bluuebunny/crossref_metadata_2025 huggingface dataset:
Recurrent triamcinolone injections for the treatment of Hunner’s lesions in bladder pain syndrome
Authors: Neu Sarah , Locke Jennifer A , Rebullar Karla , Carr Lesley , Herschorn Sender
Published: September 2022

Objective:

To determine if periodic triamcinolone injections into Hunner’s lesion in patients with bladder pain syndrome (BPS) reduces the need for opioids and other pain treatments.

Methods:

This is a retrospective analysis of 28 patients receiving endoscopic injections of 0.5–1.0 cc of triamcinolone acetate into Hunner’s lesions between 2010 and 2018. Wilcoxon signed-rank test was used to compare pain regimens before and after injections.

Results:

Median age at first triamcinolone injection was 63 (IQR 54–73). Median number of injections/patient was 3 (IQR 2–5.5), at a mean of 8-month intervals (2–80). The median number of pain treatments prior to triamcinolone was 4 (0–13), and 25% of patients were using opioids. With one or more injections, 92.9% had improvement in pain symptoms. There was a significant decrease in number of pain treatments following triamcinolone injections (4.1 vs 0.8, p = 0.006). Fifty-seven percent managed with triamcinolone injections alone, with no other pain treatments. Of the seven patients using opioids, four discontinued opioids altogether.

Conclusions:

Repeat triamcinolone injections into Hunner’s lesions are associated with a significant reduction in the number of pain treatments used for BPS, with an associated decrease in opioid use.

Level of evidence:

4
Orient Romanticised: Disruption of Orient’s Reality in Select Occidental Literary Discourses
Authors: Siddiqui Shireen , Sujata
Published: September 2022

This article critically analyses the side effects of the Western Imperialism through their careful manufacturing of Orientalism as a discourse over centuries and promoting a stereotyped ‘Oriental’ flavour through its literature such as, Thomas Moore’s narrative poem, Lalla Rookh (1817) that essentially obeys to confine to the identity of the Orient. Edward Said’s Orientalism (1989) forms the foundation of the article and studies the role of an Orientalist in the process of Orientalising the East, as the middleman between the East and West that helped substantiate the image of the stereotyped Orient by contributing to the literature. Modern Orientalism has a recurring theme of identity crisis and displacement, which roots from the long history of exploitation faced by the people in the name of The White Man’s Burden, coined in an 1899 poem by Rudyard Kipling as a symbol of his compassion towards the white supremacy. The article also identifies sensuality in language to express the exotic image of India in Thomas Moore’s Lalla Rookh, an Oriental romance as an Oriental romance to substantiate the image of the stereotyped Orient.
Biology in Public Health: Course-Based Experiential Learning Strategies to Promote Active Experimentation Among Undergraduate Public Health Students
Authors: Leih Rachel , Hoffman Katharine J. , “Duke” Duncan Burris
Published: September 2022

Experiential learning is a critical aspect of undergraduate public health education. However, there is limited literature on the implementation of experiential learning in undergraduate public health programs. The course “Biology in Public Health” was developed to better link population-level public health concepts with the biological sciences through multiple experiential learning opportunities. The course provides students opportunities to apply concepts of population health and biological sciences to their own lives and the lives of others. The course includes several experiential learning components and over its tenure has been adapted to increase the emphasis on experiential learning. Three core experiential components that have been the basis for the class since its inception are: (1) weekly mindfulness and meditation practice, (2) guest presentations by individuals living with the week’s health condition, and (3) participation in an optional 10-day whole-food plant-based diet intervention. Data from course evaluations and surveys of diet intervention participants show impacts on students’ health behaviors and attitudes. Thirty-eight percent of students self-reported utilizing meditation outside of class to manage stress at the end of the semester, and all participants in the diet intervention stated that they would decrease their animal protein and dairy intake at the end of the intervention. This article provides an overview of the course structure and details the experiential learning strategies utilized to promote students’ active experimentation with health behaviors, improve student comprehension of the impact of stress and diet on health outcomes, and foster the utilization of this knowledge in their future public health careers.
The Effect of E-Learning Program for COVID-19 Patient Care on the Knowledge of Nursing Students: A Quasi-Experimental Study
Authors: Khari Sorour , Pazokian Marzieh , Salimi Akin Abadi Atefe , Zarmehrparirouy Mina , Ahmadvand Yones
Published: September 2022

Introduction

As COVID-19 is an emerging disease, nursing students have little experience in caring for COVID-19 patients while they will be part of the country’s health system and have the closest relationship with the treatment team.

Objective(s)

Therefore, considering the importance and challenges of nursing students’ education during the COVID-19 pandemic, the present study aimed to investigate the effect of e-learning programs for COVID-19 patient care on nursing students’ knowledge in Tehran, Iran 2021.

Methods

The present quasi-experimental study was performed on 100 nursing students selected by a random sampling method. The demographic and knowledge assessment questionnaires were used to collect data before the intervention. Then, the e-learning program was implemented, in which students participated in three sessions for two weeks, the educational content was provided for the students in the form of text, audio, video, and image files, and questions were asked to them. Data were collected immediately after completing the e-learning program and four weeks later.

Results

The mean age value was 22 ± 1.25, and 61% of participants were female. The total mean score of knowledge immediately after training (22.95 ± 0.30) and one month after training (22.79 ± 0.30) significantly increased compared to baseline time (17.21 ± 0.48). The main effect of time was significant for the total score of knowledge from baseline to immediately after training (B = 5.79) and one-month follow-up (B = 5.63).

Conclusion

The findings of the study showed that the total mean score of the knowledge of students increased significantly in all dimensions after the e-learning program for COVID-19 patient care.

Implications for nursing practice

Considering the effectiveness of the e-learning program for COVID-19 patient care in increasing the knowledge of nursing students, it is necessary to provide more training programs focusing on new scientific findings because increasing nurses’ and nursing students’ knowledge plays a significant role in achieving more skills and promoting community health.
Percutaneous revascularization for the treatment of refractory digital ischemia in systemic sclerosis
Authors: Romero-Karam Lily A , Honan Kevin A , Arain Salman A , Mayes Maureen D.
Published: September 2022

Objective:

The objective of this study is to explore the role of adjunctive percutaneous revascularization of the hand in the management of patients with systemic sclerosis–associated refractory digital ischemia.

Methods:

We present our initial experience of using percutaneous upper extremity interventions to treat patients with systemic sclerosis and symptomatic Raynaud’s phenomenon who presented with either refractory digital ischemia or non-healing ulcers. We discuss patient characteristics, procedural findings, and short-term clinical outcomes of these interventions.

Results:

We performed 14 interventions in 6 patients with non-healing digital ulcers or refractory ischemia secondary to systemic sclerosis. Angioplasty was performed at or below the wrist in conjunction with intravenous prostaglandin therapy, started prior to or immediately after the revascularization procedure. All patients experienced symptomatic relief and demonstrated accelerated wound healing. Two patients required an additional procedure to treat recurrent ischemia (without new ulceration) in the treated digit. Three of the patients underwent multiple procedures during the study period to treat new ischemic lesions or Raynaud’s phenomenon symptoms, highlighting the progressive nature of the vascular occlusions in systemic sclerosis. There were no adverse events related to the interventions.

Conclusions:

Our retrospective analysis suggests that percutaneous revascularization in combination with vasodilator therapy in systemic sclerosis–associated digital ischemia is safe and can facilitate the healing of long-standing ulcers. Its role in the management of refractory digital ischemia in patients with systemic sclerosis should be explored further.
Little Aleppo: The neighbourhood experiences of Syrian refugees in Adana, Turkey, ‘poor to poor, peer to peer’
Authors: Akçalı Emel
Published: September 2022

The current refugee regimes (national/international and EUropean) present significant limitations in the ways they deal with refugee flows. However, both refugees and the host societies are able to develop their own agencies and strategies against such confines. This article pieces together the place-making and reterritorialisation efforts of Syrian refugees, the impact of their arrival on and interaction with the local population in the neighbourhoods of Adana in Turkey that has hosted the largest number of Syrian refugees and have become known as ‘Little Aleppo’. The analysis of Syrians’ experiences that emerge in their new settlements sheds new light on the ways in which urban refugees are able to increase their own agency and choose the solution(s) most appropriate to their own particular circumstances by establishing ‘poor-to-poor, peer-to-peer’ contacts, rather than depending on the few choices offered to them through refugee regimes. The locals, in return, are motivated by the newcomers’ presence to reassess their own socio-economic positions and choices in the land of nation states, even though encounters with the refugees may at times elicit negative feelings.
Beyond Enrolment and Appropriation Politics in Dalit Girls’ Education: Caste and Patriarchy Among Scavenging Communities of Urban Haryana, India
Authors: Shokeen Namrata
Published: September 2022

While contemplating on Dalit girls’ education, a large body of research and policy drafts generally draws from the integration of enrolment and appropriation politics (around being a ‘Dalit’ and ‘women’) to explore the educational experiences and challenges of Dalit girls in the Indian education system. However, less attention is given to what lies beyond the enrolment and appropriation politics in Dalit girls’ education. This article is based on an empirical study conducted among households associated with ‘Unclean’ occupations from two urban cities of Haryana. In order to position Dalit girls’ education beyond enrolment and appropriation politics, the article attempts to unmask the ‘multiple patriarchies’ embedded in the socio-economic barriers often pervading Dalit girls in the Indian education system. While doing so, the article demonstrates the inseparable intersectionality of caste and gender, through the workings of external Brahmanical as well as internal Dalit patriarchy simultaneously functioning against Dalit girls’ education. Eventually, the article calls for a need to position Dalit girls’ education in a Dalit feminist standpoint framework.
Building 21st Century Skills Through Technology in General Music Classes
Authors: Yoo Hyesoo
Published: September 2022

In today’s global community, 21st century skills are essential for all students. In addition, in a digital world, technology is expected to be part of students’ educational experiences. In this article, I provide practical strategies and ideas for incorporating technology into general music curriculum to promote students’ 21st century skills. In particular, I offer specific practices that utilize technology to meet 21st century skills—creativity, critical thinking, collaboration, communication, global awareness, and technology literacy.
Lineage switching of the cellular distribution of BRAF
V600E in multisystem Langerhans cell histiocytosis
Authors: Milne Paul , Bomken Simon , Slater Olga , Kumar Ashish , Nelson Adam , Roy Somak , Velazquez Jessica , Mankad Kshitij , Nicholson James , Yeomanson Dan , Grundy Richard , Kamal Ahmed , Penn Anthony , Pears Jane , Millen Gerard , Morland Bruce , Hayden James , Lam Jason , Madkhali Maymoon , MacDonald Jamie , Singh Preeti , Pagan Sarah , Rodriguez-Galindo Carlos , Minkov Milen , Donadieu Jean , Picarsic Jennifer , Allen Carl , Bigley Venetia , Collin Matthew
Published: September 2022

Most children with high-risk Langerhans cell histiocytosis (LCH) have BRAFV600E mutation. BRAFV600E alleles are detectable in myeloid mononuclear cells at diagnosis but it is not known if the cellular distribution of mutation evolves over time. Here, the profiles of 16 patients with high-risk disease were analyzed. Two received conventional salvage chemotherapy, 4 patients on inhibitors were tracked at intervals of 3 to 6 years, and 10 patients, also given inhibitors, were analyzed more than 2 years after diagnosis. In contrast to the patients responding to salvage chemotherapy who completely cleared BRAFV600E within 6 months, children who received inhibitors maintained high BRAFV600E alleles in their blood. At diagnosis, mutation was detected predominantly in monocytes and myeloid dendritic cells. With time, mutation switched to the T-cell compartment, which accounted for most of the mutational burden in peripheral blood mononuclear cells, more than 2 years from diagnosis (median, 85.4%; range, 44.5%-100%). The highest level of mutation occurred in naïve CD4+ T cells (median, 51.2%; range, 3.8%-93.5%). This study reveals an unexpected lineage switch of BRAFV600E mutation in high-risk LCH, which may influence monitoring strategies for the potential withdrawal of inhibitor treatment and has new implications for the pathogenesis of neurodegeneration, which occurred in 4 patients.
A novel infrasound and audible machine-learning approach to the diagnosis of COVID-19
Authors: Dori Guy , Bachner-Hinenzon Noa , Kasim Nour , Zaidani Haitem , Perl Sivan Haia , Maayan Shlomo , Shneifi Amin , Kian Yousef , Tiosano Tuvia , Adler Doron , Adir Yochai
Published: September 2022

Background

The coronavirus disease 2019 (COVID-19) outbreak has rapidly spread around the world, causing a global public health and economic crisis. A critical limitation in detecting COVID-19-related pneumonia is that it is often manifested as a “silent pneumonia”,i.e.pulmonary auscultation that sounds “normal” using a standard stethoscope. Chest computed tomography is the gold standard for detecting COVID-19 pneumonia; however, radiation exposure, availability and cost preclude its utilisation as a screening tool for COVID-19 pneumonia. In this study we hypothesised that COVID-19 pneumonia, “silent” to the human ear using a standard stethoscope, is detectable using a full-spectrum auscultation device that contains a machine-learning analysis.

Methods

Lung sound signals were acquired, using a novel full-spectrum (3–2000 Hz) stethoscope, from 164 COVID-19 pneumonia patients, 61 non-COVID-19 pneumonia patients and 141 healthy subjects. A machine-learning classifier was constructed and the data were classified into three groups: 1) normal lung sounds, 2) COVID-19 pneumonia and 3) non-COVID-19 pneumonia.

Results

Standard auscultation found that 72% of the non-COVID-19 pneumonia patients had abnormal lung sounds compared with only 25% of the COVID-19 pneumonia patients. The classifier's sensitivity and specificity for the detection of COVID-19 pneumonia were 97% and 93%, respectively, when analysing the sound and infrasound data, and they were reduced to 93% and 80%, respectively, without the infrasound data (p<0.01 difference in receiver operating characteristic curves with and without infrasound).

Conclusions

This study reveals that useful clinical information exists in the infrasound spectrum of COVID-19-related pneumonia and machine-learning analysis applied to the full spectrum of lung sounds is useful in its detection.
Infant lung function: criteria for selecting tidal flow–volume loops
Authors: Bains Karen Eline Stensby , Gudmundsdóttir Hrefna Katrín , Färdig Martin , Amnö Erik , Jonassen Christine M. , Nordlund Björn , Rehbinder Eva Maria , Skjerven Håvard O. , Rueegg Corina Silvia , Vettukattil Riyas , Lødrup Carlsen Karin C.
Published: September 2022

Background

Tidal flow–volume (TFV) loops are commonly recorded in infants during sleep, due to the more regular breathing patterns compared to the awake state. Standardised deselection of loops outside pre-specified ranges are based on periods of regular breathing, while criteria and available software for visual evaluation of TFV loops are lacking. We aimed to determine the reliability of standardised criteria for manual selection of infant TFV loops.

Methods

Using a pre-defined set of criteria, three independent raters manually evaluated TFV loops among 57 randomly selected awake healthy 3-month-old infants with available TFV measurements in the Scandinavian Preventing Atopic Dermatitis and ALLergies in children (PreventADALL) study. The TFV loops were sampled using the Eco Medics Exhalyzer D. Criteria for selecting TFV loops included reproducible shape and volume with only one peak in tidal expiratory flow (PTEF), excluding loops with no clear or uneven flow towards PTEF. By intraclass coefficient (ICC), the reliability of agreement between raters was determined for the time to PTEF (
t
PTEF
) to expiratory time (
t
E
) and other TFV loop parameters.

Results

Five infants had unsuccessful tests. Among the remaining 52 infants, the raters selected a median of 25, 26 and 15 loops per test. The ICCs (95% CI) were 0.97 (0.92–0.98) for
t
PTEF
/
t
E
, 0.99 (0.99–1.00) for respiratory rate, 0.98 (0.97–0.99) for tidal volume per kg and 0.98 (0.97–0.99) for expiratory volume, reflecting excellent agreement in all categories.

Conclusion

Manual TFV loop selection using standardised criteria provides a reliable alternative for lung function measures in awake infants with interrupted breathing cycles in a real-life setting.
Treatment with interleukin (IL)-5/IL-5 receptor antibodies in patients with severe eosinophilic asthma and COPD
Authors: Drick Nora , Fuge Jan , Seeliger Benjamin , Speth Milan , Vogel-Claussen Jens , Welte Tobias , Suhling Hendrik
Published: September 2022

Background

Anti-eosinophilic therapy with interleukin-5/interleukin-5-receptor antibodies represents an established treatment for patients with severe eosinophilic asthma (SEA) but did not show clinical efficacy in patients with COPD. The objective of the present study was to evaluate treatment response to anti-eosinophilic antibody therapy in patients with asthma and COPD.

Methods

A retrospective comparison of pulmonary function testing, oral corticosteroid intake, quality of life and pulmonary symptom control in patients with SEA and COPD and 1:1 propensity score matched patients suffering from SEA alone was performed. All patients received treatment with either mepolizumab or benralizumab. Data were assessed prior to antibody treatment start and after 6 months of therapy.

Results

Data from 84 patients (42 patients with SEA and COPD and 42 patients with SEA) were analysed. After 6 months of treatment, patients in both groups showed improved forced expiratory volume in 1 s (improvement by 11% (IQR 5–18) in the SEA and COPD groupversus15% (IQR −3–23); p=0.637) and decreased oral corticosteroid dosages (median reduction by 3 mg in the SEA and COPD groupversus5 mg; p=0.070), without significant differences between groups. Pulmonary symptom control and quality of life improved in both groups. A significant decrease in eosinophils could be measured in both groups with similar cell numbers prior to treatment initiation (600 cells·µL−1in the SEA and COPD groupversus500 cells·µL−1).

Conclusion

Anti-eosinophilic therapy with interleukin-5/interleukin-5-receptor antibodies shows clinical efficacy in patients with SEA and COPD comparable to treatment response in patients with SEA alone.
Association of cholinesterase activities and POD in older adult abdominal surgical patients
Authors: Bosancic Zdravka , Spies Claudia D. , Müller Anika , Winterer Georg , Piper Sophie K. , Heinrich Maria ,   on behalf of the BioCog Consortium
Published: September 2022

Background

Postoperative delirium (POD) is a frequent complication after surgery. Older adult patients undergoing abdominal surgery are at higher risk for developing POD. Studies on the association of cholinesterase activities and POD are rare, but leading hypotheses implicate that the cholinergic pathway might play an important role in neuroinflammation and development of POD. The objective of this study was to figure out if there is an association between the development of POD and acetyl- and butyrylcholinesterase (AChE and BuChE) activities in older adult patients undergoing abdominal surgery.

Methods

The investigation was performed with a subpopulation of BioCog study patients. The BioCog project (http://www.biocog.eu) is a prospective multicenter observational study in older adult surgical patients. Patients ≥ 65 years undergoing elective surgery of at least 60 minutes who scored more than 23 points in the Mini-Mental-State-Examination were included. POD was assessed twice a day on seven consecutive days after the surgery, using the test instruments Nursing Delirium Screening Scale (Nu-Desc) and Confusion Assessment Method (CAM and CAM-ICU) and a patient chart review. Pre- and postoperative blood cholinesterase activities were measured with a photometric rapid-point-of-care-testing. The association between cholinesterase activities and POD was analyzed in a subpopulation of abdominal surgical patients using multivariable logistic regression analysis adjusting for confounders.

Results

One hundred twenty-seven patients were included for analysis (mean age 73 years, 59% female). Fifty-two patients (41%) fulfilled the criteria of POD. These patients were significantly older, had a longer time of surgery and anesthesia and achieved higher comorbidity scores compared to patients without POD. After adjusting for age, duration of surgery and charlson comorbity index, we found an association between pre- and postoperative AChE activity (U/gHb) and the development of POD (Odds ratio (OR), [95% confidence interval (CI)], preoperative 0.95 [0.89–1.00], postoperative 0.94 [0.89–1.00]).

Conclusions

We found an association between POD and AChE activity and provided new information considering patients with abdominal surgery. Future analyses should examine course dynamics of postoperative cholinesterase activities in order to clarify interactions between the cholinergic system and pathophysiological mechanisms leading to POD.

Trial registration

ClinicalTrials.gov: NCT02265263.
Intravenous dantrolene in hypermetabolic syndromes: a survey of the U.S. Veterans Health Administration database
Authors: Caroff Stanley N. , Roberts Christopher B. , Rosenberg Henry , Tobin Joseph R. , Watt Stacey , Mashman Darlene , Riazi Sheila , Berkowitz Rosalind M.
Published: September 2022

Background

Intravenous dantrolene is often prescribed for hypermetabolic syndromes other than the approved indication of malignant hyperthermia (MH). To clarify the extent of and indications for dantrolene use in conditions other than MH, we sought to document current practices in the frequency, diagnoses, clinical characteristics and outcomes associated with dantrolene treatment in critical care settings.

Methods

Inpatients receiving intravenous dantrolene from October 1, 2004 to September 30, 2014 were identified retrospectively in the U.S. Veterans Health Administration national database. Extracted data included; diagnoses of hypermetabolic syndromes; triggering drugs; dantrolene dosages; demographics; vital signs; laboratory values; in-hospital mortality; complications; and lengths of stay. Frequency and mortality of patients who did not receive dantrolene were obtained in selected diagnoses for exploratory comparisons.

Results

Dantrolene was administered to 304 inpatients. The most frequent diagnoses associated with dantrolene treatment were neuroleptic malignant syndrome (NMS; N = 108, 35.53%) and sepsis (N = 47, 15.46%), with MH accounting for only 13 (4.28%) cases. Over half the patients had psychiatric comorbidities and received psychotropic drugs before dantrolene treatment. Common clinical findings in patients receiving dantrolene included elevated temperature (mean ± SD; 38.7 ± 1.3 °C), pulse (116.33 ± 22.80/bpm), respirations (27.75 ± 9.58/min), creatine kinase levels (2,859.37 ± 6,646.88 IU/L) and low pO2 (74.93 ± 40.16 mmHg). Respiratory, renal or cardiac failure were common complications. Mortality rates in-hospital were 24.01% overall, 7.69% in MH, 20.37% in NMS and 42.55% in sepsis, compared with mortality rates in larger and possibly less severe groups of unmatched patients with MH (5.26%), NMS (6.66%), or sepsis (41.91%) who did not receive dantrolene.

Conclusions

In over 95% of cases, dantrolene administration was associated with diagnoses other than MH in critically-ill patients with hypermetabolic symptoms and medical and psychiatric comorbidities. Exploratory survey data suggested that the efficacy and safety of dantrolene in preventing mortality in hypermetabolic syndromes other than MH remain uncertain. However, randomized and controlled studies using standardized criteria between groups matched for severity are essential to guide practice in using dantrolene.
Improved access to and continuity of primary care after attachment to a family physician: longitudinal cohort study on centralized waiting lists for unattached patients in Quebec, Canada
Authors: Smithman Mélanie Ann , Haggerty Jeannie , Gaboury Isabelle , Breton Mylaine
Published: September 2022

Background

Having a regular family physician is associated with many benefits. Formal attachment – an administrative patient-family physician agreement – is a popular feature in primary care, intended to improve access to and continuity of care with a family physician. However, little evidence exists about its effectiveness. In Quebec, Canada, where over 20% of the population is unattached, centralized waiting lists help attach patients. This provides a unique opportunity to observe the influence of attachment in previously unattached patients. The aim was to evaluate changes in access to and continuity of primary care associated with attachment to a family physician through Quebec’s centralized waiting lists for unattached patients.

Methods

We conducted an observational longitudinal population cohort study, using medical services billing data from public health insurance in the province of Québec, Canada. We included patients attached through centralized waiting lists for unattached patients between 2012 and 2014 (n = 410,140). Our study was informed by Aday and Andersen’s framework for the study of access to health services. We compared outcomes during four 12-month periods: two periods before and two periods after attachment, with T0–2 years as the reference period. Outcome measures were number of primary care visits and Bice-Boxerman Concentration of Care Index at the physician and practice level (for patients with ≥2 visits in a given period). We included age, sex, region remoteness, medical vulnerability, and Charlson Comorbidity Index as covariates in regression models fitted with generalized estimating equations.

Results

The number of primary care visits increased by 103% in the first post attachment year and 29% in the second year (p < 0.001). The odds of having all primary care visits concentrated with a single physician increased by 53% in the first year and 22% (p < 0.001) in the second year after attachment. At the practice level, the odds of perfect concentration of care increased by 19% (p < 0.001) and 15% (p < 0.001) respectively, in first and second year after attachment.

Conclusion

Our results show an increase in patients’ number of primary care visits and concentration of care at the family physician and practice level after attachment to a family physician. This suggests that attachment may help improve access to and continuity of primary care.
Foreign allometric exponents adequately normalize isokinetic knee extension strength to identify muscle weakness and mobility limitation in Portuguese older adults: a cross-sectional study
Authors: Machado Dalmo Roberto Lopes , Abdalla Pedro Pugliesi , Bohn Lucimere , Stratton Gareth , Mota Jorge
Published: September 2022

Background

Identifying muscle weakness is challenging, because the reduction of strength with aging does not depend only on sarcopenia, but also on sensorimotor deficits. Nevertheless, this identification is improved by adjusting muscle strength allometrically, by removing the influence of body size. However, the effectiveness of foreign models to normalize these (dys)functionalities is not yet tested. This study aimed to compare and apply foreign allometric exponents for normalizing isokinetic knee extension strength in Portuguese older adults to identify muscle weakness/mobility limitation. Additionally, to attest any populational difference, data of these people and Brazilian older adults were compared

Methods

This is a cross-sectional study encompassing 226 Portuguese (n = 132) and Brazilian (n = 94) older adults. Mobility limitation (six-minute walk test, at lowest quartile), lower limb strength (knee extension isokinetic strength at 60º/s), and body dimensions measures were taken. Foreign allometric exponents (b) were used to normalize Portuguese strength (strength/body-size variablesb). Non-normalized and normalized strength were compared (ROC) to generate the most accurate cut-point for identifying muscle weakness/mobility limitation.

Results

Older Portuguese men and women had better mobility than their Brazilian counterparts. Older Portuguese women had superior muscle strength to Brazilian women. Normalization from 11 foreign models removed the influence of body size on muscle strength, with a negligible correlation (r ≤ 0.30). In contrast to the non-normalized strength, the normalized strength cut-off points were sufficiently accurate (AUC ≥ 0.70) to avoid identifying false-negative cases of weakness/mobility limitation.

Conclusions

Portuguese older women were stronger and had superior functional capacity compared to Brazilian ones. Normalized foreign models improved the accuracy in identifying muscle weakness/mobility limitation in Portuguese older adults. The isokinetic knee extension muscle strength normalized, even using foreign allometric exponents, should be better than no adjustment.
Association between previous spontaneous abortion and preeclampsia: a case–control study
Authors: Mohamedain Ahmed , Rayis Duria A. , AlHabardi Nadiah , Adam Ishag
Published: September 2022

Background

The association between previous spontaneous abortion and preeclampsia is not yet fully understood. The current study was conducted to assess the association between previous spontaneous abortion and preeclampsia among pregnant women in Sudan.

Methods

A case–control study (involving 180 women in each study group) was conducted at Saad Abuelela Hospital, Khartoum, Sudan. The cases were pregnant women with preeclampsia, while the control group included healthy pregnant women. The participants’ sociodemographic, obstetric, and clinical characteristics were assessed via a questionnaire.

Results

There was no significant difference in the age, parity, education level, employment status, blood group, body mass index, and hemoglobin level between the patient and control groups. Forty (22.2%) women with preeclampsia and 68 (37.8%) women in the control group had a history of spontaneous abortion (p = 0.001).

Multivariate logistic regression analysis (adjusted) revealed that women with a history of spontaneous abortion had a lower risk of preeclampsia than those without a history of spontaneous abortion [adjusted odds ratio (AOR) = 0.44, 95% confidence interval (CI) = 0.26‒0.73]. However, women with a history of preeclampsia had a higher risk of recurrence of preeclampsia (AOR = 1.92, 95% CI = 1.11‒3.32).

Conclusion

The present study revealed that previous spontaneous abortion reduced the risk of preeclampsia by 59.0%.
The effect of educational intervention based on theory of planned behavior on mothers’ skills in sexual care of children
Authors: Jeihooni Ali Khani , Moradi Arman , Yari Asiyeh , Kiyani Amin , Hasirini Pooyan Afzali
Published: September 2022

Background

The parent’s and especially the mothers’ skills play a major role in the the education of healthy sexual behaviors in children. This study investigates the effect of educational intervention based on the Theory of Planned Behavior (TPB) on mothers’ skills in the sexual care of children in Fasa city, Fars province, Iran in 2019.

Methods

This study was a quasi-experimental intervention with a control group. 200 mothers of children aged 5 to 6 years in Fasa preschool were selected using a multi-stage random sampling method and were divided into two groups of intervention (100) and control (100). After providing a pre-test to both groups, only the experimental group received training on sexual care of children's abilities based on the Theory of Planned Behavior constructs. The educational intervention consisted of seven 55–60-minute sessions in which the presenter gave a presentation, asked and answered questions, and used posters, brochures, films, animations, and PowerPoints. Both groups completed the questionnaire three months following the intervention. A questionnaire and Theory of planned behavior constructs were used to collect information. The data was analyzed with SPSS22 software using paired t-tests, Chi-square tests, and independent t-tests, with a significance level of 0.05.

Results

Before the intervention, there was no significant difference in the constructs of theTheory of planned behavior between the two groups (p>0.05), but after the intervention, knowledge scores from 8.33±2.97 to 20.67±2.84, attitude scores from 29.80±4.27 to 62.22±4.34, subjective norms from 20.12±4.55 to 42.28±4.20, perceived behavioral control from 20.24±4.36 to 42.88±4.52, behavioral intention from 3.24±1.60 to 7.44±1.59 and behavior from 2.98±1.13 to 8.14±1.08 in the intervention group (p< 0.001).

Conclusion

This study showed TPB constructs’ Effectiveness in adopting the level of mothers’ skills in the sexual care of children. Hence, this model can act as a framework for designing and implementing educational interventions for the sexual care of children.
Comparison of ROX index (SpO2/FIO2 ratio/respiratory rate) with a modified dynamic index incorporating PaO2/FIO2 ratio and heart rate to predict high flow nasal cannula outcomes among patients with acute respiratory failure: a single centre retrospective study
Authors: Kansal Amit , Ong Wei Jun Dan , Dhanvijay Shekhar , Siosana Arbe Tisha Pepito , Padillo Loraine Mae , Tan Chee Keat , Gulati Kansal Monika , Khan Faheem Ahmed
Published: September 2022

Background

High flow nasal cannula (HFNC) is increasingly being used to support patients with acute respiratory failure (ARF) and to avoid need for intubation. However, almost one third of the patients do not respond and require escalation of respiratory support. Previously, ROX index (SpO2/FIO2 [SF] ratio/respiratory rate) has been validated among pneumonia patients to facilitate early recognition of patients likely to fail HFNC and therefore, benefit from timely interventions. However, it has been postulated that incorporation of PaO2/FIO2 (PF) ratio from arterial blood gas (ABG) analysis may better predict the outcome of HFNC compared to indices that utilizes SF ratio. Similarly, heart rate increase after HFNC therapy initiation has been found to be associated with HFNC failure. Therefore, we aimed to compare ROX index with a new modified index to predict HFNC outcomes among ARF patients.

Materials and methods

This single centre 2-year retrospective study included ARF patients of varying etiologies treated with HFNC. The modified index incorporated heart rate and substituted PF ratio for SF ratio in addition to respiratory rate. We named the index POX-HR and calculated Delta POX-HR index as the difference pre- and post-HFNC initiation POX-HR. We also recorded ROX index at the time when post-HFNC initiation ABG was done (‘post-HFNC initiation ROX’) and calculated Delta ROX. HFNC success was defined as no need of escalation of respiratory support or discharged to ward within 48 h of HFNC initiation, or successful wean off HFNC for at least 12 h. Evaluation was performed using area under the receiver operating characteristic curve (AUROC) and cut-offs assessed for prediction of HFNC outcomes.

Results

One hundred eleven patients were initiated on HFNC for ARF, of whom 72 patients (64.9%) had HFNC success. Patients with HFNC failure had significantly lower values for all the indices. At median of 3.33 h (IQR 1.48–7.24 h), Delta POX-HR demonstrated the best prediction accuracy (AUROC 0.813, 95% CI 0.726–0.900). A Delta POX-HR > 0.1 was significantly associated with a lower risk of HFNC failure.

Conclusions

Our proposed modified dynamic index (Delta POX-HR) may facilitate early and accurate prediction of HFNC outcomes compared to ROX index among ARF patients of varied etiologies.
Effect of surface treatments on biaxial flexural strength, fatigue resistance, and fracture toughness of high versus low translucency zirconia
Authors: Elraggal Alaaeldin , Aboushelib Moustafa , Abdel Raheem Islam M. , Afifi Rania R.
Published: September 2022

Background

Mechanical surface treatments can deteriorate the mechanical properties of zirconia. This study evaluated and compared the biaxial flexural strength, fracture toughness, and fatigue resistance of high translucency (HT) to low translucency (LT) zirconia after various mechanical surface treatments.

Methods

Four hundred eighty zirconia discs were prepared by milling and sintering two HT (Katana and BruxZir) and LT (Cercon and Lava) zirconia blocks at targeted dimensions of 12 mm diameter × 1.2 mm thickness. Sintered zirconia discs received one of the following surface treatments: low-pressure airborne particle abrasion (APA) using 50 µm alumina particles, grinding using 400 grit silicon carbide paper, while as-sintered specimens served as control. Internal structure and surface roughness were evaluated by scanning electron microscope (SEM) and a non-contact laser profilometer, respectively. Half of the discs were tested for initial biaxial flexural strength, while the rest was subjected to 106 cyclic fatigue loadings, followed by measuring the residual biaxial flexural strength. Fractured surfaces were examined for critical size defects (c) using SEM to calculate the fracture toughness (KIC). The effect of surface treatments, zirconia type, and cyclic fatigue on the biaxial flexural strength was statistically analyzed using three-way analysis of variance (ANOVA) and Tukey HSD post hoc tests (α = 0.05). Weibull analysis was done to evaluate the reliability of the flexural strength for different materials.

Results

The initial biaxial flexural strength of LT zirconia was significantly higher (p < 0.001) than that of HT zirconia in all groups. While low APA significantly increased the biaxial flexural strength of LT zirconia, no significant change was observed for HT zirconia except for Katana. Surface grinding and cyclic fatigue significantly reduced the flexural strength of all groups. High translucency zirconia reported higher fracture toughness, yet with lower Weibull moduli, compared to LT zirconia.

Conclusion

LT zirconia has higher biaxial flexural strength, yet with lower fracture toughness and fatigue resistance, compared to HT zirconia. Low-pressure APA has significantly increased the biaxial flexural strength in all zirconia groups except BruxZir. Grinding was deteriorating to biaxial flexural strength and fracture toughness in all zirconia types. Cyclic fatigue has significantly decreased the biaxial flexural strength and reliability of HT and LT zirconia.
Evaluation of salivary parameters and Streptococcus’ Mutans count in children with cerebral palsy in Egypt: a case control study
Authors: Quritum Sara M. , Ali Amel M. , Raouf May M. , Omar Tarek E. I. , Dowidar Karin M. L.
Published: September 2022

Background

Children with cerebral palsy (CP) are at high risk for dental caries. Alteration of some salivary properties encountered among them compared to healthy children, could play a role in this elevated risk.

Objectives

The aim of the present study was to assess salivary physicochemical properties; including total antioxidant (TAC), flow rate, viscosity, pH and buffering capacity, as well as Streptococcus mutans level among children with CP, also to correlate these variables to their caries experience.

Materials and methods

This case control study included 80 children with CP, study group (SG) and matched number of healthy children for control group (CG). Interview-based questionnaire, clinical examination, salivary biochemical and microbiological investigations using MALDI-TOF were done.

Results

In SG, the caries experience in primary teeth dmft and S. mutans log value were significantly higher than CG (P = 0.039, P = 0.002) while unstimulated salivary flow rate, buffering capacity and salivary TAC were significantly lower (P < 0.0001). Multivariate linear regression showed that the presence of CP was significantly associated with the greatest variation in caries experience in the primary teeth and permanent teeth. Higher unstimulated salivary flow rate, or an increase in buffering capacity by 1 ml of acid/ml of saliva were associated with lower number of the affected primary and permanent teeth. On the other hand, One-unit increase in S. mutans log count and higher salivary TAC were associated with higher caries experience.

Conclusion

Children with CP have higher caries experience (dmf) due to lower salivary protective factors and higher S. mutans counts.
Physicians’ legal knowledge of informed consent and confidentiality. A cross-sectional study
Authors: Plaiasu Maria Cristina , Alexandru Dragos Ovidiu , Nanu Codrut Andrei
Published: September 2022

Background

Only a few studies have been conducted to assess physicians’ knowledge of legal standards. Nevertheless, prior research has demonstrated a dearth of medical law knowledge. Our study explored physicians’ awareness of legal provisions concerning informed consent and confidentiality, which are essential components of the physician-patient relationship of trust.

Methods

A cross-sectional study assessed attending physicians’ legal knowledge of informed consent and confidentiality regulations. The study was conducted in nine hospitals in Dolj County, Romania. Physicians were given a questionnaire with ten scenarios and instructed to select the response that best reflected their practice. We assessed the responses of physicians who claimed their practice to be entirely legal. Their legal knowledge was evaluated by comparing their answers to applicable laws. We also calculated a score for the physicians who admitted to committing a legal breach.

Results

Of the 305 respondents, 275 declared they never committed any law violation. However, their median correct answer score was 5.35 ± 1.66 out of 10. The specialty was the strongest predictor of legal knowledge, with emergency physicians rating the lowest and non-surgical physicians scoring the highest. Physicians who worked in both private and public sectors were better knowledgeable about legal issues than those who worked exclusively in the public sector. Results indicate that physicians are aware of the patient’s right to informed consent but lack comprehensive understanding. While most physicians correctly answered simple questions, only a tiny minority identified the correct solution when confronted with ethical dilemmas. The physicians who acknowledged breaching the law, on the other hand, had a slightly higher knowledge score at 5.45 ± 2.18.

Conclusion

Legal compliance remains relatively low due to insufficient legal awareness. Physicians display limited awareness of legal requirements governing patient autonomy, confidentiality, and access to health data. Law should be taught in all medical schools, including undergraduate programs, to increase physicians’ legal knowledge and compliance.
Investigation of foot and mouth disease virus and other animal pathogens in cattle, buffaloes and goats at the interface with Akagera National Park 2017 – 2020
Authors: Udahemuka Jean Claude , Aboge Gabriel , Obiero George , Ingabire Angélique , Beeton Natasha , Uwibambe Evodie , Lebea Phiyani
Published: September 2022

Background

Foot-and-Mouth Disease Virus (FMDV) is a positive-sense RNA virus of the family of the picornaviridæ that is responsible for one of the livestock diseases with the highest economic impact, the Foot-and-Mouth Disease (FMD). FMD is endemic in Rwanda but there are gaps in knowing its seroprevalence and molecular epidemiology. This study reports the FMD seroprevalence and molecular characterization of FMDV in Eastern Rwanda.

Results

The overall seroprevalence of FMD in the study area is at 9.36% in cattle and 2.65% in goats. We detected FMDV using molecular diagnostic tools such as RT-PCR and RT-LAMP and the phylogenetic analysis of the obtained sequences revealed the presence of FMDV serotype SAT 2, lineage II. Sequencing of the oropharyngeal fluid samples collected from African buffaloes revealed the presence of Prevotela ruminicola, Spathidium amphoriforme, Moraxella bovoculi Onchocerca flexuosa, Eudiplodinium moggii, Metadinium medium and Verrucomicrobia bacterium among other pathogens but no FMDV was detected in African buffaloes.

Conclusions

We recommend further studies to focus on sampling more African buffaloes since the number sampled was statistically insignificant to conclusively exclude the presence or absence of FMDV in Eastern Rwanda buffaloes. The use of RT-PCR alongside RT-LAMP demonstrates that the latter can be adopted in endemic areas such as Rwanda to fill in the gaps in terms of molecular diagnostics. The identification of lineage II of SAT 2 in Rwanda for the first time shows that the categorised FMDV pools as previously established are not static over time.
Case report: genetic analysis of a child with 18q deletion syndrome and developmental dysplasia of the hip
Authors: Yu Shufeng , Wang Caixia , Lei Ke , Leng Xuefei , Zhang Lijuan , Tian Fei , Chen Zhihong
Published: September 2022

Objective

To analyze the genotypes and phenotypes of a child with developmental dysplasia of the hip (DDH), developmental delays, recurrent fever, hypothyroidism and cleft palate.

Methods

G-banding karyotyping analysis and next-generation sequencing (NGS) were performed for the patient. The genotypes of the parents of the patient were verified by copy number variation analysis and Sanger sequencing to determine the source of variations.

Results

The karyotype of the patient was 46, XX. A 10.44 Mb deletion (chr18:67562936-78005270del) at 18q22.2q23 was found by NGS. We identified 2 HSPG2 mutations (chr1: 22206699, c.2244C > A, exon 17, p.H748Q; chr1: 22157321–22157321, c.11671 + 154insA, intron). One mutation was inherited from the father, and the other was inherited from the mother.

Conclusion

This is the first 18q deletion syndrome case accompanied by DDH. Most phenotypes of this patient, such as developmental delays and cleft palate, may be related to the 18q22.2q23 deletion, but no variants in genes related to DDH were found in this deletion region. DDH may be related to mutations of HSPG2.