bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations of longitudinal D-Dimer and Factor II on early trauma survival risk
Authors: Jiang Richard M. , Pourzanjani Arya A. , Cohen Mitchell J. , Petzold Linda
Published: March 2021

Background

Trauma-induced coagulopathy (TIC) is a disorder that occurs in one-third of severely injured trauma patients, manifesting as increased bleeding and a 4X risk of mortality. Understanding the mechanisms driving TIC, clinical risk factors are essential to mitigating this coagulopathic bleeding and is therefore essential for saving lives. In this retrospective, single hospital study of 891 trauma patients, we investigate and quantify how two prominently described phenotypes of TIC, consumptive coagulopathy and hyperfibrinolysis, affect survival odds in the first 25 h, when deaths from TIC are most prevalent.

Methods

We employ a joint survival model to estimate the longitudinal trajectories of the protein Factor II (% activity) and the log of the protein fragment D-Dimer ($$\upmu$$
μ
g/ml), representative biomarkers of consumptive coagulopathy and hyperfibrinolysis respectively, and tie them together with patient outcomes. Joint models have recently gained popularity in medical studies due to the necessity to simultaneously track continuously measured biomarkers as a disease evolves, as well as to associate them with patient outcomes. In this work, we estimate and analyze our joint model using Bayesian methods to obtain uncertainties and distributions over associations and trajectories.

Results

We find that a unit increase in log D-Dimer increases the risk of mortality by 2.22 [1.57, 3.28] fold while a unit increase in Factor II only marginally decreases the risk of mortality by 0.94 [0.91,0.96] fold. This suggests that, while managing consumptive coagulopathy and hyperfibrinolysis both seem to affect survival odds, the effect of hyperfibrinolysis is much greater and more sensitive. Furthermore, we find that the longitudinal trajectories, controlling for many fixed covariates, trend differently for different patients. Thus, a more personalized approach is necessary when considering treatment and risk prediction under these phenotypes.

Conclusion

This study reinforces the finding that hyperfibrinolysis is linked with poor patient outcomes regardless of factor consumption levels. Furthermore, it quantifies the degree to which measured D-Dimer levels correlate with increased risk. The single hospital, retrospective nature can be understood to specify the results to this particular hospital’s patients and protocol in treating trauma patients. Expanding to a multi-hospital setting would result in better estimates about the underlying nature of consumptive coagulopathy and hyperfibrinolysis with survival, regardless of protocol. Individual trajectories obtained with these estimates can be used to provide personalized dynamic risk prediction when making decisions regarding management of blood factors.
Genetic analysis of the barley variegation mutant, grandpa1.a
Authors: Yang Shengming , Overlander Megan , Fiedler Jason
Published: March 2021

Background

Providing the photosynthesis factory for plants, chloroplasts are critical for crop biomass and economic yield. However, chloroplast development is a complicated process, coordinated by the cross-communication between the nucleus and plastids, and the underlying biogenesis mechanism has not been fully revealed. Variegation mutants have provided ideal models to identify genes or factors involved in chloroplast development. Well-developed chloroplasts are present in the green tissue areas, while the white areas contain undifferentiated plastids that are deficient in chlorophyll. Unlike albino plants, variegation mutants survive to maturity and enable investigation into the signaling pathways underlying chloroplast biogenesis. The allelic variegated mutants in barley, grandpa 1 (gpa1), have long been identified but have not been genetically characterized.

Results

We characterized and genetically analyzed the grandpa1.a (gpa1.a) mutant. The chloroplast ultrastructure was evaluated using transmission electron microscopy (TEM), and it was confirmed that chloroplast biogenesis was disrupted in the white sections of gpa1.a. To determine the precise position of Gpa1, a high-resolution genetic map was constructed. Segregating individuals were genotyped with the barley 50 k iSelect SNP Array, and the linked SNPs were converted to PCR-based markers for genetic mapping. The Gpa1 gene was mapped to chromosome 2H within a gene cluster functionally related to photosynthesis or chloroplast differentiation. In the variegated gpa1.a mutant, we identified a large deletion in this gene cluster that eliminates a putative plastid terminal oxidase (PTOX).

Conclusions

Here we characterized and genetically mapped the gpa1.a mutation causing a variegation phenotype in barley. The PTOX-encoding gene in the delimited region is a promising candidate for Gpa1. Therefore, the present study provides a foundation for the cloning of Gpa1, which will elevate our understanding of the molecular mechanisms underlying chloroplast biogenesis, particularly in monocot plants.
Direct healthcare resource utilisation, health-related quality of life, and work productivity in patients with moderate rheumatoid arthritis: an observational study
Authors: Galloway James , Edwards Julie , Bhagat Shweta , Parker Ben , Tan Ai Lyn , Maxwell James , Wallington Mike , Blanthorn-Hazell Sophee , Bellamy Claire , Cole Zoe
Published: March 2021

Background

The aim was to describe the population of patients with moderate rheumatoid arthritis (RA) in the United Kingdom and the burden of disease from the perspectives of the patient, caregiver, and health service.

Methods

In this descriptive study, retrospective patient-level data were extracted from hospital medical records to assess healthcare resource utilisation and validated outcome measures were administered via questionnaire to patients with moderate RA (Disease Activity Score [DAS28] between 3.2 and 5.1) from eight secondary care centres, and their caregivers. Patient-reported outcome instruments were scored according to licensed manuals.

Results

Outcome measures were completed by 102 patients and 38 caregivers. The mean EuroQoL-5 dimension-5 level crosswalk index value for patients was 0.62 (SD 0.24) compared to an England population norm of 0.82. Mean pain VAS score was 37.7 (SD 24.0) and mean Health Assessment Questionnaire Disability Index was 1.1 (SD 0.8). In employed patients who completed the Work Productivity and Activity Impairment questionnaire (n = 26), a mean 29% (SD 26%) reduction in work productivity was recorded. Patients experienced significant fatigue as a result of their RA (median Functional Assessment of Chronic Illness Therapy fatigue score 17.2 of a possible 52, interquartile range [IQR] 11.0–28.8). Over 50% of caregivers reported providing > 7 h of support care per week to the patient with RA, and 16 and 11% took paid/unpaid leave or reduced working hours, respectively. Mean Caregiver Reaction Assessment subscale scores were 1.9 (SD 0.9) for finance, 1.7 (SD 0.8) for health, 2.3 (SD 1.0) for schedule disruption, and 1.9 (SD 0.8) for family support. Patients had a mean 5.5 (SD 4.1) outpatient attendances and a median 9.0 (IQR 2.0–20.0) diagnostic and monitoring tests in the 12 months prior to enrolment.

Conclusions

This study shows that moderate RA has a considerable impact on healthcare resources and on patients’ and caregivers’ lives. There is scope to improve the management of patients with moderate RA.
Interrater reliability for unilateral and bilateral tests to measure the popliteal angle in children and youth with cerebral palsy
Authors: Cloodt Erika , Krasny Joanna , Jozwiak Marek , Rodby-Bousquet Elisabet
Published: March 2021

Background

Short hamstring muscles can cause several problems for children with cerebral palsy. The results of the clinical measurement of hamstring length are often used in decision-making about treatment of children with cerebral palsy. There are different ways of performing this measurement. The aim of this study was to evaluate the interrater reliability of the unilateral and bilateral measurement of the popliteal angle in children and youth with cerebral palsy.

Methods

Two methods for estimating hamstring length using unilateral and bilateral measurements of the popliteal angle were applied in children with cerebral palsy. Both tests were applied bilaterally by two independent examiners on the same day for each child. The intraclass correlation coefficient (ICC) was calculated to evaluate the interrater reliability of both measurements. Seventy young people with cerebral palsy (32 females, 38 males, mean age 10 years 8 months, range 5–22 years) at Gross Motor Function Classification System levels I (n = 17), II (n = 31), III (n = 12) and IV (n = 10) were included.

Results

The interrater reliability was good for both measurements. The ICC values were 0.80 on the right and 0.86 on the left for the unilateral popliteal angle, and 0.82 on the right and 0.83 on the left for the bilateral popliteal angle.

Conclusions

Both unilateral and bilateral measurement of the popliteal angle is a reliable method for estimating hamstring length in children and youth with cerebral palsy.
Finite element analysis of double‐plate fixation using reversed locking compression‐distal femoral plates for Vancouver B1 periprosthetic femoral fractures
Authors: Takahashi Daisuke , Noyama Yoshihiro , Asano Tsuyoshi , Shimizu Tomohiro , Irie Tohru , Terkawi Mohamad Alaa , Iwasaki Norimasa
Published: March 2021

Background

Internal fixation is recommended for treating Vancouver B1 periprosthetic femoral fractures. Although several fixation procedures have been developed with high fixation stability and union rates, long-term weight-bearing constructs are still lacking. Therefore, the aim of the present study was to evaluate the stability of a double-plate procedure using reversed contralateral locking compression-distal femoral plates for fixation of Vancouver B1 periprosthetic femoral fractures under full weight-bearing.

Methods

Single- and double-plate fixation procedures for locking compression-distal femoral plates were analysed under an axial load of 1,500 N by finite element analysis and biomechanical loading tests. A vertical loading test was performed to the prosthetic head, and the displacements and strains were calculated based on load-displacement and load-strain curves generated by the static compression tests.

Results

The finite element analysis revealed that double-plate fixation significantly reduced stress concentration at the lateral plate place on the fracture site. Under full weight-bearing, the maximum von Mises stress in the lateral plate was 268 MPa. On the other hand, the maximum stress in the single-plating method occurred at the defect level of the femur with a maximum stress value of 1,303 MPa. The principal strains of single- and double-plate fixation were 0.63 % and 0.058 %, respectively. Consistently, in the axial loading test, the strain values at a 1,500 N loading of the single- and double-plate fixation methods were 1,274.60 ± 11.53 and 317.33 ± 8.03 (× 10− 6), respectively.

Conclusions

The present study suggests that dual-plate fixation with reversed locking compression-distal femoral plates may be an excellent treatment procedure for patients with Vancouver B1 fractures, allowing for full weight-bearing in the early postoperative period.
Case series and review of Ayurvedic medication induced liver injury
Authors: Karousatos Christopher M. , Lee Justin K. , Braxton David R. , Fong Tse-Ling
Published: March 2021

Background

Complementary and alternative medicine use among Americans is prevalent. Originating in India, Ayurvedic medicine use in the United States has grown 57% since 2002. CAM accounts for a significant proportion of drug induced liver injury in India and China, but there have been only three reports of drug induced liver injury from Ayurvedic medications in the U.S. We report three cases of suspected Ayurvedic medication associated liver injury seen at a Southern California community hospital and review literature of Ayurvedic medication induced liver injury.

Case presentations

Three patients presented with acute hepatocellular injury and jaundice after taking Ayurvedic supplements for 90–120 days. First patient took Giloy Kwath consisting solely of Tinospora cordifolia. Second patient took Manjishthadi Kwatham and Aragwadhi Kwatham, which contained 52 and 10 individual plant extracts, respectively. Third patient took Kanchnar Guggulu, containing 10 individual plant extracts. Aminotransferase activities decreased 50% in < 30 days and all 3 patients made a full recovery. Roussel Uclaf Causality Assessment Method (RUCAM) scores were 7–8, indicating probable causality. These products all contained ingredients in other Ayurvedic and traditional Chinese medicines with previously reported associations with drug induced liver injury.

Conclusions

These patients highlight the risk of drug induced liver injury from Ayurvedic medications and the complexity of determining causality. There is a need for a platform like LiverTox.gov to catalog Ayurvedic ingredients causing liver damage.
Cost-effectiveness of screening of coronary artery disease in patients with type 2 DIABetes at a very high cardiovascular risk (SCADIAB study) rational and design
Authors: Mohammedi Kamel , Préaubert Nathalie , Cariou Tanguy , Rigalleau Vincent , Foussard Ninon , Piazza Laurent , Bairras-Martin Céline , Couffinhal Thierry , Bezin Julien , Benard Antoine
Published: March 2021

Background

Screening for coronary artery disease (CAD) remains broadly performed in patients with type 2 diabetes (T2DM), although the lack of evidence. We conduct a real-world evidence (RWE) study to assess the risk of major clinical outcomes and economic impact of routine CAD screening in T2DM individuals at a very high cardiovascular risk.

Methods

SCADIAB is a comparative nationwide cohort study using data from the French National Health Data System. The main inclusion criteria are: age ≥ 40 years, DT2 diagnosed for ≥ 7 years, with ≥ 2 additional cardiovascular risk factors plus a history of microvascular or macrovascular disease, except CAD. We estimated ≥ 90,000 eligible participants for our study. Data will be extracted from 01/01/2008 to 31/12/2019. Eligible participants will be identified during a first 7-year selection period (2008–2015). Each participant will be assigned either in experimental (CAD screening procedure during the selection period) or control group (no CAD screening) on 01/01/2015, and followed for 5 years. The primary endpoint is the incremental cost per life year saved over 5 years in CAD screening group versus no CAD screening. The main secondary endpoints are: total 5-year direct costs of each strategy; incidence of major cardiovascular (acute coronary syndrome, hospitalization for heart failure, coronary revascularization or all-cause death), cerebrovascular (hospitalization for transient ischemic attack, stroke, or carotid revascularization) and lower-limb events (peripheral artery disease, ischemic diabetic foot, lower-limb revascularization or amputation); and the budget impact for the French Insurance system to promote the cost-effective strategy. Analyses will be adjusted for a high-dimension propensity score taking into account known and unknown confounders. SCADIAB has been funded by the French Ministry of Health and the protocol has been approved by the French ethic authorities. Data management and analyses will start in the second half of 2021.

Discussion

SCADIAB is a large and contemporary RWE study that will assess the economic and clinical impacts of routine CAD screening in T2DM people at a very high cardiovascular risk. It will also evaluate the clinical practice regarding CAD screening and help to make future recommendations and optimize the use of health care resources.

Trial registration ClinicalTrials.gov Identifier: NCT04534530 (https://clinicaltrials.gov/ct2/show/NCT04534530)
Impact of glycemic control on the association of endothelial dysfunction and coronary artery disease in patients with type 2 diabetes mellitus
Authors: Chen Shuai , Shen Ying , Liu Yong-Hua , Dai Yang , Wu Zhi-Ming , Wang Xiao-Qun , Yang Chen-Die , Li Le-Ying , Liu Jing-Meng , Zhang Li-Ping , Shen Wei-Feng , Ji Ri , Lu Lin , Ding Feng-Hua
Published: March 2021

Background

We investigated whether glycemic control affects the relation between endothelial dysfunction and coronary artery disease in patients with type 2 diabetes mellitus (T2DM).

Methods

In 102 type 2 diabetic patients with stable angina, endothelial function was evaluated using brachial artery flow-mediated dilation (FMD) with high-resolution ultrasound, and significant stenosis of major epicardial coronary arteries (≥ 50% diameter narrowing) and degree of coronary atherosclerosis (Gensini score and SYNTAX score) were determined. The status of glycemic control was assessed by blood concentration of glycated hemoglobin (HbA1c).

Results

The prevalence of significant coronary artery stenosis (67.9% vs. 37.0%, P = 0.002) and degree of coronary atherosclerosis (Gensini score: 48.99 ± 48.88 vs. 15.07 ± 21.03, P < 0.001; SYNTAX score: 15.88 ± 16.36 vs. 7.28 ± 10.54, P = 0.003) were higher and FMD was lower (6.03 ± 2.08% vs. 6.94 ± 2.20%, P = 0.036) in diabetic patients with poor glycemic control (HbA1c ≥ 7.0%; n = 56) compared to those with good glycemic control (HbA1c < 7.0%; n = 46). Multivariate regression analysis revealed that tertile of FMD was an independent determinant of presence of significant coronary artery stenosis (OR = 0.227 95% CI 0.056–0.915, P = 0.037), Gensini score (β =  − 0.470, P < 0.001) and SYNTAX score (β =  − 0.349, P = 0.004) in diabetic patients with poor glycemic control but not for those with good glycemic control (P > 0.05).

Conclusion

Poor glycemic control negatively influences the association of endothelial dysfunction and coronary artery disease in T2DM patients.
Safety and feasibility of total laparoscopic radical resection of Siewert type II gastroesophageal junction adenocarcinoma through the left diaphragm and left thoracic auxiliary hole
Authors: Huang Yun , Liu Gang , Wang Xiumei , Zhang Yan , Zou Guijun , Zhao Zhanwei , Cao Zhen , Zhao Huibin , Yuan Xinpu , Zhang Chaojun
Published: March 2021

Background

The incidence of adenocarcinoma of the esophagogastric junction (AEG) is rising every year; however, the mode of operation for Siewert II AEG is still controversial. Accumulating evidence has shown that transabdominal surgery is better than transthoracic surgery for Siewert II AEG with esophageal invasion < 3 cm. In patients with obesity, a large tumor size, and high transection of the esophagus, the transabdominal esophageal hiatus approach for lower mediastinal lymph node dissection and posterior mediastinal anastomosis is difficult. Thus, total laparoscopic radical resection of Siewert II AEG is carried out through the left diaphragm and left chest auxiliary hole for the optimal surgical field of vision and space. In this prospective study, we assessed the feasibility of carrying out the procedure abdominally through the left diaphragm and auxiliary hole.

Methods

Ten patients with Siewert II AEG were recruited between April and June 2019. Siewert II AEG was treated by total laparoscopy through the left diaphragm and left chest auxiliary hole. Clinicopathological features, surgical data, and adverse events were collected and analyzed in this prospective study.

Results

The average duration of the operation was 348 ± 37.52 min, lower mediastinal dissection took 20.6 min, the OrVil anastomosis time was 29.8 min, the time necessary to suture the seromuscular layer through the left thoracic auxiliary hole was 11 min, the safety margin was 3.2 cm, and the total number of lymph nodes dissected was 40.6. The number of lower mediastinal lymph nodes dissected was 6.2. The rate of lymph node metastasis in the N110 group was 9 ± 12.45%, and the average intraoperative blood loss was 170 ± 57.47 mL. No anastomotic leakage or anastomotic stricture occurred after the operation. The time of intestinal function recovery was 2 days, and the first time of enteral nutrition through a jejunal nutrition tube was 2.4 days. No tumor recurrence was found in 10 patients at 1 year postoperatively.

Conclusion

Total laparoscopic radical resection through the left diaphragm and left thoracic auxiliary hole for Siewert II AEG patients is feasible and safe. Thus, it may be a good surgical alternative for patients with esophageal tumors invading less than 3 cm.

Trial registration

ChiCTR, ChiCTR2000034286. Registered 8 July 2020, http://www.chictr.org.cn/showproj.aspx?proj=55866.
Frank haematuria secondary to ruptured pseudoaneurysm of the inferior vesical artery: a case report and review of the literature
Authors: Suoub Mohammed , Talahmeh Ghassan , Abdelraouf Salah , Sawaqed Fadi
Published: March 2021

Background

Pseudoaneurysm of a vesical artery is an extremely rare iatrogenic complication; however, it may cause fatal haematuria.

Case presentation

A 21-year-old Arab Jordanian male had multiple optical urethrotomies for an iatrogenic urethral stricture after he had rectal surgery for Hirschsprung’s disease at the age of 2 years. During one of his admissions to the Emergency Room (ER) with urinary retention, an attempt at suprapubic catheter insertion was complicated by massive bleeding at the insertion site of the catheter. Abdominal exploration showed a distended urinary bladder with clots and bleeding seen at the bladder neck that was controlled with multiple sutures. The patient rebled again two times; the first was controlled with cystoscopy and cautery for a pulsatile bleeder seen at the bladder neck. The second time, the patient required blood transfusion of three units of packed red blood cells. Angiography was performed, and a pseudoaneurysm at the base of the urinary bladder from the inferior vesical artery was diagnosed, which was controlled by embolization.

Conclusion

Pulsatile bladder haemorrhage following urological intervention is suggestive of pseudoaneurysm or arteriovesical fistula, and angiography with embolization is recommended.
Wild radish (Raphanus sativus var. hortensis f. raphanistroides) root extract protects neuronal cells by inhibiting microglial activation
Authors: Do Moon Ho , Kim Mina , Choi Sang-Yoon , Lee Pyeongjae , Kim Yoonsook , Hur Jinyoung
Published: March 2021

External stimulus-induced activation of microglia plays an important role in the protection of neurons in the central nervous system; however, over-activation of microglia could cause neuronal damage, and it is implicated in the pathogenesis of neurodegenerative diseases. The aim of the present study was to investigate the effects of wild radish (Raphanus sativus var. hortensis f. raphanistroides) root extract (WRE) on microglial over-activation. Mouse microglia BV-2 cells and rat primary microglia were stimulated with lipopolysaccharide (LPS), treated with WRE, and analyzed for nitric oxide (NO) production, pro-inflammatory cytokine secretion, inducible NO synthase (iNOS) expression, and p38 kinase phosphorylation. Human neuroblastoma SH-SY5Y cells were treated with microglia-conditioned medium and analyzed for cell viability. Stimulation with LPS increased NO production and iNOS expression in BV-2 cells and primary microglia, but the treatment with WRE decreased both. Furthermore, WRE downregulated the mRNA expression and secretion of inflammatory cytokines interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α), and inhibited the phosphorylation of p38 in LPS-activated microglia. Treatment with the conditioned medium of LPS-induced BV-2 cells decreased the viability of SH-SY5Y cells, but the damaging effect was significantly alleviated in cells treated with the conditioned medium of LPS plus WRE-cultured microglia. This indicated that the WRE treatment of microglia could protect neuronal cells from microglial activation-induced neurotoxicity. WRE may be a potential food product to attenuate neuroinflammation via the inhibition of microglial over-activation, which can slow down the neurodegenerative processes in the brain.
Mediators Linking Maternal Weight to Birthweight and Neonatal Fat Mass in Healthy Pregnancies
Authors: Kristiansen Oddrun , Zucknick Manuela , Reine Trine M , Kolset Svein O , Jansson Thomas , Powell Theresa L , Haugen Guttorm , Henriksen Tore , Michelsen Trond M
Published: March 2021

Context

Lifestyle interventions have not efficaciously reduced complications caused by maternal weight on fetal growth, requiring insight into explanatory mediators.

Objective

We hypothesized that maternal mediators, including adiponectin, leptin, insulin, and glucose, mediate effects of pregestational BMI (pBMI) and gestational weight gain (GWG) on birthweight and neonatal fat mass percentage (FM%) through placental weight and fetal mediators, including insulin levels (Ifv) and venous-arterial glucose difference (ΔGfva). Hypothesized confounders were maternal age, gestational age, and parity.

Methods

A cross-sectional study of healthy mother-offspring-pairs (n = 165) applying the 4-vessel in vivo sampling method at Oslo University Hospital, Norway. We obtained pBMI, GWG, birthweight, and placental weight. FM% was available and calculated for a subcohort (n = 84). We measured circulating levels of adiponectin, leptin, glucose, and insulin and performed path analysis and traditional mediation analyses based on linear regression models.

Results

The total effect of pBMI and GWG on newborn size was estimated to be 30 g (range, 16-45 g) birthweight and 0.17 FM% (range, 0.04-0.29 FM%) per kg∙m–2 pBMI and 31 g (range, 18-44 g) and 0.24 FM% (range, 0.10-0.37 FM%) per kg GWG. The placental weight was the main mediator, mediating 25-g birthweight and 0.11 FM% per kg∙m–2 pBMI and 25-g birthweight and 0.13 FM% per kg GWG. The maternal mediators mediated a smaller part of the effect of pBMI (3.8-g birthweight and 0.023 FM% per kg∙m–2 pBMI) but not GWG.

Conclusion

Placental weight was the main mediator linking pBMI and GWG to birthweight and FM%. The effect of pBMI, but not GWG, on birthweight and FM%, was also mediated via the maternal and fetal mediators.
Effect of displacement on Adherence to TB Treatment: An observational study in TB patients from Internally Displaced Persons of Pakistan
Authors: Khan Farman Ullah , Asghar Zahid , Tipu Muhammad Khalid , Rehman Asim .ur. , Khan Asif , Rehman Tofeeq Ur-
Published: March 2021

Objective: This study was aimed to investigate TB patients adherence and treatment outcomes among internally displaced patients in comparison with adjacent settled areas.

Methods: The study was designed as an observational cross-sectional study among the TB patients of internally displaced populations (IDPs) of North Waziristan Agency (NWA) and adjacent settled areas of Bannu and Lakki Marwat (NIDPs). Based on the study inclusion and exclusion criteria 330 patients fullfilled the inclusion criteria and were assigned equally to both IDPs and NIDPs study groups. Odds ratio (OR) with 95% confidence interval was calculated and p-values, 0.05 were considered statistically significant.

Results: The treatment outcomes with the status of “cured” and “completed treatment” were better among NIDPs as compared to IDPs. Patients with treatment outcome status of “defaulted treatment”, “without documentary evidence, and “failure” were high in IDPs as compared to NIDPs. Adherence to TB treatment was better among NIDPs (50.9%) as compared to IDPs (39.4%). The patients showing non-adherence to TB treatment were more among IDPS (27.3%) than NIDPs (10.9%).

Conclusion: Overall results of this study revealed a poor adherence to the TB treatment medications with an odds ratio of 0.286, (p<0.05) among IDPs as compared with NIDPs.

doi: https://doi.org/10.12669/pjms.37.3.2992

How to cite this:Khan FU, Asghar Z, Tipu MK, Asim.ur.Rehman, Khan A, Tofeeq Ur-Rehman. Effect of displacement on Adherence to TB Treatment: An observational study in TB patients from Internally Displaced Persons of Pakistan. Pak J Med Sci. 2021;37(3):675-679.  doi: https://doi.org/10.12669/pjms.37.3.2992

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Screening of ZIKA virus infection among dengue-like illness patients with negative RT-PCR for dengue virus in Punjab–Pakistan
Authors: Iqtadar Somia , Vo Thuan Huu , Mehmood Mehreen , Salman Muhammad , Malik Mamunur Rahman , Masud Faisal , Minh Nhu Nguyen Tran
Published: March 2021

Objective: To detect ZIKV using reverse transcription-polymerase chain reaction (RT-PCR) among clinical samples tested negative for Dengue virus (DENV) by RT-PCR in Punjab, 2016.

Methods: A descriptive cross-sectional study was carried out for duration of two months. Total of 506 samples were collected within seven days from onset of illness from all over hospitals of Punjab, Pakistan of which 350 were selected simply randomly to test for presence of ZIKV by using “Trioplex Real-Time RT-PCR Assay (Trioplex)”. Cohen’s kappa coefficient (κ) and 95% confidence interval (CI) were used to assess the degree of concordance between DENV positive results of non-structural protein 1 (NS1) and IgM solid-phase enzyme immunoassay (ELISA).

Results: No samples were positive for any ZIKV, DENV or Chikungunya virus (CHIKV) by Trioplex. Among the 350 samples, 26 samples were positive concordant and the degree of concordance between NS1- and IgM-ELISA was 13% and κ coefficient was -0.71 (95% CI -0.79, -0.63).

Conclusion: At study time, no samples were positive for ZIKV. Strengthening laboratory capacity to confirm arboviruses for Punjab’s laboratories is warranted. Trioplex RT-PCR has 100% sensitivity so there are nominal chances of false negative results. Establishing syndromic surveillance for Zika and conducting a sero-surveillance survey for Zika in areas with high human and Aedes mosquito density are recommended in Punjab.

List of Abbreviations: ZIKV: Zika virus, DENV: Dengue virus, CI: Confidence interval, NS1: Non-structural protein 1, HRP: Horseradish peroxidase, IQR: interquartile range, CHIKV: Chikungunya virus, YF: Yellow fever, JE: Japanese encephalitis, PoE: Points of entry.

doi: https://doi.org/10.12669/pjms.37.3.3369

How to cite this:Iqtadar S, Vo TH, Mehmood M, Salman M, Malik MR, Masud F, et al. Screening of ZIKA virus infection among dengue-like illness patients with negative RT-PCR for dengue virus in Punjab–Pakistan. Pak J Med Sci. 2021;37(3):721-726. doi: https://doi.org/10.12669/pjms.37.3.3369

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Η Παιδαγωγική αξία της Ολυμπιακής Παιδείας
Authors: Μακρής Αλέξανδρος , Γεωργιάδης Κωνσταντίνος , Μουντάκης Κωνσταντίνος
Published: March 2021

Σκοπός της παρούσας εργασίας είναι να μελετηθεί εάν η Ολυμπιακή Παιδεία στηρίζεται στις ιστορικές και παιδαγωγικές βάσεις του Ολυμπισμού, αλλά και σε σύγχρονα εκπαιδευτικά συστήματα και αντιλήψεις. Ως όρος εμφανίστηκε στις αρχές της δεκαετίας του ’70. Ο σκοπός και οι στόχοι της πηγάζουν από τις αρχές του Ολυμπισμού και εκφράζεται μέσα από το τρίπτυχο παιδεία–αθλητισμός– πολιτισμός. Από τις αρχές της δεκαετίας του ’90, αρκετοί επιστήμονες και ερευνητές άρχισαν να παρουσιάζουν τις βασικές αρχές της Ολυμπιακής Παιδείας, στις οποίες υπάρχει μια γενικότερη ταύτιση στις ιδέες των περισσότερων εκφραστών της. Σύμφωνα με τα αποτελέσματα της έρευνας, η παιδαγωγική αξία της Ολυμπιακής Παιδείας έχει τα εξής χαρακτηριστικά: α) ο σκοπός και οι στόχοι της στηρίζονται στον Ολυμπιακό Χάρτη, στις ιστορικές βάσεις του Ολυμπισμού, λαμβάνοντας υπόψη το σύγχρονο τρόπο ζωής και τις κοινωνικές εξελίξεις, β) το περιεχόμενο προάγει τη διαθεματικότητα/διεπιστημονικότητα και γ) η διδακτική της προσέγγιση στηρίζεται σε ομαδο-συνεργατικά μοντέλα διδασκαλίας που ως χαρακτηριστικό έχουν τη βιωματική μάθηση.
Το μεταρρυθμιστικό έργο του Παιδαγωγικού Ινστιτούτου και του Κέντρου Εκπαιδευτικών Μελετών και Επιμορφώσεως στη Φυσική Αγωγή (1964-2012)
Authors: Λάμπρου Χρήστος , Μπουρνέλλη Παγώνα , Νομικός Νικήτας , Μελίστας Νίκος
Published: March 2021

Η παρούσα εργασία εστιάζει στη συγκέντρωση και επεξεργασία στοιχείων, τα οποία αφορούν στο έργο που συντελέσθηκε από τα στελέχη του Παιδαγωγικού Ινστιτούτου (Π.Ι.) και του Κέντρου Εκπαιδευτικών Μελετών και Επιμορφώσεως (Κ.Ε.Μ.Ε.) ως υπευθύνων για το μάθημα της Φυσικής Αγωγής (Φ.Α.). Η περίοδος που μελετάται αφορά συνολικά στο χρονικό διάστημα λειτουργίας του Π.Ι. και του K.Ε.Μ.Ε., δηλαδή από το 1964 μέχρι το 2012. Για τη μελέτη της Φ.Α. το διάστημα αυτό χωρίσθηκε στις παρακάτω περιόδους: α) 1964-1967: Περίοδος κατά την οποία ο υπεύθυνος της Φ.Α., Ίωνας Ιωαννίδης, επιχειρεί τη στροφή της ελληνικής Φ.Α. από το σουηδικό σύστημα γυμναστικής προς την Αγωνιστική και με τον στόχο αυτό γράφονται τα Αναλυτικά Προγράμματα (Α.Π.) αυτής της περιόδου. β) 1967-1974: Περίοδος της στρατιωτικής δικτατορίας, οπότε το Π.Ι. καταργείται και οι μεταρρυθμίσεις στη Φ.Α. και στην παιδεία γενικότερα οπισθοδρομούν. γ) 1974-1975: Μετά το πέρας της δικτατορίας καταργούνται οι Γυμναστικές Επιδείξεις, ενώ παράλληλα τα έτη φοίτησης στην Εθνική Ακαδημία Σωματικής Αγωγής (Ε.Α.Σ.Α.) αυξάνονται σε τέσσερα. δ) 1976-1988: πραγματοποιείται αναμόρφωση των Α.Π. της Φ.Α., θέσπιση και λειτουργία εβδομαδιαίων αθλητικών δραστηριοτήτων, καθώς και προώθηση των μεταρρυθμίσεων, τις οποίες θεώρησαν απαραίτητες οι Σχολικοί Σύμβουλοι. Υπεύθυνος του μαθήματος της Φ.Α. στο Κ.Ε.Μ.Ε./Π.Ι. για αυτή την περίοδο ήταν ο Ιωάννης Σκορδίλης. ε) 1988-1997: Αναμόρφωση των Α.Π. της Πρωτοβάθμιας και της Δευτεροβάθμιας εκπαίδευσης και συγγραφή ενός βιβλίου Φυσικής Αγωγής για την Πρωτοβάθμια εκπαίδευση. στ) 1997-2005: Τα Α.Π. εκσυγχρονίσθηκαν σύμφωνα με τις διεθνείς θεωρίες της Κινητικής Μάθησης και της Παιδαγωγικής. Ιδιαίτερη βαρύτητα δόθηκε στην Πρωτοβάθμια εκπαίδευση, αφού το μάθημα καθιερώθηκε να διδάσκεται μόνο από εκπαιδευτικούς Φ.Α. Σταθμό για το μάθημα αποτελεί η παραγωγή πλούσιου διδακτικού υλικού για το Δημοτικό και το Γυμνάσιο. Την περίοδο αυτή υπεύθυνος του μαθήματος Φ.Α. στο Π.Ι. ήταν ο Κώστας Μουντάκης, ενώ σοβαρό ρόλο την περίοδο αυτή έπαιξε και η συμβολή του τότε Σχολικού Συμβούλου Θεσσαλονίκης, Ιωάννη Σεραφειμίδη. ζ) 2007-2012: Περίοδος κατά την οποία υπεύθυνος του μαθήματος της Φυσικής Αγωγής ήταν ο Πάρεδρος με θητεία, Σταύρος Τσόνιας, ο οποίος συνέχισε τις προσπάθειες των προκατόχων του.
Right Against Exploitation under Article 24 of the Indian Constitution
Authors: Pande Nishant
Published: March 2021

Article 24 of the Constitution prohibits the employment of children in hazardous environments. The provision is worded in a manner that allows horizontal application of the right guaranteed thereby. However, the Hon’ble Supreme Court of India’s method of applying this horizontal right is obscure. On one hand, the Court in People’s Union for Democratic Rights v. Union of India indulged in a direct horizontal application of the right conferred under the Article, while on the other hand, the Court in the case of M. C. Mehta v. State of Tamil Nadu, undertook a combined indirect horizontal and vertical application of the Article. This paper attempts to identify the exact manner of applicability of the right under Article 24, by tracing its development, with specific reference to the Supreme Court’s interpretation of the same. Further, this paper explores the possibility of reading the right against exploitation in a more inclusive manner, as has been done for right to life under Article 21. The author has been inspired by the International community’s perception of child labour, specifically, the Constitution of Ireland and the Bill of Rights of South Africa, in putting forward arguments to augment the expansion of the scope of Article 24.
Maratha Reservation in Maharashtra: A Challenge to the Principles of Equality
Authors: Agarwal Kartik
Published: March 2021

The Maharashtra Government has passed a Special Educational and Backward class Act, 2018 to provide additional reservation for Marathas. Article 15(4) and 16(4) authorizes the State to provide reservation for backward classes. However, the same has to be exercised in a very cautious manner. The judicial approach towards reservation has resulted in the evolution of numerous requirements that are mandated to be fulfilled, while providing reservation. This includes, inter alia, a ceiling limit of 50%, inadequacy of representation and quantifiable data. Maratha reservation took the total reservation count in the state to 68%, which is way ahead of the ceiling limit. The step was considered to be more towards appeasing politically influential Marathas than to do justice to them. Upon being challenged in Bombay High Court, the court upheld the reservation and gave a justification for the existence of extraordinary circumstances in favour of reservation for Marathas. This paper aims to constitutionally analyze the said Act, to understand whether the Marathas fulfil all the abovementioned yardsticks of ‘backwardness’. The paper also aims to determine whether creating a separate class for Marathas is justifiable or not.
Wandering intrauterine contraceptive device: an unusual case of migration to the sigmoid colon
Authors: Samara Elpida , Howe-Bush Kerry , Portet Mark , Howlett David C
Published: March 2021

An intrauterine device is a well-tolerated and widely used contraceptive method. A rare but major complication is perforation of the uterus and migration into the sigmoid colon. In this case report, a 33-year-old woman presented for follow up after placement of a copper-T intrauterine device 4 months previously. A clinical examination found significant tenderness on palpation, and the threads could not be detected. An ultrasound was conducted, which revealed no coil in the uterine cavity. The pelvic x-ray found it in the mid-pelvis and pelvic magnetic resonance imaging confirmed the position of the T-component at the mid-sigmoid colon. The patient underwent a sigmoidoscopy, which confirmed the position in the sigmoid colonic wall. The device was removed with an endoscopy without further complications. Uterine perforation and translocation to the sigmoid colon is an unusual complication of an intrauterine device. Removal of a translocated intrauterine device is recommended in all symptomatic cases.
ECG of the month
Authors: Regan Martin
Published: March 2021

In this issue's ECG of the month, Martin Regan presents part two of a case of a 50-year-old man with an implantable cardioverter defibrillator and a history of arrhythmogenic right ventricular cardiomyopathy.
Transcatheter aortic valve implantation is still inappropriate in low-risk, young patients: a UK perspective
Authors: Luthra Suvitesh , Ohri Sunil K
Published: March 2021

The PARTNER 3 and Evolut LRT trials have provided the evidence base for transcatheter aortic valve implantation in low-risk patients. However, there are still issues with durability, long-term follow up and complications before their widespread use can be considered appropriate in this group.
Antibiotic stewardship in UK surgical departments: challenges and possible solutions
Authors: Callan Rory , Loud Emily
Published: March 2021

Antibiotics are one of the most widely used classes of drugs within hospitals in the UK. They have a wide range of uses within all surgical specialties, both as preoperative prophylaxis and for treatment of acute surgical conditions. Antimicrobial resistance has increasingly been seen as a major issue, as the production of new antibiotics has decreased and overall use worldwide has increased. With the COVID-19 pandemic increasing concerns about antimicrobial resistance, there is an ever-increasing need for action. This article examines the particular challenges of antibiotic stewardship in surgical departments within the UK, and outlines possible solutions for improving adherence and reducing the risk of antimicrobial resistance in the future.
Cutaneous T-cell lymphoma: practical recommendations to enhance clinical practice
Authors: Howles Allison , Scarisbrick Julia
Published: March 2021

Management of cutaneous T-cell lymphoma should provide a holistic approach to a patient's wellbeing. Treatments depend on the stage of lymphoma. Patients with the early stages tend to have a near-normal life expectancy. Management should be aimed at improving the extent of disease and reducing symptoms with minimal therapeutic adverse effects. Skin-directed treatments are preferred and may be used in combination with treatments for symptom relief such as anti-pruritic medication. In advanced stages of disease where the median life expectancy is reduced the aims are also to prevent disease progression and prolong life, and this requires a multidisciplinary approach. Symptom control remains important as patients often have painful, itchy disfiguring lesions which greatly impact on health-related quality of life.

National and international guidelines provide stage-related treatment options to be considered with first-line options followed by subsequent second-line therapies. All are listed in no particular order of preference and are chosen according to patients' needs and expertise of the treating centre. Several first-line options may be chosen before moving to the second-line options.

Three drugs received European Medicines Agency approval in 2017 and 2018 (chlormethine gel, brentuximab and mogamulizumab) but there still remains an unmet need for more improved treatments or combinations. Most treatments only result in a partial response and there is no cure for early-stage disease; as such, patients live for a long time with their disease. In the advanced stages if a good response is achieved eligible patients will be considered for an allogeneic haematopoietic stem cell transplant.
Development of Handbooks of Guidance and Counseling to Enhance Elementary School Teachers’ Competence in Cultivating Students’ Creativity
Authors: Rahim Maryam , Hulukati Wenny
Published: March 2021

Central to the creativity development in elementary schools are competent teachers. Enhancement of teachers’ competence could be done through the provision of guidance handbooks for the teachers. As based on the problem statements, this research was aimed at developing handbooks of guidance and counseling that could improve teachers’ competence in providing quality guidance and counseling services; the handbooks were expected to help teachers in cultivating the creativity of elementary school students. In this research and development study, the designed handbooks consisted of book 1 Guidance and Counseling Implementation Plan, Book 2 Service Materials, Book 3 Teachers’ Guideline, and Book 4 Evaluation Guideline. The effectiveness of the handbooks was examined using a quasi-experimental method with one group pre-test and posttest. According to the results of experimental data analysis, the tcount and ttable arrived at 7.665 (significance level of 0.05 (14)) and 1.76, respectively, meaning that tcount > ttable. This result signified that the handbooks were practical to build teachers’ competence in providing quality guidance and counseling services, which was helpful in assisting the teachers in instilling the creativity of elementary school students. In brief, the handbooks are recommended to be used by teachers in promoting the creativity of elementary school students.
The Effectiveness of Science, Technology, Engineering, and Mathematics-Inquiry Learning for 15-16 Years Old Students Based on K-13 Indonesian Curriculum: The Impact on the Critical Thinking Skills
Authors: Pahrudin Agus , Misbah Misbah , Alisia Gita , Saregar Antomi , Asyhari Ardian , Anugrah Adyt , Susilowati Nur Endah
Published: March 2021

Industrial revolution 4.0 is currently present in various countries, including Indonesia. Indonesia responded quickly through technological developments, especially education. The actions of the Indonesian government to deal with industrial 4.0 are contained in the 4C principle, one of which is Critical Thinking. The Science, Technology, Engineering, and Mathematics (STEM) learning approach has become an alternative in building critical thinking skills, especially in science learning. The purpose of this study is to quantitatively measure the impact of the STEM-inquiry model based on the K-13 Indonesian Curriculum towards critical thinking skills of 15-16 years old students. This study employed quasi-experimental with non-equivalent control group design at SMAN 1 (State Senior High School) Padang Cermin, Lampung, Indonesia. The research subjects consisted of 50 students. The critical thinking skill was measured through 10 items of an essay question on the momentum and impulse material. Based on the results of the non-parametric statistical hypothesis test Mann Whitney, the significance level of 0.004 was obtained (sig <0.05). The results of the hypothetical test showed that the student's critical thinking skills before and after using the STEM-based inquiry model were different. It can be concluded that the application of the STEM-based inquiry model was effective in increasing students' critical thinking skills.
A new measure to understand the role of science in US Congress: lessons learned from the Legislative Use of Research Survey (LURS)
Authors: Long Elizabeth C. , Smith Rebecca L. , Scott J.Taylor , Gay Brittany , Giray Cagla , Storace Rachel , Guillot-Wright Shannon , Crowley D. Max
Published: March 2021

Background:

There is growing interest in and recognition of the need to use scientific evidence to inform policymaking. However, many of the existing studies on the use of research evidence (URE) have been largely qualitative, and the majority of existing quantitative measures are underdeveloped or were tested in regional or context-dependent settings. We are unaware of any quantitative measures of URE with national policymakers in the US.

Aims and objectives:

Explore how to measure URE quantitatively by validating a measure of congressional staff’s attitudes and behaviors regarding URE, the Legislative Use of Research Survey (LURS), and by discussing the lessons learned through administering the survey.

Methods:

A 68-item survey was administered to 80 congressional staff to measure their reported research use, value of research, interactions with researchers, general information sources, and research information sources. Confirmatory factor analyses were conducted on each of these five scales. We then trimmed the number of items, based on a combination of poor factor loadings and theoretical rationale, and ran the analyses on the trimmed subscales.

Findings:

We substantially improved our model fits for each scale over the original models and all items had acceptable factor loadings with our trimmed 35-item survey. We also describe the unique set of challenges and lessons learned from surveying congressional staff.

Discussion and conclusions:

This work contributes to the transdisciplinary field of URE by offering a tool for studying the mechanisms that can bridge research and policy and shedding light into best practices for measuring URE with national policymakers in the US.