bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Clinical Trials
Authors: Nie Liu-yan , Zhao Kun , Ruan Jiaqi , Xue Jing
Published: March 2021

Background:

The effectiveness of platelet-rich plasma (PRP) injections for knee osteoarthritis and the effects of leukocyte-poor PRP (LP-PRP) versus leukocyte-rich PRP (LR-PRP) are still controversial.

Purpose:

To assess the effectiveness of different PRP injections through a direct and indirect meta-analysis of randomized controlled trials.

Study Design:

Systematic review; Level of evidence, 1.

Methods:

A systematic literature search of electronic databases (PubMed, Cochrane Library, and EMBASE) was performed to locate randomized controlled trials published through March 2019 that compared PRP with control treatment. A random-effects meta-analysis was conducted to synthesize the evidence, and meta-regression analyses were conducted to determine the influence of trial characteristics. An indirect comparison was performed to assess the effects of LP-PRP and LR-PRP compared with hyaluronic acid (HA).

Results:

A total of 21 trials were included. A clinically important benefit for pain relief was seen for intra-articular PRP compared with intra-articular saline (standardized mean difference [SMD] = –1.38 [95% CI, –2.07 to –0.70]; P < .0001; I 2 = 37%) and corticosteroid solution injection (SMD = –2.47 [95% CI, –3.34 to –1.61]; P < .00001; I 2 = 47%). As a result of heterogeneity ( I 2 = 89%), there was no conclusive effect compared with HA, even though the pooling effect provided clinically relevant pain relief (SMD = –0.59 [95% CI, –0.97 to –0.21]; P = .003). Indirect meta-analysis showed that there was no significant difference between LR-PRP and LP-PRP.

Conclusion:

PRP injections are beneficial for pain relief and functional improvement in knee osteoarthritis. Larger, randomized high-quality studies are needed to compare the effects of LP-PRP and LR-PRP.
Leigh Syndrome as a Phenotype of Near-Homoplasmic m.8344 A>G Variant in Children
Authors: Russo Sam Nicholas , Goldstein Amy , Karaa Amel , Koenig Mary Kay , Walker Melissa
Published: March 2021

In the field of mitochondrial medicine, correlation of clinical phenotype with mutation heteroplasmy remains an outstanding question with few, if any, clear thresholds corresponding to a given phenotype. The m.8344A>G mutation is most commonly associated with myoclonus epilepsy and ragged red fiber syndrome (MERRF) at varying levels of heteroplasmy. However, a handful of cases been previously reported in which individuals homoplasmic or nearly homoplasmic for this mutation in the blood have presented with multiple bulbar palsies, respiratory failure, and progressive neurologic decline almost uniformly following a respiratory illness. MRI brain in all affected individuals revealed symmetric T2 hyperintense lesions of subcortical gray matter structures, consistent with Leigh syndrome. Here, we present 3 cases with clinical, biochemical, and neuro-imaging findings with the additional reporting of spinal lesions. This new phenotype supports a heteroplasmy-dependent phenotype model for this mutation and recognition of this can help clinicians with diagnosis and anticipatory clinical guidance.
The Importance of Place: Effects of Community Job Loss on College Enrollment and Attainment Across Rural and Metropolitan Regions
Authors: Sorensen Lucy C. , Hwang Moontae
Published: March 2021

Youth living in remote rural communities face significant geographic barriers to college access. Even those living near to a postsecondary institution may not have the means for, or may not see the value of, pursuing a college degree within their local economy. This study uses 18 years of national county-level data to ask how local economic shocks affect the postsecondary enrollment and attainment of rural students, as compared to students in metropolitan and metropolitan-adjacent regions. Results from an instrumental variables analysis indicate that each 1 percentage point increase in local unemployment increases local college enrollment by 10.0% in remote rural areas, as compared to a 5.2% increase in metropolitan-adjacent areas and no detectable increase in metropolitan areas. The rise in rural college enrollment is driven primarily by students enrolling in or continuing in associate degree programs, and by students transferring from 2-year to 4-year programs.
Acute General Surgical Emergency and COVID-19 Is a Pandemic Challenge for Surgeons: A United Kingdom-Based Practical Experience
Authors: Nahid Md Abu Kamal , Rahman Sanjida , Shah Ankur Jyotindra
Published: March 2021

Transmission of coronavirus (COVID-19) is a considerable risk during the perioperative period of emergency surgery. A prospective observational study was performed between March 30, 2020, and June 30, 2020, at a large District General Hospital in England. The primary outcome was perioperative COVID-19-related complications, and secondary outcome measures included incidence of COVID-19 infections among the acute surgical patients, doctors, and healthcare workers. A total of 584 patients admitted through the emergency surgical pathway and 43% (n = 253) underwent surgical intervention. Approximately 5% (n = 30) patients contracted COVID-19 during the perioperative period and 6 of them died. Eight surgical doctors and 11 theater staff were confirmed for COVID-19 by swab test. Acute surgical emergencies and perioperative management of the urgent surgical patients during the COVID-19 pandemic is a global challenge, but adequate preparedness and strategic plan to adjust the surgical services can reduce the exposures to this highly contagious virus.
Medical Students’ Knowledge and Perception of Deep Brain Stimulation
Authors: Saway Brian F , Monjazeb Sanaz , Godbe Kerilyn , Anwyll Tessa , Kablinger Anita , Witcher Mark
Published: March 2021

Background:

Deep brain stimulation (DBS) is a well-established neurosurgical procedure commonly used in movement and psychiatric disorders. Its widespread clinical implementation, however, may not be commensurate with medical education. No current assessment of medical student’s understanding of DBS as a treatment option for indicated conditions is available, potentially threatening the availability of DBS to future patients. The aim of the present study is to explore the current knowledge and attitudes of medical students toward DBS as a treatment modality.

Methods:

A total of 65 medical students at Virginia Tech Carilion School of Medicine were surveyed regarding their knowledge of DBS. The survey consisted of a 25-item questionnaire including a demographic section and 3 separate inventories designed to assess bias, knowledge, and self-assessment of knowledge specific to DBS therapy. Students in pre-clinical and clinical years were analyzed separately to describe changes in knowledge or attitude associated with clinical exposure to DBS. Comparisons were analyzed using t tests, ANOVA, and Pearson correlations.

Results:

Of surveyed students, 36% were unsure of the FDA approval status of DBS treatment; 65% of students believed they had not been adequately educated about DBS and its utility; and 10.6% of students believed that DBS is likely associated with severe adverse effects and/or brain damage. The overall baseline attitudes of students toward DBS were positive. There was no observed difference between surveyed pre-clinical and clinical students, highlighting a lack of exposure throughout the clinical years of medical school education.

Conclusion:

Although DBS is an effective treatment modality for various conditions, current education is non-commensurate with its application, which can negatively impact awareness and understanding for its implications by medical professionals. In order to better serve patients who may benefit from DBS, medical curricula must change to educate future physicians on the benefit of this intervention.
A Stepwise Approach to the Surgical Management of Hemorrhagic Choroidal Detachments
Authors: Yeung Shanna C. , Mason Ryan H. , Minaker Samuel A. , AlAli Alaa , Kertes Peter J. , Yan Peng
Published: March 2021

Purpose:

This work describes a stepwise surgical approach to draining choroidal detachments and 2 cases for which this approach was used.

Methods:

The first step involves insertion of an anterior chamber maintainer and a nonvalved 23- or 25-gauge trocar cannula at the highest peak of hemorrhagic choroidal detachment (as determined using B-scan ultrasonography), 6 to 8 mm from and angled 20° to 30° toward the limbus. The second step involves removal of the trocar to expose the sclerotomy. Alternatively, the second step can be insertion of a second trocar. The third step involves the creation of a small focal peritomy around the preexisting sclerotomy and enlargement of the preexisting sclerotomy into a radial sclerotomy. Progression between steps only occurs if prior steps did not provide adequate drainage.

Results:

Two cases of appositional hemorrhagic choroidal detachments in hypotonic eyes were successfully resolved by this stepwise approach. In case 1, a choroidal detachment developed after a corneal ulcer perforation. The hemorrhagic choroidal detachment in case 1 was resolved with steps 1 and 2, and an unnecessary scleral cutdown was avoided. In case 2, a choroidal detachment developed after a trabeculectomy. The detachment in case 2 required progression to step 3, extension of the trocar insertion site into a radial sclerotomy.

Conclusions:

This stepwise approach should be considered to reduce excessive manipulation of the globe and conjunctiva in hemorrhagic and serous choroidal detachments that warrant surgical intervention.
Making the Black Box Transparent: A Template and Tutorial for Registration of Studies Using Experience-Sampling Methods
Authors: Kirtley Olivia J. , Lafit Ginette , Achterhof Robin , Hiekkaranta Anu P. , Myin-Germeys Inez
Published: March 2021

A growing interest in understanding complex and dynamic psychological processes as they occur in everyday life has led to an increase in studies using ambulatory assessment techniques, including the experience-sampling method (ESM) and ecological momentary assessment. These methods, however, tend to involve numerous forking paths and researcher degrees of freedom, even beyond those typically encountered with other research methodologies. Although a number of researchers working with ESM techniques are actively engaged in efforts to increase the methodological rigor and transparency of research that uses them, currently there is little routine implementation of open-science practices in ESM research. In this article, we discuss the ways in which ESM research is especially vulnerable to threats to transparency, reproducibility, and replicability. We propose that greater use of study registration, a cornerstone of open science, may address some of these threats to the transparency of ESM research. Registration of ESM research is not without challenges, including model selection, accounting for potential model-convergence issues, and the use of preexisting data sets. As these may prove to be significant barriers for ESM researchers, we also discuss ways of overcoming these challenges and of documenting them in a registration. A further challenge is that current general preregistration templates do not adequately capture the unique features of ESM. We present a registration template for ESM research and also discuss registration of studies using preexisting data.
Venetoclax sensitivity in multiple myeloma is associated with B-cell gene expression
Authors: Gupta Vikas A. , Barwick Benjamin G. , Matulis Shannon M. , Shirasaki Ryosuke , Jaye David L. , Keats Jonathan J. , Oberlton Benjamin , Joseph Nisha S. , Hofmeister Craig C. , Heffner Leonard T. , Dhodapkar Madhav V. , Nooka Ajay K. , Lonial Sagar , Mitsiades Constantine S. , Kaufman Jonathan L. , Boise Lawrence H.
Published: March 2021

Venetoclax is a highly potent, selective BCL2 inhibitor capable of inducing apoptosis in cells dependent on BCL2 for survival. Most myeloma is MCL1-dependent; however, a subset of myeloma enriched for translocation t(11;14) is codependent on BCL2 and thus sensitive to venetoclax. The biology underlying this heterogeneity remains poorly understood. We show that knockdown of cyclin D1 does not induce resistance to venetoclax, arguing against a direct role for cyclin D1 in venetoclax sensitivity. To identify other factors contributing to venetoclax response, we studied a panel of 31 myeloma cell lines and 25 patient samples tested for venetoclax sensitivity. In cell lines, we corroborated our previous observation that BIM binding to BCL2 correlates with venetoclax response and further showed that knockout of BIM results in decreased venetoclax sensitivity. RNA-sequencing analysis identified expression of B-cell genes as enriched in venetoclax-sensitive myeloma, although no single gene consistently delineated sensitive and resistant cells. However, a panel of cell surface makers correlated well with ex vivo prediction of venetoclax response in 21 patient samples and may serve as a biomarker independent of t(11;14). Assay for transposase-accessible chromatin sequencing of myeloma cell lines also identified an epigenetic program in venetoclax-sensitive cells that was more similar to B cells than that of venetoclax-resistant cells, as well as enrichment for basic leucine zipper domain–binding motifs such as BATF. Together, these data indicate that remnants of B-cell biology are associated with BCL2 dependency and point to novel biomarkers of venetoclax-sensitive myeloma independent of t(11;14).
AID overexpression leads to aggressive murine CLL and nonimmunoglobulin mutations that mirror human neoplasms
Authors: Morande Pablo Elías , Yan Xiao-Jie , Sepulveda Julieta , Seija Noé , Marquez María Elena , Sotelo Natalia , Abreu Cecilia , Crispo Martina , Fernández-Graña Gabriel , Rego Natalia , Bois Therence , Methot Stephen P. , Palacios Florencia , Remedi Victoria , Rai Kanti R. , Buschiazzo Alejandro , Di Noia Javier M. , Navarrete Marcelo A. , Chiorazzi Nicholas , Oppezzo Pablo
Published: March 2021

Most cancers become more dangerous by the outgrowth of malignant subclones with additional DNA mutations that favor proliferation or survival. Using chronic lymphocytic leukemia (CLL), a disease that exemplifies this process and is a model for neoplasms in general, we created transgenic mice overexpressing the enzyme activation-induced deaminase (AID), which has a normal function of inducing DNA mutations in B lymphocytes. AID not only allows normal B lymphocytes to develop more effective immunoglobulin-mediated immunity, but is also able to mutate nonimmunoglobulin genes, predisposing to cancer. In CLL, AID expression correlates with poor prognosis, suggesting a role for this enzyme in disease progression. Nevertheless, direct experimental evidence identifying the specific genes that are mutated by AID and indicating that those genes are associated with disease progression is not available. To address this point, we overexpressed Aicda in a murine model of CLL (Eμ-TCL1). Analyses of TCL1/AID mice demonstrate a role for AID in disease kinetics, CLL cell proliferation, and the development of cancer-related target mutations with canonical AID signatures in nonimmunoglobulin genes. Notably, our mouse models can accumulate mutations in the same genes that are mutated in human cancers. Moreover, some of these mutations occur at homologous positions, leading to identical or chemically similar amino acid substitutions as in human CLL and lymphoma. Together, these findings support a direct link between aberrant AID activity and CLL driver mutations that are then selected for their oncogenic effects, whereby AID promotes aggressiveness in CLL and other B-cell neoplasms.
Porphyrin Iron-Grafted Mesoporous Silica Composites for Drug Delivery, Dye Degradation and Colorimetric Detection of Hydrogen Peroxide
Authors: Zhu Ping , Xu Zhihui , Cai Ling , Chen Jin
Published: March 2021

Porphyrin iron molecules (hemin) were successfully grafted on the channeled mesoporous silica of SBA-15 (FeIX-SBA-15), in which attached hemin molecules acted as the enzyme mimic for catalyzing oxidation reactions. In the presence of H2O2, the prepared FeIX-SBA-15 composite effectively degraded industrial dye Orange II and catalyzed tetramethylbenzidine hydrochloride (TMB) both in the solution and on the membrane, from which the colorimetric H2O2 detection was achieved. Moreover, the hemin-grafted composites showed high loading content of anticancer drug of doxorubicin hydrochloride (DOX) displaying the sustained releasing behavior as monitored by real-time cell analysis, which resulted in improved inhibitory effect on cancer cells growth compared with that DOX/SBA-15. The hemin-modified mesoporous silica nanocomposite provides an integrated nanoplatform with promising biomedical applications.
Outcome of urethral reconstruction among vesico-vaginal fistula patients: a cross-sectional study
Authors: Lawal Olatunji O. , Abdus-salam Rukiyat Adeola , Bello Oluwasomidoyin O. , Morhason-Bello Imran O. , Ojengbede Oladosu A.
Published: March 2021

Background

Obstetric fistula (OF) complicated by urethral loss (UL) poses a challenge to both the fistula surgeon and obstetric fistula patient. The involvement of the urethra and urethral closure mechanism in OF is an important determinant of successful closure of fistula and restoration of urinary continence. OF with UL is often associated with unsuccessful repair outcome. We describe urethral reconstruction in genital tract fistula patients with UL and the outcomes of the repair.

Methods

AimTo review the clinical characteristics and outcome of vesico-vaginal fistula associated urethral loss following urethral reconstruction.

This was a descriptive cross-sectional study conducted at the University College Hospital, Ibadan, Nigeria. A 5-year prospective data of all vesico-vaginal fistula patients with urethral loss (2011–2016) were reviewed and analysed. Data collected include socio-demographic and obstetric characteristics; cause of the fistula; and fistula characteristics—type of fistula, number of previous repairs, urethral loss, outcome of repair and follow-up. Data were entered and analysed using IBM SPSS version 20.

Results

Urethral loss occurred in 23 (15.3%) out of 150 women with OF; these women had urethral reconstruction surgery. The commonest type of urethral loss encountered in this cohort was proximal urethral loss which was seen in 12 (52.2%) patients. The most common types of fistula seen with urethral loss were large vesico-vaginal fistula (34.8%) and mid-vaginal fistula (26.1%). More than half of the women (56.6%) had previous unsuccessful repair at other facilities before presentation. The fistula closure rate was high (82.6%) regardless of type of urethral loss. Among the women with successful closure of OF with UL, about 36.8% had urinary stress incontinence post-fistula repair.

Conclusion

Urethral loss appears to be a rare complication of obstetric fistula. Successful closure with stress incontinence was seen in a sizeable number of women with OF with UL. Preoperative assessment for determinant of post-repair incontinence and surgical repair by experienced surgeons will improve successful outcome of repair in women with obstetric fistula with UL.
SNP panels for the estimation of dairy breed proportion and parentage assignment in African crossbred dairy cattle
Authors: Gebrehiwot Netsanet Z. , Strucken Eva M. , Marshall Karen , Aliloo Hassan , Gibson John P.
Published: March 2021

Background

Understanding the relationship between genetic admixture and phenotypic performance is crucial for the optimization of crossbreeding programs. The use of small sets of informative ancestry markers can be a cost-effective option for the estimation of breed composition and for parentage assignment in situations where pedigree recording is difficult. The objectives of this study were to develop small single nucleotide polymorphism (SNP) panels that can accurately estimate the total dairy proportion and assign parentage in both West and East African crossbred dairy cows.

Methods

Medium- and high-density SNP genotype data (Illumina BovineSNP50 and BovineHD Beadchip) for 4231 animals sampled from African crossbreds, African Bos taurus, European Bos taurus, Bos indicus, and African indigenous populations were used. For estimating breed composition, the absolute differences in allele frequency were calculated between pure ancestral breeds to identify SNPs with the highest discriminating power, and different combinations of SNPs weighted by ancestral origin were tested against estimates based on all available SNPs. For parentage assignment, informative SNPs were selected based on the highest minor allele frequency (MAF) in African crossbred populations assuming two Scenarios: (1) parents were selected among all the animals with known genotypes, and (2) parents were selected only among the animals known to be a parent of at least one progeny.

Results

For the medium-density genotype data, SNPs selected for the largest differences in allele frequency between West African indigenous and European Bos taurus breeds performed best for most African crossbred populations and achieved a prediction accuracy (r2) for breed composition of 0.926 to 0.961 with 200 SNPs. For the high-density dataset, a panel with 70% of the SNPs selected on their largest difference in allele frequency between African and European Bos taurus performed best or very near best across all crossbred populations with r2 ranging from 0.978 to 0.984 with 200 SNPs. In all African crossbred populations, unambiguous parentage assignment was possible with ≥ 300 SNPs for the majority of the panels for Scenario 1 and ≥ 200 SNPs for Scenario 2.

Conclusions

The identified low-cost SNP assays could overcome incomplete or inaccurate pedigree records in African smallholder systems and allow effective breeding decisions to produce progeny of desired breed composition.
Abnormal ferritin levels predict development of poor outcomes in cirrhotic outpatients: a cohort study
Authors: Tornai David , Antal-Szalmas Peter , Tornai Tamas , Papp Maria , Tornai Istvan , Sipeki Nora , Janka Tamas , Balogh Boglarka , Vitalis Zsuzsanna
Published: March 2021

Background

Both iron overload and iron deficient anemia can associate with cirrhosis. At the same time, inflammation might be continuously present in cirrhotic patients due to bacterial translocation and patients’ susceptibility to infections. Ferritin is a sensitive and widely available marker of iron homeostasis, in addition it acts as an acute phase protein. Therefore, we evaluated the prognostic potential of serum ferritin in the long-term follow-up of cirrhotic outpatients.

Methods

A cohort of 244 cirrhotic outpatients was recruited and followed for 2 years. We measured their serum ferritin levels in our routine laboratory unit at enrolment and investigated its association with clinical outcomes.

Results

Ferritin serum level was higher in males and older patients than in females (median: 152.6 vs. 75 μg/L, p < 0.001) or younger individuals (median: 142.9 vs. 67.9 μg/L, p = 0.002). Patients who previously survived variceal bleeding had lower ferritin levels (median: 43.1 vs. 146.6 μg/L, p < 0.001). In multivariate regression models, including laboratory and clinical factors, lower (< 40 μg/L) ferritin concentration was associated with the development of decompensated clinical stage in patients with previously compensated cirrhosis (sHR: 3.762, CI 1.616–8.760, p = 0.002), while higher (> 310 μg/L) circulating ferritin levels were associated with increased risks of bacterial infections in decompensated patients (sHR: 2.335, CI 1.193–4.568, p = 0.013) and mortality in the whole population (HR: 2.143, CI 1.174–3.910, p = 0.013).

Conclusion

We demonstrated usefulness of serum ferritin as a prognostic biomarker in cirrhosis, pointing out that both low and high concentrations need attention in these patients.
Evaluation of intensified provider initiated testing and counselling program in Harare City, 2017–2018
Authors: Mandere Edias , Mungati More , Gonese Gloria , Gombe Notion , Juru Tsitsi , Chiwanda Simbarashe , Govha Emmanuel , Shambira Gerald , Tshimanga Mufuta
Published: March 2021

Background

Knowledge of HIV status remains a challenge despite implementation of various testing strategies including provider-initiated HIV testing (PITC). Harare City intensified provider-initiated HIV testing by targeting testing all eligible clients visiting facilities to achieve the UNAIDS first 95. This study aimed at evaluating the intervention to improve its effectiveness and inform programming decisions for universal access to HIV testing.

Methods

A descriptive cross-sectional study was conducted in Harare from April to June 2019. Evaluation of the intervention was conducted using the logic model approach to assess the inputs, processes and outputs. Health workers were interviewed using an interviewer administered questionnaire. Exit interviews were conducted for eligible clients > 18 years who refused to be tested. A checklist was used to assess the inputs used and a desk review of HIV screening and testing records was done.

Results

A total of (n-45) health care workers and (n = 70) clients were interviewed with a response rate of (92%) and (84%) respectively. The median age for clients was 31(Q1 = 24: Q3 = 38) and median years in service for health workers was 2 (Q1 = 1;Q3 = 26). Of the 133,899 clients who were eligible for testing after screening, 98,587 (74%) accepted the test leaving a gap of 35,312 (26%). However, 21/45 (47%) of health workers indicated high workload in the morning as the major reason for the leakage. In addition, 25/70 (36%) of the clients indicated long waiting time as the reason for opting out of HIV testing.

Conclusion and recommendation

HIV testing coverage for eligible clients was not optimal, 26% opted out. We recommend strengthening of health facility systems such as review of patient flow, re-allocation of staff during busy HIV testing time and scaling up the use of HIV self-test kits for clients concerned with waiting time to improve HIV testing coverage.
Moral judgement development during medical student clinical training
Authors: McDonald Jenny , Graves Jane , Abrahams Neeshaan , Thorneycroft Ryan , Hegazi Iman
Published: March 2021

Background

Whereas experience and cognitive maturity drives moral judgement development in most young adults, medical students show slowing, regression, or segmentation in moral development during their clinical years of training. The aim of this study was to explore the moral development of medical students during clinical training.

Methods

A cross-sectional sample of medical students from three clinical years of training were interviewed in groups or individually at an Australian medical school in 2018. Thematic analysis identified three themes which were then mapped against the stages and dimensions of Self-authorship Theory.

Results

Thirty five medical students from years 3–5 participated in 11 interviews and 6 focus groups. Students shared the impacts of their clinical experiences as they identified with their seniors and increasingly understood the clinical context. Their accounts revealed themes of early confusion followed by defensiveness characterised by desensitization and justification. As students approached graduation, some were planning how they would make moral choices in their future practice. These themes were mapped to the stages of self-authorship: External Formulas, Crossroads and Self-authorship.

Conclusions

Medical students recognise, reconcile and understand moral decisions within clinical settings to successfully reach or approach self-authorship. Curriculum and support during clinical training should match and support this progress.
The use of soluble fibre for the management of chronic idiopathic large-bowel diarrhoea in police working dogs
Authors: Alves J. C. , Santos A. , Jorge P. , Pitães A.
Published: March 2021

Background

Chronic intermittent or persistent diarrhoea is a common condition in dogs and may be a reflex of gastrointestinal or non-gastrointestinal disorders. Besides diarrhoea, many athletes experience other gastrointestinal symptoms. Dietary fiber can help normalize colonic motility and transit time, support normal gastrointestinal microflora growth and provide fuel for colonocytes. This study aimed to evaluate dietary supplementation effectiveness with psyllium husk in police working dogs with chronic large-bowel diarrhoea. Twenty-two animals were selected. Concurrent conditions were ruled out through complete blood count and serum biochemistry. FecalClostridiumandSalmonellawere also screened. A soluble fiber, psyllium husk, was added to the diet at the dose of 4 tablespoons/day for 1 month. A daily log of fecal characteristics (type, frequency, and color) was maintained during the supplementation month and for an additional month, without supplementation.

Results

Response to treatment was classified as “very good” in 50% of animals, “good” in 40% of animals, and “poor” in 10% of cases. During the month of psyllium husk supplementation, defecation frequency decreased from 3.5 to 2.9 times a day, with 90% of animals showing consistent stools regularly and registering a mean increase of 2 kg in body weight. Beneficial effects were still observed during the second month, without psyllium husk supplementation.

Conclusion

Psyllium husk can be useful in the management of chronic large-bowel diarrhoea in working dogs, which exhibited lower defecation frequency, improved stool consistency, and gained weight. Effects were felt beyond the supplementation period. Alternative approaches for non-responsive cases need to be evaluated.
Magnetic resonance imaging of the normal dromedary camel tarsus
Authors: Al Mohamad Zakriya Ali , Hagag Usama , Tawfiek Mohamed Gomaa , El Nahas Ayman
Published: March 2021

Background

Magnetic resonance imaging (MRI) is the most versatile and informative imaging modality for the diagnosis of locomotor injuries in many animal species; however, veterinary literature describing the MRI of the dromedary camel tarsus is lacking. Our purpose was to describe and compare the MRI images of twelve cadaveric tarsi, examined in a 1.5 Tesla MRI scanner, with their corresponding anatomical gross sections. Turbo spin-echo (TSE) T1-weighted (T1), T2-weighted (T2), proton density-weighted (PD), and short tau inversion recovery (STIR) sequences were obtained in 3 planes. Tarsi were sectioned in sagittal, dorsal, and transverse planes. MRI images from different sequences and planes were described and compared with the anatomical sections.

Results

The soft and osseous tissues of the dromedary camel tarsus could be clearly defined on MRI images and corresponded extensively with the gross anatomic sections. The obtained MRI images enabled comprehensive assessment of the anatomic relationships among the osseous and soft tissues of the camel tarsus. Several structure were evaluated that cannot be imaged using radiography or ultrasonography, including the transverse inter-tarsal ligaments, the talocalcaneal ligament, the short dorsal ligament, branches of the short medial and lateral collateral ligaments and the tarsometatarsal ligaments. Specific anatomical features regarding the dromedary camel tarsus were identified, including the fused second and third tarsal bone, an additional bundle of the short medial collateral ligament connecting the talus and metatarsus and the medial and lateral limbs of the long plantar ligament.

Conclusions

MRI images provided a thorough evaluation of the normal dromedary camel tarsus. Information provided in the current study is expected to serve as a basis for interpretation in clinical situations.
Carbon monoxide poisoning: a prediction model using meteorological factors and air pollutant
Authors: Ruan Hai-Lin , Deng Wang-Shen , Wang Yao , Chen Jian-Bing , Hong Wei-Liang , Ye Shan-Shan , Hu Zhuo-Jun
Published: March 2021

Background

While the influence of meteorology on carbon monoxide (CO) poisoning has been reported, few data are available on the association between air pollutants and the prediction of CO poisoning. Our objective is to explore meteorological and pollutant patterns associated with CO poisoning and to establish a predictive model.

Results

CO poisoning was found to be significantly associated with meteorological and pollutant patterns: low temperatures, low wind speeds, low air concentrations of sulfur dioxide (SO2) and ozone (O38h), and high daily temperature changes and ambient CO (r absolute value range: 0.079 to 0.232, allPvalues < 0.01). Based on the above factors, a predictive model was established: “logitPj = aj - 0.193 * temperature - 0.228 * wind speed + 0.221 * 24 h temperature change + 1.25 * CO - 0.0176 * SO2+ 0.0008 *O38h; j = 1, 2, 3, 4; a1 = -4.12, a2 = -2.93, a3 = -1.98, a4 = -0.92.” The proposed prediction model based on combined factors showed better predictive capacity than a model using only meteorological factors as a predictor.

Conclusion

Low temperatures, wind speed, and SO2and high daily temperature changes, O38h, and CO are related to CO poisoning. Using both meteorological and pollutant factors as predictors could help facilitate the prevention of CO poisoning.
Integrated analysis of lncRNA–miRNA–mRNA ceRNA network and the potential prognosis indicators in sarcomas
Authors: Gao Lu , Zhao Yu , Ma Xuelei , Zhang Ling
Published: March 2021

Background

Competitive endogenous RNA (ceRNA) networks have revealed a new mechanism of interaction between RNAs, and play crucial roles in multiple biological processes and development of neoplasms. They might serve as diagnostic and prognosis markers as well as therapeutic targets.

Methods

In this work, we identified differentially expressed mRNAs (DEGs), lncRNAs (DELs) and miRNAs (DEMs) in sarcomas by comparing the gene expression profiles between sarcoma and normal muscle samples in Gene Expression Omnibus (GEO) datasets. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analyses were applied to investigate the primary functions of the overlapped DEGs. Then, lncRNA-miRNA and miRNA-mRNA interactions were predicted, and the ceRNA regulatory network was constructed using Cytoscape software. In addition, the protein–protein interaction (PPI) network and survival analysis were performed.

Results

A total of 1296 DEGs were identified in sarcoma samples by combining the GO and KEGG enrichment analyses, 338 DELs were discovered after the probes were reannotated, and 36 DEMs were ascertained through intersecting two different expression miRNAs sets. Further, through target gene prediction, a lncRNA–miRNA–mRNA ceRNA network that contained 113 mRNAs, 69 lncRNAs and 29 miRNAs was constructed. The PPI network identified the six most significant hub proteins. Survival analysis revealed that seven mRNAs, four miRNAs and one lncRNA were associated with overall survival of sarcoma patients.

Conclusions

Overall, we constructed a ceRNA network in sarcomas, which might provide insights for further research on the molecular mechanism and potential prognosis biomarkers.
Reflecting on the current scenario and forecasting the future demand for medical doctors in South Africa up to 2030: towards equal representation of women
Authors: Tiwari Ritika , Wildschut-February Angelique , Nkonki Lungiswa , English René , Karangwa Innocent , Chikte Usuf
Published: March 2021

Background

Increasing feminization of medical professions is well-acknowledged. However, this does not always equate to equitable representation of women within medicine, regarding their socio-demographic indicators, regions, sectors and fields of practice. Thus, this paper quantifies the gap in supply of female medical doctors in relation to demand, towards reaching different gender equity scenarios.

Methods

A retrospective review of the Health Professions Council of South Africa’s (HPCSA) database on registered medical doctors (medical practitioners and medical specialists) from 2002 until 2019 was utilized as an indicator of supply. Descriptive statistics were used to summarize data, and inferential statistics (considering a significance level of 0.05) were utilized to determine the association between the number of male and female doctors, disaggregated by demographic variables. We forecasted future gaps of South African male and female doctors up to 2030, based on maintaining the current male-to-female ratio and attaining an equitable ratio of 1:1.

Results

While the ratio of female doctors per 10 000 population has increased between 2000 and 2019, from 1.2 to 3.2, it remains substantially lower than the comparative rate for male doctors per 10 000 population which increased from 3.5 in 2000 to 4.7 in 2019. Men continue to dominate the medical profession in 2019, representing 59.4% (27,579) of medical doctors registered with the HPCSA with females representing 40.6% (18,841), resulting in a male-to-female ratio of 1:0.7. Female doctors from the Black population group have constantly grown in the medical workforce from 4.4% (2000), to 12.5% (2019). There would be a deficit of 2242 female doctors by 2030 to achieve a 1:1 ratio between male and female medical doctors. An independent-samples t-test revealed that there was a significant difference in the number of male and female doctors. The Kruskal–Wallis test indicated that there was a sustained significant difference in terms of the number of male and female doctors by population groups and geographical distribution.

Conclusions

Based on the investigation, we propose that HRH planning incorporate forecasting methodologies towards reaching gender equity targets to inform planning for production of healthcare workers.
Second trimester maternal serum D-dimer combined with alpha-fetoprotein and free β-subunit of human chorionic gonadotropin predict hypertensive disorders of pregnancy: a systematic review and retrospective case–control study
Authors: Chen Yiming , Chen Yijie , Wang Xue , Chu Xuelian , Ning Wenwen , Gu Linyuan , Li Liyao , Xie Zhen , Wen Caihe
Published: March 2021

Background

This study investigated whether maternal serum D-dimer (DD) alone or DD combined with alpha-fetoprotein (AFP) and free β-subunit of human chorionic gonadotropin (free β-hCG) in the second trimester could be used to predict hypertensive disorders of pregnancy (HDP).

Materials and methods

In this retrospective case–control study, the data of gravidas patients who delivered at hospital were divided into the following groups: control (n = 136), gestational hypertension (GH, n = 126), preeclampsia (PE, n = 53), and severe preeclampsia (SPE, n = 41). Receiver operator characteristic (ROC) curves were used to evaluate the diagnostic value of maternal serum DD, AFP, and free β-hCG levels for HDP.

Results

DD levels of the GH, PE, and SPE groups were significantly higher than that of the control group (P < 0.001). The order of effectiveness for models predicting HDP was as follows: DD + AFP + free β-hCG > DD > DD + AFP > DD + free β-hCG > AFP + free β-hCG > AFP > free β-hCG. For predicting different types of HDP, DD alone had the best diagnostic value for SPE, followed by PE and GH. DD alone had a sensitivity of 100% with a 0% false negative rate and had the highest positive likelihood ratio (+ LR) for SPE. DD alone in combination with AFP alone, free β-hCG alone and AFP + free β-hCG could reduce false positive rate and improve + LR.

Conclusion

DD is possible the best individual predictive marker for predicting HDP. Levels of DD alone in the second trimester were positively correlated with the progression of elevated blood pressure in the third trimester, demonstrating the predicting the occurrence of HDP. The risk calculation model constructed with DD + free β-hCG + AFP had the greatest diagnostic value for SPE.
Comparing the effect of two educational interventions on mothers’ awareness, attitude, and self-efficacy regarding sexual health care of educable intellectually disabled adolescent girls: a cluster randomized control trial
Authors: Goli Shadi , Noroozi Mahnaz , Salehi Mehrdad
Published: March 2021

Background

Sexual problems of intellectually disabled adolescents are associated with their inability to understand sexuality. Given the important role of parents in forming the attitude of their adolescents towards sexuality, the present study aimed to compare the effect of two educational interventions on mothers’ awareness, attitude and self-efficacy regarding sexual health care of intellectually disabled adolescent girls.

Materials and methods

This cluster randomized control trial was conducted in six intellectually disabled adolescent education centers in Isfahan, Iran in 2018. The centers were randomly assigned to intervention groups (group training and training through booklet) and control group. Mothers of educable intellectually disabled adolescent girls (n = 81) were entered into the three groups using convenience sampling and their awareness, attitude and self-efficacy regarding sexual health care of adolescent girls were assessed using questionnaires before and after the educational intervention. Data were analyzed using descriptive and inferential statistical methods.

Results

The mean score of mothers’ awareness, attitude and self-efficacy in each of the “group training”, “training through booklet group” and “control group” was significantly different after the intervention compared to before the intervention (p < 0.05). The mean score of mothers’ awareness and self-efficacy after the intervention in the “group training” was higher than the “control group” and “training through booklet group” (p < 0.001). The mean score of mothers’ awareness and self-efficacy after the intervention in the “training through booklet group” was higher than in “control group” (p = 0.005, p = 0.02). Also, after the intervention, the mean score of mothers’ attitude in the “group training” was higher than the “control group” and the “training through booklet group” (p < 0.001), but there was no significant statistical difference between the mean score of mothers’ attitude in “control group” and “training through booklet group” (p > 0.05).

Conclusion

Implementation of the group training intervention for mothers of intellectually disabled adolescent girls in comparison with training through booklet was associated with a greater increase in their awareness, attitude and self-efficacy regarding sexual health care of adolescent girls. Therefore, group training is suggested as a suitable way to educate mothers about sexual health care of intellectually disabled adolescent girls.

Trial registrationIRCT, IRCT20160224026756N5. Registered 22 June 2018,https://en.irct.ir/user/trial/31704/view.
An integrated community and primary healthcare worker intervention to reduce stigma and improve management of common mental disorders in rural India: protocol for the SMART Mental Health programme
Authors: Daniel Mercian , Maulik Pallab K. , Kallakuri Sudha , Kaur Amanpreet , Devarapalli Siddhardha , Mukherjee Ankita , Bhattacharya Amritendu , Billot Laurent , Thornicroft Graham , Praveen Devarsetty , Raman Usha , Sagar Rajesh , Kant Shashi , Essue Beverley , Chatterjee Susmita , Saxena Shekhar , Patel Anushka , Peiris David
Published: March 2021

Background

Around 1 in 7 people in India are impacted by mental illness. The treatment gap for people with mental disorders is as high as 75–95%. Health care systems, especially in rural regions in India, face substantial challenges to address these gaps in care, and innovative strategies are needed.

Methods

We hypothesise that an intervention involving an anti-stigma campaign and a mobile-technology-based electronic decision support system will result in reduced stigma and improved mental health for adults at high risk of common mental disorders. It will be implemented as a parallel-group cluster randomised, controlled trial in 44 primary health centre clusters servicing 133 villages in rural Andhra Pradesh and Haryana. Adults aged ≥ 18 years will be screened for depression, anxiety and suicide based on Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorders (GAD-7) scores. Two evaluation cohorts will be derived—a high-risk cohort with elevated PHQ-9, GAD-7 or suicide risk and a non-high-risk cohort comprising an equal number of people not at elevated risk based on these scores. Outcome analyses will be conducted blinded to intervention allocation.

Expected outcomes

The primary study outcome is the difference in mean behaviour scores at 12 months in the combined ‘high-risk’ and ‘non-high-risk’ cohort and the mean difference in PHQ-9 scores at 12 months in the ‘high-risk’ cohort. Secondary outcomes include depression and anxiety remission rates in the high-risk cohort at 6 and 12 months, the proportion of high-risk individuals who have visited a doctor at least once in the previous 12 months, and change from baseline in mean stigma, mental health knowledge and attitude scores in the combined non-high-risk and high-risk cohort. Trial outcomes will be accompanied by detailed economic and process evaluations.

Significance

The findings are likely to inform policy on a low-cost scalable solution to destigmatise common mental disorders and reduce the treatment gap for under-served populations in low-and middle-income country settings.

Trial registration

Clinical Trial Registry India CTRI/2018/08/015355. Registered on 16 August 2018.
Monitoring migrant groups as a post-validation surveillance approach to contain the potential reemergence of lymphatic filariasis in Togo
Authors: Dorkenoo Monique Ameyo , Tchankoni Martin Kouame , Yehadji Degninou , Yakpa Kossi , Tchalim Mawèké , Sossou Efoe , Bronzan Rachel , Ekouevi Didier Koumavi
Published: March 2021

Background

In March 2017, Togo was declared the first country in sub-Saharan Africa to eliminate lymphatic filariasis as a public health problem, but post-validation surveillance has been lacking. In some areas of the country, migrant groups from neighboring countries that are still endemic for LF pose a risk of reintroduction of LF to Togo. The objective of this study was to identify the risk posed by migrant groups by measuring their prevalence of LF infection and investigating any positive case using Togo’s case investigation algorithm to prevent resurgence of LF and sustain Togo’s elimination success.

Method

A cross-sectional study was conducted in 2018 in the northernmost region of the country. Three migrant populations were identified: (i) nomadic Peuhls, (ii) Togolese members of local communities who migrate annually to neighboring countries for seasonal labor, and (iii) refugees from Ghana who came to Togo because of a communal conflict in Ghana. A questionnaire was designed to collect data on demographics and history of LF and MDA; all participants were tested for circulating filariasis antigen (CFA) using the filariasis test strip (FTS). Any CFA-positive case was confirmed with nocturnal microfilaremia.

Results

Refugees, seasonal economic migrants and nomadic Peuhls represented 42.1%, 31.4% and 26.5% of the study participants, respectively. The overall prevalence of CFA was 4.2% (58/1391) with the highest prevalence in the nomadic Peuhl group (11.9%), but only one of them (0.07%) was confirmed positive with nocturnal microfilaremia. Using the case investigation algorithm, no other positive case was identified in the positive case’s surroundings.

Conclusion

This study demonstrates that nomadic Peuhls, with a CFA prevalence of 11.9%, pose a potential risk for reintroduction of LF into Togo while Ghanaian refugees and seasonal economic migrants do not appear to pose a significant risk. Periodic monitoring of migrants, especially the nomadic Peuhl population, is a potential post-validation surveillance approach that could be used to promptly detect any LF cluster that may arise.

Graphical Abstract