bluuebunny/crossref_metadata_2025 huggingface dataset:
Delayed presentation of food protein-induced enterocolitis syndrome (FPIES) to okra in a toddler
Authors: Hall Hunter , Anvari Sara , Schultz Fallon , Ojuola Olubukola , Rider Nicholas L.
Published: February 2024

Background

Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E (IgE) -mediated food allergy predominantly observed in infants and characterized by the delayed onset of vomiting following ingestion of a trigger food. An increase in research and clinical consideration of FPIES has led to the discovery of unique deviations from the standard FPIES triggers and presentations.

Case presentation

A 34-month-old female patient with a history of consuming okra daily presented to medical attention after developing classic FPIES symptoms to okra beginning at 14-months of age.

Conclusions

Recently, awareness about the varied nature of FPIES clinical presentation has come to light. This case is the first to describe FPIES to the fruit okra that developed over a 12-month time span after previously tolerating the food. This case serves to emphasize the importance of understanding the range of FPIES symptoms to improve recognition and expedite best practice recommendations.
Prevalence and prognosis of hyperdynamic left ventricular systolic function in septic patients: a systematic review and meta-analysis
Authors: Sato Ryota , Sanfilippo Filippo , Hasegawa Daisuke , Prasitlumkum Narut , Duggal Abhijit , Dugar Siddharth
Published: February 2024

Purpose

The prevalence of hyperdynamic left ventricular (LV) systolic function in septic patients and its impact on mortality remain controversial. In this systematic review and meta-analysis, we investigated the prevalence and association of hyperdynamic LV systolic function with mortality in patients with sepsis.

Methods

We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. Primary outcomes were the prevalence of hyperdynamic LV systolic function in adult septic patients and the associated short-term mortality as compared to normal LV systolic function. Hyperdynamic LV systolic function was defined using LV ejection fraction (LVEF) of 70% as cutoff. Secondary outcomes were heart rate, LV end-diastolic diameter (LVEDD), and E/e’ ratio.

Results

Four studies were included, and the pooled prevalence of hyperdynamic LV systolic function was 18.2% ([95% confidence interval (CI) 12.5, 25.8]; I2 = 7.0%, P < 0.0001). Hyperdynamic LV systolic function was associated with higher mortality: odds ratio of 2.37 [95%CI 1.47, 3.80]; I2 = 79%, P < 0.01. No difference was found in E/e’ (P = 0.43) between normal and hyperdynamic LV systolic function, while higher values of heart rate (mean difference: 6.14 beats/min [95%CI 3.59, 8.69]; I2 = 51%, P < 0.0001) and LVEDD (mean difference: − 0.21 cm [95%CI − 0.33, − 0.09]; I2 = 73%, P < 0.001) were detected in patients with hyperdynamic LV systolic function.

Conclusion

The prevalence of hyperdynamic LV systolic function is not negligible in septic patients. Such a finding is associated with significantly higher short-term mortality as compared to normal LV systolic function.
Offline and online task allocation algorithms for multiple UAVs in wireless sensor networks
Authors: Ye Liang , Yang Yu , Meng Weixiao , Wu Xuanli , Li Xiaoshuai , Zhu Rangang
Published: February 2024

In recent years, UAV techniques are developing very fast, and UAVs are becoming more and more popular in both civilian and military fields. An important application of UAVs is rescue and disaster relief. In post-earthquake evaluation scenes where it is difficult or dangerous for human to reach, UAVs and sensors can form a wireless sensor network and collect environmental information. In such application scenarios, task allocation algorithms are important for UAVs to collect data efficiently. This paper firstly proposes an improved immune multi-agent algorithm for the offline task allocation stage. The proposed algorithm provides higher accuracy and convergence performance by improving the optimization operation. Then, this paper proposes an improved adaptive discrete cuckoo algorithm for the online task reallocation stage. By introducing adaptive step size transformation and appropriate local optimization operator, the speed of convergence is accelerated, making it suitable for real-time online task reallocation. Simulation results have proved the effectiveness of the proposed task allocation algorithms.
A systematic review and meta-analysis on the effects of ill health and health shocks on labour supply
Authors: Shawa Ken Chamuva , Hollingsworth Bruce , Zucchelli Eugenio
Published: February 2024

Background

Several studies have explored the effects of ill health and health shocks on labour supply. However, there are very few systematic reviews and meta-analyses in this area. The current work aims to fill this gap by undertaking a systematic review and meta-analysis on the effects of ill health and health shocks on labour supply.

Methods

We searched using EconLit and MEDLINE databases along with grey literature to identify relevant papers for the analysis. Necessary information was extracted from the papers using an extraction tool. We calculated partial correlations to determine effect sizes and estimated the overall effect sizes by using the random effects model. Sub-group analyses were conducted based on geography, publication year and model type to assess the sources of heterogeneity. Model type entailed distinguishing articles that used the standard ordinary least squares (OLS) technique from those that used other estimation techniques such as quasi-experimental methods, including propensity score matching and difference-in-differences methodologies. Multivariate and univariate meta-regressions were employed to further examine the sources of heterogeneity. Moreover, we tested for publication bias by using a funnel plot, Begg’s test and the trim and fill methodology.

Results

We found a negative and statistically significant pooled estimate of the effect of ill health and health shocks on labour supply (partial r = −0.05, p < .001). The studies exhibited substantial heterogeneity. Sample size, geography, model type and publication year were found to be significant sources of heterogeneity. The funnel plot, and the trim and fill methodology, when imputed on the left showed some level of publication bias, but this was contrasted by both the Begg’s test, and the trim and fill methodology when imputed on the right.

Conclusion

The study examined the effects of ill health and health shocks on labour supply. We found negative statistically significant pooled estimates pertaining to the overall effect of ill health and health shocks on labour supply including in sub-groups. Empirical studies on the effects of ill- health and health shocks on labour supply have oftentimes found a negative relationship. Our meta-analysis results, which used a large, combined sample size, seem to reliably confirm the finding.
Differential effects of antiretroviral treatment on immunity and gut microbiome composition in people living with HIV in rural versus urban Zimbabwe
Authors: Burkhart Colorado Angela Sofia , Lazzaro Alessandro , Neff Charles Preston , Nusbacher Nichole , Boyd Kathryn , Fiorillo Suzanne , Martin Casey , Siebert Janet C. , Campbell Thomas B. , Borok Margaret , Palmer Brent E. , Lozupone Catherine
Published: February 2024

Background

The widespread availability of antiretroviral therapy (ART) has dramatically reduced mortality and improved life expectancy for people living with HIV (PLWH). However, even with HIV-1 suppression, chronic immune activation and elevated inflammation persist and have been linked to a pro-inflammatory gut microbiome composition and compromised intestinal barrier integrity. PLWH in urban versus rural areas of sub-Saharan Africa experience differences in environmental factors that may impact the gut microbiome and immune system, in response to ART, yet this has not previously been investigated in these groups. To address this, we measured T cell activation/exhaustion/trafficking markers, plasma inflammatory markers, and fecal microbiome composition in PLWH and healthy participants recruited from an urban clinic in the city of Harare, Zimbabwe, and a district hospital that services surrounding rural villages. PLWH were either ART naïve at baseline and sampled again after 24 weeks of first-line ART and the antibiotic cotrimoxazole or were ART-experienced at both timepoints.

Results

Although expected reductions in the inflammatory marker IL-6, T-cell activation, and exhaustion were observed with ART-induced viral suppression, these changes were much more pronounced in the urban versus the rural area. Gut microbiome composition was the most highly altered from healthy controls in ART experienced PLWH, and characterized by both reduced alpha diversity and altered composition. However, gut microbiome composition showed a pronounced relationship with T cell activation and exhaustion in ART-naïve PLWH, suggesting a particularly significant role for the gut microbiome in disease progression in uncontrolled infection. Elevated immune exhaustion after 24 weeks of ART did correlate with both living in the rural location and a more Prevotella-rich/Bacteroides-poor microbiome type, suggesting a potential role for rural-associated microbiome differences or their co-variates in the muted improvements in immune exhaustion in the rural area.

Conclusion

Successful ART was less effective at reducing gut microbiome-associated inflammation and T cell activation in PLWH in rural versus urban Zimbabwe, suggesting that individuals on ART in rural areas of Zimbabwe may be more vulnerable to co-morbidity related to sustained immune dysfunction in treated infection.
A hybrid twin based on machine learning enhanced reduced order model for real-time simulation of magnetic bearings
Authors: Ghnatios Chady , Rodriguez Sebastian , Tomezyk Jerome , Dupuis Yves , Mouterde Joel , Da Silva Joaquim , Chinesta Francisco
Published: February 2024

The simulation of magnetic bearings involves highly non-linear physics, with high dependency on the input variation. Moreover, such a simulation is time consuming and can’t run, within realistic computation time for control purposes, when using classical computation methods. On the other hand, classical model reduction techniques fail to achieve the required precision within the allowed computation window. To address this complexity, this work proposes a combination of physics-based computing methods, model reduction techniques and machine learning algorithms, to tackle the requirements. The physical model used to represent the magnetic bearing is the classical Cauer Ladder Network method, while the model reduction technique is applied on the error of the physical model’s solution. Later on, in the latent space a machine learning algorithm is used to predict the evolution of the correction in the latent space. The results show an improvement of the solution without scarifying the computation time. The solution is computed in almost real-time (few milliseconds), and compared to the finite element reference solution.
Analyzing tiger interaction and home range shifts using a time-geographic approach
Authors: Liu Yifei , Dodge Somayeh , Simcharoen Achara , Ahearn Sean C. , Smith James L. D.
Published: February 2024

Background

Interaction through movement can be used as a marker to understand and model interspecific and intraspecific species dynamics, and the collective behavior of animals sharing the same space. This research leverages the time-geography framework, commonly used in human movement research, to explore the dynamic patterns of interaction between Indochinese tigers (Panthera tigris corbeti) in the western forest complex (WEFCOM) in Thailand.

Methods

We propose and assess ORTEGA, a time-geographic interaction analysis method, to trace spatio-temporal interactions patterns and home range shifts among tigers. Using unique GPS tracking data of tigers in WEFCOM collected over multiple years, concurrent and delayed interaction patterns of tigers are investigated. The outcomes are compared for intraspecific tiger interaction across different genders, relationships, and life stages. Additionally, the performance of ORTEGA is compared to a commonly used proximity-based approach.

Results

Among the 67 tracked tigers, 42 show concurrent interactions at shared boundaries. Further investigation of five tigers with overlapping home ranges (two adult females, a male, and two young male tigers) suggests that the mother tiger and her two young mostly stay together before their dispersal but interact less post-dispersal. The male tiger increases encounters with the mother tiger while her young shift their home ranges. On another timeline, the neighbor female tiger mostly avoids the mother tiger. Through these home range dynamics and interaction patterns, we identify four types of interaction among these tigers: following, encounter, latency, and avoidance. Compared to the proximity-based approach, ORTEGA demonstrates better detects concurrent mother–young interactions during pre-dispersal, while the proximity-based approach misses many interactions among the dyads. With larger spatial buffers and temporal windows, the proximity-based approach detects more encounters but may overestimate the duration of interaction.

Conclusions

This research demonstrates the applicability and merits of ORTEGA as a time-geographic based approach to animal movement interaction analysis. We show time geography can develop valuable, data-driven insights about animal behavior and interactions. ORTEGA effectively traces frequent encounters and temporally delayed interactions between animals, without relying on specific spatial and temporal buffers. Future research should integrate contextual and behavioral information to better identify and characterize the nature of species interaction.
Back analysis of cohesion and friction angle of failed slopes using probabilistic approach: two case studies
Authors: Nassirzadeh Reza , Dini Abdollah , Balagar Vahid
Published: February 2024

In general, geotechnical investigations deal with the back analysis of the geotechnical parameters on the basis of the field observation. According to the back analysis method introduced in the present study, geometry of a number of failed slopes have been carefully mapped and then statistical features of the groundwater level, the bulk unit weight and other measurable parameters have been determined. After that, a series of two-dimensional models for back analysis of the failures have been established. Moreover, statistical analyses based on probabilistic approaches have been utilized to estimate the variation ranges of the shear strength variables. The study provided the probabilistic back analysis of the slope failure with the two case studies in the copper mines of Anjerd and Daraloo. Results indicated that the approach to the probabilistic back analysis has been effective in the analysis of the slope failures wherein considerable uncertainty has been observed in the shear strength and other influential variables. Furthermore, the probabilistic back analysis presented a lot of information in comparison to the approach to the deterministic back analysis and thus had more reasonable matching with the practice of geotechnical engineering in the real world. Therefore, this method would be beneficial and practical for stability analysis, redesigning the slopes, designing the new slopes under the same geotechnical conditions and promote the construction safety. The probabilistic back analysis could be also used to estimate the shear parameters and analyze the stability of slopes as a cost-effective and high reliability method.
Protocol for a pilot cluster randomised controlled trial of a multicomponent sustainable return to work IGLOo intervention
Authors: Davis Oliver , Dawson Jeremy , Degerdon Lizzie , Delgadillo Jaime , Kadam Umesh , Nielsen Karina , Sinclair Alice , Yarker Jo , Munir Fehmidah
Published: February 2024

Background

Long-term sickness costs businesses in the United Kingdom (UK) approximately £7 billion per annum. Most long-term sickness absences are attributed to common mental health conditions, which are also highly prevalent in people with acute or musculoskeletal health conditions. This study will pilot the IGLOo (Individual, Group, Leaders, Organisation, overarching context) intervention which aims to support workers in returning to and remaining in work following long-term sickness absence. The potential impact of the intervention is a timely return to work (main trial primary outcome) and prevention of a further episode of long-term sick leave. The intervention will be piloted in a randomised controlled trial (RCT) to examine the feasibility of the intervention (pilot trial primary outcome) and to inform a fully powered definitive trial to evaluate sustainable return to work (RTW) in people with primary or secondary mental ill-health who go on long-term sick leave.

Methods and design

A two-arm feasibility randomised controlled trial (with a 30-month study period including 12-month follow-up) of the IGLOo intervention will be conducted in large organisations (≥ 600 workers) from the Yorkshire and Humberside regions, in the UK. Eight consenting organisations will be recruited and randomised to the intervention or control arms of the study (1:1 ratio), with a minimum recruitment target of 13 workers eligible to participate from each. Organisations assigned to the control group will continue with their usual practice. Feasibility data will include data collected on recruitment, retention and attrition of participants; completion of research outcome measures; and intervention compliance. Measurements of mental health, RTW, work outcomes, quality-of-life, workplace support and communication and other demographic data will be taken at baseline, 3, 6, 9 and 12 months in all participants. Qualitative interviews and survey data with all participants will explore the experiences of participants, acceptability of the intervention components and evaluation measures. Exploratory economic evaluation will be conducted to further inform a definitive trial.

Discussion

The findings from this pilot study will help to inform the development of a definitive cluster RCT designed to examine the efficacy of this intervention on health and work-related outcomes in UK workers on long-term sick leave.

Trial registration

ISRCTN11788559 (prospectively registered, date registered 6 October 2022)
Present and future screening programs for diabetic retinopathy: a narrative review
Authors: Abou Taha Andreas , Dinesen Sebastian , Vergmann Anna Stage , Grauslund Jakob
Published: February 2024

Diabetes is a prevalent global concern, with an estimated 12% of the global adult population affected by 2045. Diabetic retinopathy (DR), a sight-threatening complication, has spurred diverse screening approaches worldwide due to advances in DR knowledge, rapid technological developments in retinal imaging and variations in healthcare resources.

Many high income countries have fully implemented or are on the verge of completing a national Diabetic Eye Screening Programme (DESP). Although there have been some improvements in DR screening in Africa, Asia, and American countries further progress is needed. In low-income countries, only one out of 29, partially implemented a DESP, while 21 out of 50 lower-middle-income countries have started the DR policy cycle. Among upper-middle-income countries, a third of 59 nations have advanced in DR agenda-setting, with five having a comprehensive national DESP and 11 in the early stages of implementation.

Many nations use 2–4 fields fundus images, proven effective with 80–98% sensitivity and 86–100% specificity compared to the traditional seven-field evaluation for DR. A cell phone based screening with a hand held retinal camera presents a potential low-cost alternative as imaging device. While this method in low-resource settings may not entirely match the sensitivity and specificity of seven-field stereoscopic photography, positive outcomes are observed.

Individualized DR screening intervals are the standard in many high-resource nations. In countries that lacks a national DESP and resources, screening are more sporadic, i.e. screening intervals are not evidence-based and often less frequently, which can lead to late recognition of treatment required DR.

The rising global prevalence of DR poses an economic challenge to nationwide screening programs AI-algorithms have showed high sensitivity and specificity for detection of DR and could provide a promising solution for the future screening burden.

In summary, this narrative review enlightens on the epidemiology of DR and the necessity for effective DR screening programs. Worldwide evolution in existing approaches for DR screening has showed promising results but has also revealed limitations. Technological advancements, such as handheld imaging devices, tele ophthalmology and artificial intelligence enhance cost-effectiveness, but also the accessibility of DR screening in countries with low resources or where distance to or a shortage of ophthalmologists exists.
Nature’s therapeutic power: a study on the psychophysiological effects of touching ornamental grass in Chinese women
Authors: Hassan Ahmad , Deshun Zhang
Published: February 2024

The health of city residents is at risk due to the high rate of urbanization and the extensive use of electronics. In the context of urbanization, individuals have become increasingly disconnected from nature, resulting in elevated stress levels among adults. The goal of this study was to investigate the physical and psychological benefits of spending time in nature. The benefits of touching real grass and artificial turf (the control activity) outdoors with the palm of the hand for five minutes were measured. Blood pressure and electroencephalography (EEG) as well as State-trait Anxiety Inventory (STAI) scores, and the semantic differential scale (SDM) were used to investigate psychophysiological responses. Touching real grass was associated with significant changes in brainwave rhythms and a reduction in both systolic and diastolic blood pressure compared to touching artificial turf. In addition, SDM scores revealed that touching real grass increased relaxation, comfort, and a sense of naturalness while decreasing anxiety levels. Compared to the control group, the experimental group had higher mean scores in both meditation and attentiveness. Our findings indicate that contact with real grass may reduce physiological and psychological stress in adults.
Challenges facing Palestinian crime scene investigators
Authors: Khalilia Walid Mahmoud , Ricard Simon , Rabaia Abd Al Latif , Arès Mathieu , Crispino Frank
Published: February 2024

Background

Crime scene investigation (CSI) in general means the standard procedures and techniques used for processing and reconstructing of scene of crime. In Palestine, the competent authorities delegated by law to carry out the task of research and investigation of crimes and inspection at the crime scene are the officers granted by law the status of the judicial police. CSIs face numerous challenges that affect every worker involved. These challenges arise from legal, administrative, security, and technical aspects. This study aimed to point out the challenges faced by field police personnel during CSI in Palestine. To achieve the aims of this study, a validated and reliable questionnaire was developed. The study sample consisted of 354 crime scene investigators and officers affiliated with the Palestinian Civil Police (PCP) across all governorates of the West Bank.

Results

In addition to the training of CSI officers, and shortage of equipment, the findings of this study indicate that there are many challenges amplified by the Israeli occupation facing PCP officers concerning crime scene management and technical procedures during CSIs such as the collection, transportation, and storage of forensic evidence. Overlapping responsibilities and difficulties in coordinating specialized agencies working at the crime scene are also factors that should be better studied.

Conclusion

This study invites decision-makers within the Palestinian police agencies to prioritize efforts to address the significant challenges encountered by workers at crime scenes. They should give special attention on enhancing training programs and providing the necessary tools and devices for effective crime scene work. It also recommends Palestinian representatives at international stage to highlight the obstacles facing workers at crime scenes due to the occupation.
Isolation of Pasteuria penetrans, an obligate hyper-parasite, infecting root knot nematode, Meloidogyne spp. from the rhizosphere of pulses in India
Authors: Jagadeeswaran Rajendran , Singh Bansa , Dubey Jyotirmay
Published: February 2024

Background

Pasteuria penetrans is a mycelial, endospore forming, obligate, bacterial parasite that has shown enormous potential for biological control of root-knot nematode, Meloidogyne spp. In the present study, the effort has been made to isolate effective and high temperature tolerant indigenous strains from pulse rhizosphere in India.

Results

Surveys were carried out in four different agro-climatic zones and collected 106 root-knot nematode infected soil and plant samples from pulses rhizosphere. Of these, we observed Pasteuria spore attachment on root knot nematode juveniles from seven samples: three from Varanasi, two from Salem and one each from Deoria and Kushinagar. The pure cultures of these seven isolates (named as IIPR-Pp-1 to IIPR-Pp-7 from single infected female, respectively) were developed in 7 cm pot and soil-less CYG medium. The nematode host species was identified as Meloidogyne incognita by perineal pattern and confirmed by sequencing of ITS region. The host range study with M. incognita and Heterodera cajani showed the spore attachment was specific to M. incognita revealed that the species of the parasite was Pasteuria penetrans. SEM study on morphometrics of Pasteuria spores belong to two groups. In vitro assay on endospore attachment assay with pre-treated endospores at 20, 30, 40, 50, 60 and 70 °C revealed that maximum number of endospore attachment of all isolates was observed at 30 °C followed by 40 °C, and the least number of them was observed at 60 °C and above. The isolate Pp3 exhibited maximum number of spore attachments among all isolates at 30 °C treatment (14) and 40 °C treatment (10.67). Endospore attachment assay with pre-treated J2 at 20, 25, 30, 35, 40 and 45 °C revealed that maximum number of attachment of all isolates was observed at 30 °C treatment, and no attachment was observed at 40 °C and above.

Conclusion

Pasteuria penetrans isolate IIPR-Pp3 exhibited high temperature tolerance and can be used further to develop Pasteuria-based biopesticide for management of root-knot nematode, M. incognita in pulses.
Effects of acute cannabis inhalation on reaction time, decision-making, and memory using a tablet-based application
Authors: Brooks-Russell Ashley , Wrobel Julia , Brown Tim , Bidwell L. Cinnamon , Wang George Sam , Steinhart Benjamin , Dooley Gregory , Kosnett Michael J.
Published: February 2024

Background

Acute cannabis use has been demonstrated to slow reaction time and affect decision-making and short-term memory. These effects may have utility in identifying impairment associated with recent use. However, these effects have not been widely investigated among individuals with a pattern of daily use, who may have acquired tolerance. The purpose of this study was to examine the impact of tolerance to cannabis on the acute effects as measured by reaction time, decision-making (gap acceptance), and short-term memory.

Methods

Participants (ages 25–45) completed a tablet-based (iPad) test battery before and approximately 60 min after smoking cannabis flower. The change in performance from before to after cannabis use was compared across three groups of cannabis users: (1) occasional use (n = 23); (2) daily use (n = 31); or (3) no current use (n = 32). Participants in the occasional and daily use group self-administered ad libitum, by smoking or vaping, self-supplied cannabis flower with a high concentration of total THC (15–30%).

Results

The occasional use group exhibited decrements in reaction time (slowed) and short-term memory (replicated fewer shapes) from before to after cannabis use, as compared to the no-use group. In the gap acceptance task, daily use participants took more time to complete the task post-smoking cannabis as compared to those with no use or occasional use; however, the level of accuracy did not significantly change.

Conclusions

The findings are consistent with acquired tolerance to certain acute psychomotor effects with daily cannabis use. The finding from the gap acceptance task which showed a decline in speed but not accuracy may indicate a prioritization of accuracy over response time. Cognitive and psychomotor assessments may have utility for identifying impairment associated with recent cannabis use.
Screening of GHSR, GHRHR, GH1 genes in isolated growth hormone deficiency disease in Egyptian patients
Authors: Ammar Tamer H. A. , Al-Ettribi Ghada M. M. , Abo Hashish Maha M. A. , Farid Tarek M. , Abou-Elalla Amany A. , Thomas Manal M.
Published: February 2024

Background

Isolated growth hormone deficiency (IGHD) is a hereditary disorder that causes significant short stature. GHD has a reported incidence of 1/4000–1/10,000 births. It is caused by mutations in the major somatotroph axis genes, involving GH1, codes for growth hormone, GHSR, and GHRHR, codes for growth hormone secretagogue receptor and growth hormone-releasing hormone receptor, respectively.

Aims of the study

The present study aims to examine the clinical phenotype and investigate the genetic etiology of ten Egyptian patients with type I isolated growth hormone insufficiency.

Patients and methods

Patients recruited for the study were clinically diagnosed by two provocation tests and were subjected to a thorough history, clinical examination, and anthropometric measurements. Sanger sequencing and mutational analysis of the three genes, GH1, GHSR, and GHRHR, was our approach, performed in all enrolled IGHD patients. The variants identified were analyzed using the biological, population, sequence variants, and clinical genetics databases. Prediction of the pathogenicity of the novel variants was done by in silico prediction tools following the American College of Medical Genetics and Genomics (ACMG) guidelines.

Results

Sanger sequencing revealed a previously reported pathogenic mutation (NM_000823.4: c.1069C > T; p.Arg357Cys) in the GHRHR gene in one patient and a novel frameshift variant (NM_198407.2: c.1043dup; Ser349Leu fs*6) in the GHSR gene in another patient. This is the fourth report highlighting the autosomal dominant inheritance of the GHSR mutation as a cause of isolated growth hormone deficiency. A number of previously reported variants, but of rare frequency, were identified in this study. In our IGHD cases, 90% of the patients were underweight, 50% had anemia, and 80% showed hypovitaminosis D.

Conclusion

Our findings broaden the mutational spectrum underlying the IGHD in Egyptian patients and point out the importance of mutation screening of the GHSR and GHRHR genes. This study also acknowledges the autosomal dominant mode of inheritance of the GHSR mutation as a cause for dwarfism.
Frequency of neuro-imaging in the emergency room in patients with vertigo: A cross-sectional study at a tertiary care hospital in Karachi, Pakistan
Authors: Baig Mirza Noor Ali , Kapadia Nazir , Raheem Ahmed , Ismail Madiha
Published: February 2024

Objective: To determine the frequency of neuro-imaging and the prevalence of positive findings in patients with vertigo visiting an emergency room of a low-middle-income-country, Pakistan.

Methods: This is a retrospective cross-sectional study conducted in the emergency room of the Aga Khan University Hospital, a 550 bedded tertiary care teaching facility located in Karachi, Pakistan. The frequency of neuro-imaging in patients visiting emergency room with vertigo during 20 years (2000-2020), their findings and disposition was calculated in percentages. A cost-analysis was performed in Pakistani Rupees & US Dollars to estimate the financial burden.

Results: During the emergency room visits for vertigo, neuro-imaging (CT scans, MRIs, or both) was conducted for 159 patients, accounting for 70.98% of the cases. Out of these, 64 individuals (40.25%) received a positive diagnosis, which included acute infarcts, hemorrhages, metastases, space-occupying lesions, and meningeal enhancements. Interestingly, among those with negative findings, the 98 patients faced significantly higher costs, amounting to Rs.4,108,000 ($22,449), in contrast to the positive cases, which incurred Rs.2,496,600 ($13,642).

Conclusion: The frequency of obtaining neuro-imaging tests in patients with vertigo were significantly high in our study. In addition, there was a significant financial burden associated with neuro-imaging especially for our low-middle-income country.

doi: https://doi.org/10.12669/pjms.40.4.7029

How to cite this: Baig MNA, Kapadia N, Raheem A, Ismail M. Frequency of neuro-imaging in the emergency room in patients with vertigo: A cross-sectional study at a tertiary care hospital in Karachi, Pakistan. Pak J Med Sci. 2024;40(4):582-588. doi: https://doi.org/10.12669/pjms.40.4.7029

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.
Safety of fasting in diabetic and non-diabetic patients with stable chronic kidney disease during Ramadan
Authors: Haroon Anita , Riaz Musarrat , Rabbani Bushra , Saeed Ammarah
Published: February 2024

Objective: To assess the safety of fasting in diabetic and non-diabetic patients with stable CKD during Ramadan.

Methods: This prospective observational study was conducted at three secondary and tertiary care hospitals of Karachi during the month of Ramadan from 25th March to 7th May 2022. Patients who met the eligibility criteria were assessed pre-Ramadan, and their baseline blood pressure, serum urea, creatinine, electrolytes, uric acid, and estimated glomerular filtration rate (eGFR) were documented and tracked over the course of Ramadan and up to one week post-Ramadan. Deterioration in renal functions (defined as a rise of ≥30% in serum creatinine from the baseline or the decline of ≥25% in eGFR from the baseline) was observed during the month of Ramadan.

Results: A total of 68 patients (34 males and 32 females) with the mean age 58.7±12.16 years were included in the study. Out of 66 patients, 38 were diabetic and 28 were non diabetic. Majority 23(34.8%) were stage-3a and 23(34.8%) were stage-4 followed by stage-3b in 14(21.2%), stage-2 in 3(4.5%) and stage-5 in 3(4.5%) patients respectively. Statistically significant improvement in pre and post Ramadan values of systolic and diastolic blood pressure, serum creatinine and uric acid levels were found in both diabetic and non-diabetic group (P value <0.0001).

Conclusion: Our study shows no worsening of renal functions in both diabetic and non-diabetic patients with stable CKD who intended to fast.

doi: https://doi.org/10.12669/pjms.40.4.7989

How to cite this: Haroon A, Riaz M, Rabbani B, Saeed A. Safety of fasting in diabetic and non-diabetic patients with stable chronic kidney disease during Ramadan. Pak J Med Sci. 2024;40(4):563-567. doi: https://doi.org/10.12669/pjms.40.4.7989

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.
Comparison of efficacy of daily and alternate day maintenance treatment of GERD with Vonoprazan 10-mg using Gastroesophageal Reflux Disease Symptom Assessment Scale
Authors: Rasheed Tazeen , Zuberi Bader Faiyaz , Ali Faiza Sadaqat , Hussain Sana , Kumar Pawan , Saleem Anoshia
Published: February 2024

Objectives: To compare efficacy of 10-mg of vonoprazan daily & on alternate days by Gastroesophageal Reflux Disease Symptom Assessment Scale (GSAS)

Method: This prospective interventional cohort was done at Department of Medicine/Gastroenterology Dow Medical College, Karachi, Pakistan during the period August 2022 & January 2023. Potential participants fulfilling inclusion and exclusion criteria were asked to fill out GSAS questionnaires after their written consent. Patients were allocated in to two groups using random tables. Group-A was given Tab Vonoprazan 10-mg daily for two weeks. Group-B was given Tab Vonoprazan 10-mg on alternate day. GSAS was scored by totaling scores across symptoms and then they are divided by the total number of non-missing symptom scores. Both groups were assessed week-0 & week-2.

Results: Only 90 proformas that were completely filled were included, Group-A had 30 males and 15 females while Group-B had 29 males and 16 females. No significant difference in score was found in GSAS score at week-0 except that in item ‘gurgling’ while at week two there was no significant difference between any of the items. Total GSAS score were significantly lower at Week-2 than at week-0 (p = <.001).

Conclusions: Vonoprazan of 10-mg on alternate day is equally effective as 10-mg daily in maintenance of GERD patients at two weeks.

doi: https://doi.org/10.12669/pjms.40.4.8063

How to cite this: Rasheed T, Zuberi BF, Ali FS, Hussain SM, Kumar P, Saleem A. Comparison of efficacy of daily and alternate day maintenance treatment of GERD with Vonoprazan 10-mg using Gastroesophageal Reflux Disease Symptom Assessment Scale. Pak J Med Sci. 2024;40(4):623-628. doi: https://doi.org/10.12669/pjms.40.4.8063

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.
Pregnancy-induced hypertension awareness, knowledge and its risk factors: A cross-sectional study
Authors: Peter Bulelwa Beatrice , Okafor Uchenna Benedine
Published: February 2024

Background and Objective: Pregnancy-induced hypertension (PIH) has severe implications for maternal morbidity and mortality; thus, boosting pregnant women’s awareness and knowledge of this medical condition is crucial for improving the mother’s and foetus’s health. This study assessed the awareness and knowledge of PIH and its risk factors among pregnant women in Mdantsane, South Africa.

Methods: This cross-sectional study involved 249 conveniently selected and consenting pregnant women attending antenatal care clinics in Mdantsane, Buffalo City Metropolitan Municipality, South Africa. A self-designed questionnaire was utilised to collect data. Descriptive statistics, chi-square (χ2) test and multivariate logistic regression analysis were performed. The significance level was 0.05.

Results: Over 50% of the women were knowledgeable about PIH and associated risk factors ((χ2=4.92; p = 0.04). The prevalence of PIH was 51.8%, and married women were more aware of the PIH risk factors (71.1%). Women with previous pregnancies were more likely to be aware of PIH (OR = 17.1, 95%; CI = 9.09 to 32.15) compared to first time mothers. Women in age group 36-45 were 2.5 times more likely to be aware of PIH (OR = 2.5, 95% CI: 1.19–3.24) compared to women aged <35 years. Likewise, women aged 36-45 years were two times more likely to be knowledgeable about risk factors for PIH (OR = 2.3, 95% CI: 1.14–2.81) compared to women aged <35 years. Married women were more likely to be aware of PIH risk factors (OR = 2.70, 95% CI = 1.35-5.47) than unmarried women. Moreover, pregnancy increases the likelihood (OR=12.8, 95% CI: 6.97-23.58) of being aware of PIH risk factors. There was a significant difference between the mean ages of women who knew about PIH risk factors and those who do not (t=3.49, Mean difference = 3.49, p=0.0001, 95% CI (2.54; 4.44)).

Conclusion: The prevalence of PIH was high. Age, history of PIH, previous pregnancy, and marital status were predictors of PIH knowledge/awareness and risk factors for PIH. Context-specific health education programmes during prenatal visits are crucial to improving pregnant women’s knowledge of PIH.

doi: https://doi.org/10.12669/pjms.40.4.8247

How to cite this: Peter BB, Okafor UB. Pregnancy-induced hypertension awareness, knowledge and its risk factors: A cross-sectional study. Pak J Med Sci. 2024;40(4):629-636. doi: https://doi.org/10.12669/pjms.40.4.8247

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.
Different doses of atorvastatin in the treatment of patients with cardiorenal syndrome Type-2: A retrospective cohort study
Authors: Zhang Ermiao , Xu Tao , Zhang Bin , Meng Lei
Published: February 2024

Objective: To assess the cardiorenal protective effects of different doses of atorvastatin in patients with cardiorenal syndrome (CRS) Type-2.

Methods: Medical records of 113 patients with CRS Type-2, admitted to First Affiliated Hospital of Hebei North University from August 2021 to August 2022 and treated with atorvastatin, were retrospectively analyzed. Patients were retrospectively grouped based on the dosage of atorvastatin. A total of 38 patients who received 10mg/day atorvastatin were selected as a Low-dose group, 36 patients who received 20mg/day atorvastatin comprised a Medium-dose group, and 39 patients who received 40mg/day atorvastatin comprised a High-dose group. Cardiac function indicators (Left ventricular end-diastolic dimension [LVEDD], left ventricular end-stage systole diameter [LVESD], and left ventricular ejection fraction [LVEF]), renal function indicators (creatinine [SCr], serum uric acid [SUA], heme oxygenase-1 [HO-1], urinary albumin [UALB]), and inflammatory factors (Serum interleukin-6 [IL-6], hypersensitive C-reactive protein [hs-CRP], and tumor necrosis factor -α [TNF-α]) were compared between the three groups.

Results: After the treatment, levels of renal and cardiac function indicators, and inflammatory factor indicators of the three groups were significantly improved compared to the before-treatment levels. The degree of improvement in the Medium-dose and the High-dose groups was significantly higher than in the Low-dose group (p<0.05). There were no significant differences in all cardiorenal function indicators and inflammatory factors between the Medium-dose and the High-dose groups after the treatment. During the treatment process, no adverse events were reported in all three groups.

Conclusions: In the treatment of patients with CRS Type-2, medium dose (20mg/day) atorvastatin can have the same therapeutic effect as the high dose (40mg/day) treatment. Medium dose has a good protective effect on the heart and kidneys of the patients, and helps to reduce inflammatory reactions and improve heart and kidney function.

doi: https://doi.org/10.12669/pjms.40.4.8706

How to cite this: Zhang E, Xu T, Zhang B, Meng L. Different doses of atorvastatin in the treatment of patients with cardiorenal syndrome Type-2: A retrospective cohort study. Pak J Med Sci. 2024;40(4):568-571. doi: https://doi.org/10.12669/pjms.40.4.8706

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.
Comparison of InterTAN and PFNA internal fixation for elderly patients with intertrochanteric fracture: A retrospective cohort study
Authors: Li Li , Fang Xing , Gao Jie , Han Weizhen , Kong Xiangan
Published: February 2024

Objective: To compare the clinical outcomes of InterTAN nail and proximal femoral nail antirotation (PFNA) internal fixation for the treatment of intertrochanteric fractures in the elderly.

Methods: We retrospectively reviewed the clinical records of 151 elderly patients with intertrochanteric fractures treated in The Second People’s Hospital of Hefei from October 2019 to December 2021. Among them, 73 patients had undergone InterTAN (InterTAN group) and 78 patients had undergone PFNA (PFNA group) internal fixation. Operation-related variables (operation time, incision length, intraoperative bleeding volume, hospital stays length, and fracture healing time), complications, and Harris scores were compared between the two groups.

Results: The operation time and incision length were shorter and the intraoperative bleeding was less in the PFNA group than in the InterTAN group (all P-values <0.05), but the fracture healing time was longer in the PFNA group (P<0.05). We found similar hospital stays and surgical complications in the two groups (P>0.05). In addition, the Harris hip joint scores were significantly higher in the InterTAN group than in the PFNA group at one, six, and twelve months after the operation (P<0.05).

Conclusions: InterTAN and PFNA internal fixation have their own advantages in treating patients with intertrochanteric fractures. InterTAN has better postoperative recovery results, while PFNA has less perioperative trauma. Clinically, InterTAN or PFNA should be selected based on the specific conditions of each patient to maximize the therapeutic benefit of each treatment method.

doi: https://doi.org/10.12669/pjms.40.4.8794

How to cite this: Li L, Fang X, Gao J, Han W, Kong X. Comparison of InterTAN and PFNA internal fixation for elderly patients with intertrochanteric fracture: a retrospective cohort study. Pak J Med Sci. 2024;40(4):589-594. doi: https://doi.org/10.12669/pjms.40.4.8794

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.