measured RC volumes for the different raters and the automated method (Kruskal-Wallis test: chi-square = 1.46, p = 0.69). The main sources of error were due to signal inhomogeneity and similar intensity patterns between cavity and brain tissues.

Conclusions

The proposed DL approach yields promising results for automated RC segmentation in this proof of concept study. Compared to human experts, the DC are still subpar.