bluuebunny/crossref_metadata_2025 huggingface dataset:
Translating the Strengthening and Stretching for Rheumatoid Arthritis of the Hand Programme from clinical trial to clinical practice: An effectiveness–implementation study
Authors: Williamson Esther , Srikesavan Cynthia , Thompson Jacqueline , Tonga Eda , Eldridge Lucy , Adams Jo , Lamb Sarah E
Published: September 2020

Introduction

The Strengthening and Stretching for Rheumatoid Arthritis of the Hand programme is a hand exercise programme for people with rheumatoid arthritis. It was clinically effective when delivered during a clinical trial but there was a need to evaluate translation into routine care.

Methods

We conducted an effectiveness–implementation study. We adapted the trial training into an online format for National Health Service hand therapists. Educational outcomes included confidence and capability to deliver the programme. Implementation outcomes included training reach and adoption. Therapists were invited to collect clinical outcomes. Patients receiving the programme provided data on function (Michigan Hand Questionnaire function scale), pain and grip strength at baseline, treatment discharge and four-month follow-up.

Results

A total of 790 therapists (188 National Health Service organizations) enrolled in the training; 584/790 (74%) therapists (162 National Health Service organizations) completed the training; 448/790 therapists (145 National Health Service organizations) (57%) evaluated the training and were confident (447/448, 99.8%) and capable (443/448, 99%) to deliver the programme with 85% intending to adopt it (379/448). Follow-up data were provided by 116/448 (26%) therapists. Two-thirds (77/116; 51 National Health Service organizations) reported adopting the programme. One hundred and eighteen patients (15 National Health Service trusts) participated. Patients reported improved function (mean change Michigan Hand Questionnaire scores: 10 (95% CI 6.5–13.6) treatment discharge; 7 (95% CI 3.8–10.2) 4-month follow-up). Grip strength increased 24.5% (left) and 31% (right). Pain was stable.

Discussion

Online training was an effective way to train therapists with good reach. Clinical outcomes were similar to the clinical trial providing preliminary evidence of successful translation into routine care.
Wernicke-Korsakoff Syndrome in Hyperemesis Gravidarum: A Case Report and Literature Review
Authors: Pagaling Gerald T. , Espiritu Adrian I. , Leochico Carl Froilan D. , Andal Vida Margarette D. , Blasco Krystle Anne R. , Bagnas Marjorie Anne C. , Pasco Paul Matthew D.
Published: September 2020

Background:

Wernicke-Korsakoff syndrome (WKS) is a triad of ophthalmoplegia, ataxia and memory deficits due to thiamine insufficiency resulting from under- or untreated Wernicke’s encephalopathy (WE), which may be associated with hyperemesis gravidarum (HEG).

Case presentation:

We present a case of a 36-year-old Filipino woman in her first trimester with HEG, along with the WKS triad and abnormal hyperintense signals in the bilateral thalami and midbrain, left occipital lobe, periaqueductal gray matter and pontine periventricular areas. Neurologic deficits partially improved but persisted despite intravenous thiamine administration.

Evidence review:

A review of current treatments for WE, and the prevention and neurocognitive recovery of WKS was done. The beneficial effects of thiamine for acute WKS are supported by several case reports and clinical experience. Evidence from one randomized controlled trial wherein thiamine was given in various doses for treating WE or preventing WKS in an alcohol-dependent population is limited by methodological issues. Rehabilitation and pharmacotherapy for neurocognitive recovery seems promising, but they have inadequate evidentiary support. More robust studies on multi-modal strategies are warranted to facilitate the neurocognitive recovery of patients with WKS.
‘Gender inequality- now available on digital platform’: an interplay between gender equality and the gig economy in the European Union
Authors: Vyas Neha
Published: September 2020

This article is directed towards addressing the employment related issues encountered by female workers in the gig economy in the EU. It revolves around analysing ‘the switch’ from the traditional labour market to the platform economy. It subsequently explains, by drawing comparisons, that the issues of gender inequality in the brick and mortar world are still prevalent in world of the digital platform. In fact, new challenges have emerged which are specifically related to the gig economy. Female workers are now affected by the inherent bias of algorithms. Moreover, due to the unequivocal propagation of ‘flexibility’ which is used as a weapon to glorify the gig economy; women are even more likely to be pushed into precarious work. The other prominent issues of gender inequality like the dynamics of intersectionality, the gender pay gap and hiring policies in traditional and digital platforms are also examined. Furthermore, the existing regulatory frameworks addressing these issues are discussed with the possibility of catering to the gender inequality issues in the gig economy through policy development. The article concludes with a reflection on the need for the EU to take immediate and efficacious policy measures in respect of female workers in the gig economy.
Comparative efficacy and safety of anti-vascular endothelial growth factor regimens for neovascular age-related macular degeneration: systematic review and Bayesian network meta-analysis
Authors: Ye Lu , Jiaqi Zhao , Jianchao Wang , Zhaohui Feng , Liang Yao , Xiaohui Zhang
Published: September 2020

Background:

As a debilitating neurodegenerative disease, neovascular age-related macular degeneration (nAMD) accounts for more than 90% of severe visual loss or legal blindness among AMD patients. Anti-vascular endothelial growth factor (VEGF) had been applied widely in nAMD treatment. To date, debate regarding efficacy and safety still exists among different anti-VEGF regimens as management of nAMD. To provide substantial evidence for clinical nAMD treatment, this study ranks the priority of anti-VEGF regimens via Bayesian network meta-analysis (NMA), comparing data collected from randomized controlled trials (RCTs).

Methods:

We searched PubMed Central, MEDLINE Ovid, Embase Ovid, ISRCTN, ICTRP and ClinicalTrials. gov from a database established until 1 April 2019 systematically for anti-VEGF regimens. Bayesian NMA with random-effect was conducted to compare efficacy and safety and rank priority of anti-VEGF regimens. The primary efficacy and safety outcomes were the proportion of patients gaining 15 or more letters, and the incidence of arterial thromboembolic (ATC) events. The effect measure is the standard mean difference (SMD), or the odds ratio (OR) with their 95% confidence interval (CI). The study protocol is registered with PROSPERO, number CRD42019132243.

Results:

We obtained 6467 citations and identified 29 RCTs including 13,596 participants; 86% of these trials were low risk or of uncertain risk bias. In NMA, ORs compared with sham injection for the proportion of patients gaining 15 or more letters (12,699 participants from 23 trials) ranged from 4.05 [95% Bayesian credible interval (CrI) 1.62–10.11] for ranibizumab quarterly regimen to 8.57 (95% CrI 4.66–15.73) for a ranibizumab treat-and-extend regimen. No difference was found between sham injection and anti-VEGF regimens for ATC events (11,500 participants from 18 trials). Results for the primary outcome did not substantially change in sensitivity analyses after removing studies at high risk of bias and small sample size ( n < 100), respectively.

Conclusion:

The treat-and-extend regimen of ranibizumab and aflibercept are the preferred anti-VEGF regimens for nAMD. Bevacizumab treat-and-extend regimens need more head-to-head comparisons with other regimens or sham injection for advanced application. The treat-and-extend regimen proved to be the most effective regimen for each anti-VEGF drug in the NMA. Pegaptanib every 6 weeks and Conbercept quarterly are unable to satisfy the best corrected visual acuity (BCVA) improvement requirement of nAMD patients.
Is there an association between orthostatic hypotension and cerebral white matter hyperintensities in older people? The Irish longitudinal study on ageing
Authors: Buckley Anne , Carey Daniel , Meaney James M , Kenny RoseAnne , Harbison Joseph
Published: September 2020

Introduction

Orthostatic Hypotension (OH) is an abnormal drop in blood pressure (BP) that occurs following orthostatic challenge. OH is associated with increased risk of falls, cognitive impairment and death. White Matter Hyperintensities (WMH) on MR Brain are associated with vascular risk factors such as hypertension, diabetes and age. We examined whether extent White matter intensities were associated with presence of OH detected in a community dwelling population of older people.

Methods

Individuals from the MR sub-study of the Irish Longitudinal Study of Ageing underwent a 3 Tesla MR Brain scan to assess WMH severity (Schelten’s Score). The scans were performed during the Wave 3 TILDA health assessment phase when the subjects also underwent assessment for OH with an active stand protocol. Data was analysed for association between WMH and vascular risks and orthostatic change in BP 10 second intervals during the OH evaluation.

Results

440 subjects were investigated; median age 72 years (65–92 years) and 228 (51.5%) female. Range of Scheltens’ Scores was 0–32. Mean score was 9.72 (SD 5.87). OH was detected in 68.4% (301). On linear regression, positive associations were found between Scheltens’ Score and age, hypertension, prior history of stroke and TIA, and with OH at 30, 70, 90 and 100 seconds following standing (p < 0.05, O.R. 1.9–2.5).

Conclusion

WMD is associated with OH detected at multiple time points using active stand in community dwelling older subjects. Further research is necessary to evaluate the direction of this association.
Chimney technique with endoanchors in treatment of late type 1a endoleak after endovascular aortic repair
Authors: Gatta Emanuele , Pagliariccio Gabriele , Schiavon Sara , Grilli Cicilioni Carlo , Carbonari Luciano
Published: September 2020

The late type Ia endoleak after endovascular aortic repair could be a challenging issue. Over the last years, in case of short or enlarged neck, fenestrated and branched stent grafts have been increasingly employed with improving results. However, these devices have limited use in urgent/emergent cases as custom graft manufacturing takes long time, and may not be fit in patients with particular anatomic features. In this setting, chimney and relining remain an alternative but sometimes may not be adequate. According to literature, the use of the endoanchors associated to chimney technique can improve the procedure results in primary endovascular aortic repair. We treated two patients with a late type Ia endoleak after endovascular aortic repair with a simultaneous relining, single renal chimney, and endoanchors implant. These patients were valuated unfit for open repair with neck configuration unadapt for a simple relining, ballooning, or stenting. The patient conditions were unfavorable for an endovascular repair with branched endovascular aortic repair–fenestrated endovascular aortic repair. The same procedure was performed in both patients. Postoperative angio-computed tomographic scan demonstrated the resolution of the endoleak with patency of renal graft. Our preliminary experience, in these selected cases, demonstrate the feasibility of the technique in late type Ia endoleak.
Improving Sexual Function in People With Chronic Kidney Disease: A Narrative Review of an Unmet Need in Nephrology Research
Authors: Harrison Tyrone G. , Skrtic Marko , Verdin Nancy E. , Lanktree Matthew B. , Elliott Meghan J.
Published: September 2020

Purpose of review:

Sexual dysfunction occurs commonly in people with chronic kidney disease (CKD) and has been recognized as a research priority. We sought to evaluate the current state of the literature addressing sexual dysfunction in people with CKD and identify barriers and strategies to improve our management of this important symptom.

Sources of information:

OVID Medline and Google Scholar were searched for English, peer-reviewed studies using keywords and terms related to “Chronic Kidney Disease,” “sexuality,” and “sexual dysfunction OR function.”

Methods:

In this narrative review, we describe definitions of sexual dysfunction and contributors exacerbated by CKD, barriers to researching sexual dysfunction in people with CKD, and possible avenues for future research.

Key findings:

Sexual dysfunction is common in people with CKD and results from a combination of kidney disease itself, as well as its associated physical (ie, comorbidities) and nonphysical factors. Barriers to the study of sexual dysfunction in CKD include inconsistent disease definitions, stigma, variable efficacy and safety of established therapies, and evolving gender roles in sexual function. Potential avenues for future research to improve the sexual function in people with CKD may include evaluating the safety and efficacy of established therapies in people with CKD using a variety of observational and interventional study designs, engaging people with CKD and multidisciplinary team members in research, and using implementation science methods to translate what is known about sexual function into clinical practice. Concerted efforts are required to break down barriers and improve sexual function in people with CKD. Patients have identified this as an important research priority, and national networks need to direct efforts to reduce symptom burden.

Limitations:

This narrative review was limited by a paucity of high-quality studies examining sexual dysfunction specifically in people with kidney disease.
Derivation and Internal Validation of a Clinical Risk Prediction Tool for Hyperkalemia-Related Emergency Department Encounters Among Hemodialysis Patients
Authors: Ronksley Paul E. , Wick James P. , Elliott Meghan J. , Weaver Robert G. , Hemmelgarn Brenda R. , McRae Andrew , James Matthew T. , Harrison Tyrone G. , MacRae Jennifer M.
Published: September 2020

Background:

Approximately 10% of emergency department (ED) visits among dialysis patients are for conditions that could potentially be managed in outpatient settings, such as hyperkalemia.

Objective:

Using population-based data, we derived and internally validated a risk score to identify hemodialysis patients at increased risk of hyperkalemia-related ED events.

Design:

Retrospective cohort study.

Setting:

Ten in-center hemodialysis sites in southern Alberta, Canada.

Patients:

All maintenance hemodialysis patients (≥18 years) between March 2009 and March 2017.

Measurements:

Predictors of hyperkalemia-related ED events included patient demographics, comorbidities, health-system use, laboratory measurements, and dialysis information. The outcome of interest (hyperkalemia-related ED events) was defined by International Classification of Diseases (10th Revision; ICD-10) codes and/or serum potassium [K+] ≥6 mmol/L.

Methods:

Bootstrapped logistic regression was used to derive and internally validate a model of important predictors of hyperkalemia-related ED events. A point system was created based on regression coefficients. Model discrimination was assessed by an optimism-adjusted C-statistic and calibration by deciles of risk and calibration slope.

Results:

Of the 1533 maintenance hemodialysis patients in our cohort, 331 (21.6%) presented to the ED with 615 hyperkalemia-related ED events. A 9-point scale for risk of a hyperkalemia-related ED event was created with points assigned to 5 strong predictors based on their regression coefficients: ≥1 laboratory measurement of serum K+ ≥6 mmol/L in the prior 6 months (3 points); ≥1 Hemoglobin A1C [HbA1C] measurement ≥8% in the prior 12 months (1 point); mean ultrafiltration of ≥10 mL/kg/h over the preceding 2 weeks (2 points); ≥25 hours of cumulative time dialyzing over the preceding 2 weeks (1 point); and dialysis vintage of ≥2 years (2 points). Model discrimination (C-statistic: 0.75) and calibration were good.

Limitations:

Measures related to health behaviors, social determinants of health, and residual kidney function were not available for inclusion as potential predictors.

Conclusions:

While this tool requires external validation, it may help identify high-risk patients and allow for preventative strategies to avoid unnecessary ED visits and improve patient quality of life.

Trial registration:

Not applicable—observational study design.
Oral Health and Cardiovascular Disease: Mapping Clinical Heterogeneity and Methodological Gaps
Authors: Aldossri M. , Farmer J. , Saarela O. , Rosella L. , Quiñonez C.
Published: September 2020

Background:

Numerous studies have examined the associations between poor oral health and the incidence of cardiovascular disease (CVD) over the past 25 y. This long history of research has resulted in a broad and heterogenous epidemiological field whose implications are difficult to understand and whose methodological gaps are hard to track.

Objectives:

This systematic mapping review aims to systematically map clinical heterogeneity and methodological gaps in assessing the relationship between poor oral health and CVD outcomes.

Methods:

Medline, Embase, and Cochrane Library were searched to identify longitudinal studies that examined the relationship between any oral health indicator and CVD outcomes. Each database was searched from its inception date and June 27, 2018. Extracted data assess the clinical heterogeneity (participants’ characteristics, exposure and outcome measures, length of follow-up) and methodological gaps (availability of randomized controlled trials, utilization of time-varying exposures, propensity methods, mediation analysis, and competing risks analysis).

Results:

Eighty-five studies met the inclusion criteria. Clinical heterogeneity is evident in participants’ characteristics (age, clinical status, and occupation) and in the definitions of oral health indicators and CVD outcomes. More important, a significant proportion of studies reported unclear definitions for CVD outcomes. The search strategy did not reveal any randomized controlled trials. Time-varying exposures, propensity methods, mediation analysis, and competing risks analysis are used infrequently in the identified studies.

Conclusion:

There is a need for a universally accepted conceptual framework on the association between oral health and CVD to derive more consistent definitions for oral health and CVD outcomes that are aligned with the investigated research questions. There is also a need to use emerging research methods to maximize the impact of research in this area.

Knowledge Transfer Statement:

Clinical heterogeneity is evident in the definitions of oral health indicators and cardiovascular disease outcomes. Propensity methods, mediation analysis, and competing risks analysis are used infrequently in the identified studies. The identified clinical heterogeneity and methodological gaps interfere with summarizing existing evidence and understanding their practical implications. Advancing the current understanding of the associations between oral health and cardiovascular disease goes hand in hand with minimizing clinical heterogeneity and closing the identified methodological gaps.
Work-life balance policies in high performance organisations: A comparative interview study with millennials in Dutch consultancies
Authors: Bouwmeester Onno , Atkinson Rose , Noury Lucie , Ruotsalainen Riku
Published: September 2020

The literature on work-life balance primarily focuses on how individuals cope with high work demands. This study, however, investigates how young professionals experience the work-life balance support offered by organisations. Twenty-four millennial consultants were interviewed to explore their perceptions of work-life balance and organisational support policies in an extreme work context. Twelve consultants worked for strategy houses with an average working week of around 60 hours, while the other 12 worked for general management consultancies with average working weeks of roughly 50 hours. Our comparative findings suggest that overall work-life balance perceptions stay positive in both settings. In strategy houses, where work pressures are highest, reported policies and practices go beyond health programmes, training and coaching, which are the most common work-life balance measures. Strategy houses monitor their consultants’ work-life balance experience weekly, provide options to outsource components of the work, and offer multiple forms of compensation. These further policies are much appreciated. Despite these positive assessments, we also observe an increase of negative work-life balance experiences due to the higher work pressures at strategy houses. There is, therefore, some ambiguity in the work-life balance perceptions of consultants, who recalibrate what are ‘normal’ work demands and reframe and refocus on the bright side of work life. Such occupational ideologies indicate a ‘dirty work’ experience.
Improvements across a range of patient-reported domains with fremanezumab treatment: results from a patient survey study
Authors: Buse Dawn C. , Gandhi Sanjay K. , Cohen Joshua M. , Ramirez-Campos Verena , Cloud Blaine , Yang Ronghua , Cowan Robert P.
Published: September 2020

Background

The long-term safety and efficacy of fremanezumab were evaluated in a 52-week extension study (NCT02638103). Patient satisfaction with fremanezumab, dosing preferences, and patient-reported outcomes were assessed in a subpopulation who completed the extension study and consented to a follow-up questionnaire.

Methods

In the extension study (N = 1842), adults with migraine were randomized to quarterly or monthly fremanezumab. After completing active treatment, patients answered a survey evaluating patient satisfaction, treatment and dosing preferences, and changes in patient-reported outcomes.

Results

Of the 557 patients who could have been contacted upon completing the extension study, 302 consented and 253 completed the survey. The mean (standard deviation) satisfaction rating for fremanezumab was 6.1 (1.4; 1 = “extremely dissatisfied” to 7 = “extremely satisfied”). Most patients (175 [69.2%]) preferred quarterly over monthly fremanezumab dosing. Among patients taking antiepileptics (most common class of prior preventive medication;n = 130), 91.5% preferred fremanezumab. Patients reported improvements in anxiety (74 [67.9%]), sleep quality (143 [56.5%]), and quality of time spent with others (210 [83.0%]) with fremanezumab.

Conclusion

In this study, treatment satisfaction with fremanezumab was high, most patients preferred quarterly fremanezumab dosing, and fremanezumab was generally preferred to prior preventive medications.

Trial registration

ClinicalTrials.govNCT02638103(HALO LTS), registered December 22, 2015.
Signatures of selection reveal candidate genes involved in economic traits and cold acclimation in five Swedish cattle breeds
Authors: Ghoreishifar Seyed Mohammad , Eriksson Susanne , Johansson Anna M. , Khansefid Majid , Moghaddaszadeh-Ahrabi Sima , Parna Nahid , Davoudi Pourya , Javanmard Arash
Published: September 2020

Background

Thousands of years of natural and artificial selection have resulted in indigenous cattle breeds that are well-adapted to the environmental challenges of their local habitat and thereby are considered as valuable genetic resources. Understanding the genetic background of such adaptation processes can help us design effective breeding objectives to preserve local breeds and improve commercial cattle. To identify regions under putative selection, GGP HD 150 K single nucleotide polymorphism (SNP) arrays were used to genotype 106 individuals representing five Swedish breeds i.e. native to different regions and covering areas with a subarctic cold climate in the north and mountainous west, to those with a continental climate in the more densely populated south regions.

Results

Five statistics were incorporated within a framework, known as de-correlated composite of multiple signals (DCMS) to detect signatures of selection. The obtainedp-values were adjusted for multiple testing (FDR < 5%), and significant genomic regions were identified. Annotation of genes in these regions revealed various verified and novel candidate genes that are associated with a diverse range of traits, including e.g. high altitude adaptation and response to hypoxia (DCAF8,PPP1R12A,SLC16A3,UCP2,UCP3,TIGAR), cold acclimation (AQP3,AQP7,HSPB8), body size and stature (PLAG1,KCNA6,NDUFA9,AKAP3,C5H12orf4,RAD51AP1,FGF6,TIGAR,CCND2,CSMD3), resistance to disease and bacterial infection (CHI3L2,GBP6,PPFIBP1,REP15,CYP4F2,TIGD2,PYURF,SLC10A2,FCHSD2,ARHGEF17,RELT,PRDM2,KDM5B), reproduction (PPP1R12A, ZFP36L2,CSPP1), milk yield and components (NPC1L1,NUDCD3,ACSS1,FCHSD2), growth and feed efficiency (TMEM68,TGS1,LYN,XKR4,FOXA2,GBP2,GBP5,FGD6), and polled phenotype (URB1,EVA1C).

Conclusions

We identified genomic regions that may provide background knowledge to understand the mechanisms that are involved in economic traits and adaptation to cold climate in cattle. Incorporatingp-values of different statistics in a single DCMS framework may help select and prioritize candidate genes for further analyses.
Professional roles of general practitioners, community pharmacists and specialist providers in collaborative medication deprescribing - a qualitative study
Authors: Gerlach Navina , Michiels-Corsten Matthias , Viniol Annika , Schleef Tanja , Junius-Walker Ulrike , Krause Olaf , Donner-Banzhoff Norbert
Published: September 2020

Background

Collaborative care approaches between general practitioners (GPs) and pharmacists have received international recognition for medication optimization and deprescribing efforts. Although specialist providers have been shown to influence deprescribing, their profession so far remains omitted from collaborative care approaches for medication optimization. Similarly, while explorative studies on role perception and collaboration between GPs and pharmacists grow, interaction with specialists for medication optimization is neglected. Our qualitative study therefore aims to explore GPs’, community pharmacists’ and specialist providers’ role perceptions of deprescribing, and to identify interpersonal as well as structural factors that may influence collaborative medication optimization approaches.

Method

Seven focus-group discussions with GPs, community pharmacists and community specialists were conducted in Hesse and Lower Saxony, Germany. The topic guide focused on views and experiences with deprescribing with special attention to inter-professional collaboration. We conducted conventional content analysis and conceptualized emerging themes using the Theoretical Domains Framework.

Results

Twenty-six GPs, four community pharmacists and three community specialists took part in the study. The main themes corresponded to the four domains ‘Social/professional role and identity’ (1), ‘Social influences’ (2), ‘Reinforcement’ (3) and ´Environmental context and resources’ (4) which were further described by beliefs statements, that is inductively developed key messages. For (1), GPs emerged as central medication managers while pharmacists and specialists were assigned confined or subordinated tasks in deprescribing. Social influences (2) encompassed patients’ trust in GPs as a support, while specialists and pharmacists were believed to threaten GPs’ role and deprescribing attempts. Reinforcements (3) negatively affected GPs’ and pharmacists’ effort in medication optimization by social reprimand and lacking reward. Environmental context (4) impeded deprescribing efforts by deficient reimbursement and resources as well as fragmentation of care, while informational and gate-keeping resources remained underutilized.

Conclusion

Understanding stakeholders’ role perceptions on collaborative deprescribing is a prerequisite for joint approaches to medication management. We found that clear definition and dissemination of roles and responsibilities are premise for avoiding intergroup conflicts. Role performance and collaboration must further be supported by structural factors like adequate reimbursement, resources and a transparent continuity of care.
Feeding practices and association of fasting and low or hypo glycaemia in severe paediatric illnesses in Malawi – a mixed method study
Authors: Ngwalangwa Fatsani , Chirambo Chawanangwa Mahebere , Lindsjö Cecilia , Dube Queen , Langton Josephine , Baker Tim , Hildenwall Helena
Published: September 2020

Background

The presence of low or hypo glycaemia in children upon admission to hospital in low income countries is a marker for poor outcome. Fasting during illness may contribute to low blood glucose and caretakers’ feeding practices during childhood illnesses may thus play a role in the development of low or hypo glycaemia. This study aims to describe the caretaker’s feeding practices and association of fasting with low or hypo glycaemia in sick children in Malawi.

Methods

A mixed method approach was used combining quantitative cross-sectional data for children aged 0–17 years admitted to Queen Elizabeth Central Hospital (QECH), a tertiary hospital in Malawi, with qualitative focus group discussions conducted with caretakers of young children who were previously referred to QECH from the five health centres around QECH. Logistic regression was used to analyse the quantitative data and thematic content analysis was conducted for qualitative data analysis.

Results

Data for 5131 children who were admitted through the hospital’s Paediatric Accident and Emergency Department (A&E) were analysed whereof 2.1% presented with hypoglycaemia (< 2.5 mmol/l) and 6.6% with low glycaemia (≥2.5mmoll/l – < 5 mmol/l). Fasting for more than eight hours was associated with low glycaemia as well as hypoglycaemia with Adjusted Odds Ratios (AOR) of 2.9 (95% Confidence Interval (CI) of 2.3–3.7) and 4.6, (95% CI 3.0–7.0), respectively. Caretakers demonstrated awareness of the importance of feeding during childhood illness and reported intensified feeding attention to sick children but face feeding challenges when illness becomes severe causing them to seek care at a health facility.

Conclusion

Results suggests that caretakers understand the importance of feeding during illness and make efforts to intensify feeding a sick child but challenges occur when illness is severe leading to fasting. Fasting among children admitted to hospitals may serve as a marker of severe illness and determine those at risk of low and hypoglycaemia.
PRMT5 inhibition attenuates cartilage degradation by reducing MAPK and NF-κB signaling
Authors: Dong Yonghui , Wang Ping , Yang Yongguang , Huang Jincheng , Dai Zhipeng , Zheng Wendi , Li Zhen , Yao Zheng , Zhang Hongjun , Zheng Jia
Published: September 2020

Objectives

A role for the type II arginine methyltransferase PRMT5 in various human diseases has been identified. In this study, the potential mechanism underlying the involvement of PRMT5 in the pathological process leading to osteoarthritis (OA) was investigated.

Methods

PRMT5 expression in cartilage tissues from patients with OA and control individuals was assessed by immunohistochemical staining. The regulatory and functional roles of PRMT5 in the chondrocytes of patients with OA and control individuals were determined by western blotting and reverse transcription polymerase chain reaction. The effects of the PRMT5 inhibitor EPZ on interleukin-1β-induced inflammation were examined in the chondrocytes of patients with OA and in the destabilized medial meniscus (DMM) of a mouse model of OA.

Results

PRMT5 was specifically upregulated in the cartilage of patients with OA. Moreover, adenovirus-mediated overexpression of PRMT5 in human chondrocytes caused cartilage degeneration. This degeneration was induced by elevated expression levels of matrix-degrading enzymes (matrix metalloproteinase-3 (MMP-3) and matrix metalloproteinase-13 (MMP-13)) in chondrocytes. The activation of the MAPK and nuclear factor κB signaling pathways was evidenced by elevated levels of p-p65, p-p38, and p-JNK. These effects were attenuated by inhibiting the expression of PRMT5. In the mouse model, EPZ inhibited PRMT5 expression, thus protecting mouse cartilage from DMM-induced OA.

Conclusions

Our results demonstrate that PRMT5 is a crucial regulator of OA pathogenesis, implying that EPZ has therapeutic value in the treatment of this cartilage-destroying disease.
Existence and uniqueness of solutions for coupled system of fractional differential equations involving proportional delay by means of topological degree theory
Authors: Ali Anwar , Sarwar Muhammad , Zada Mian Bahadur , Abdeljawad Thabet
Published: September 2020

In this manuscript, we obtain sufficient conditions required for the existence of solution to the following coupled system of nonlinear fractional order differential equations: $$ \begin{gathered} D^{\gamma}\omega(\ell)= \mathcal{F} \bigl( \ell,\omega(\lambda\ell), \upsilon(\lambda\ell) \bigr), \\ D^{\delta}\upsilon(\ell)=\mathcal{\overline{F}} \bigl(\ell,\omega ( \lambda\ell), \upsilon(\lambda\ell) \bigr), \end{gathered} $$

D
γ

ω
(
ℓ
)
=
F

(
ℓ
,
ω
(
λ
ℓ
)
,
υ
(
λ
ℓ
)
)

,

D
δ

υ
(
ℓ
)
=

F
‾

(
ℓ
,
ω
(
λ
ℓ
)
,
υ
(
λ
ℓ
)
)

,

with fractional integral boundary conditions $$ \begin{gathered} \mathfrak{a}_{1}\omega(0)- \mathfrak{b}_{1}\omega(\eta)-\mathfrak {c}_{1}\omega(1)= \frac{1}{\varGamma(\gamma)} \int_{0}^{1}(1-\rho )^{\gamma-1} \phi \bigl( \rho, \omega(\rho) \bigr)\, d\rho\quad\text{and} \\ \mathfrak{a}_{2}\upsilon(0)-\mathfrak{b}_{2} \upsilon (\xi)-\mathfrak{c}_{2}\upsilon(1)=\frac{1}{\varGamma(\delta)} \int _{0}^{1}(1-\rho)^{\delta-1} \psi \bigl( \rho, \upsilon(\rho) \bigr) \,d\rho, \end{gathered} $$

a
1

ω
(
0
)
−

b
1

ω
(
η
)
−

c
1

ω
(
1
)
=

1

Γ
(
γ
)

∫

0

1

(
1
−
ρ
)

γ
−
1

ϕ

(
ρ
,
ω
(
ρ
)
)

d
ρ

and

a
2

υ
(
0
)
−

b
2

υ
(
ξ
)
−

c
2

υ
(
1
)
=

1

Γ
(
δ
)

∫

0

1

(
1
−
ρ
)

δ
−
1

ψ

(
ρ
,
υ
(
ρ
)
)

d
ρ
,

where $\ell\in\mathfrak{Z}=[0,1]$
ℓ
∈
Z
=
[
0
,
1
]
, $\gamma, \delta\in(0,1]$
γ
,
δ
∈
(
0
,
1
]
, $0<\lambda<1$
0
<
λ
<
1
, D denotes the Caputo fractional derivative (in short CFD), $\mathcal{F}, \mathcal{\overline{F}}: \mathfrak{Z}\times \mathfrak{R}\times\mathfrak{R} \rightarrow\mathfrak{R}$
F
,

F
‾

:
Z
×
R
×
R
→
R
and $\phi , \psi:\mathfrak{Z}\times\mathfrak{R}\rightarrow\mathfrak{R}$
ϕ
,
ψ
:
Z
×
R
→
R
are continuous functions. The parameters η, ξ are such that $0<\eta, \xi<1$
0
<
η
,
ξ
<
1
, and $\mathfrak{a}_{i}, \mathfrak{b}_{i}, \mathfrak {c}_{i}$

a
i

,

b
i

,

c
i

($i=1, 2$
i
=
1
,
2
) are real numbers with $\mathfrak{a}_{i}\neq\mathfrak {b}_{i}+\mathfrak{c}_{i}$

a
i

≠

b
i

+

c
i

($i=1, 2$
i
=
1
,
2
). Using topological degree theory, sufficient results are constructed for the existence of at least one and unique solution to the concerned problem. For the validity of our result, an appropriate example is presented in the end.
Analytical properties of the Hurwitz–Lerch zeta function
Authors: Nadeem Raghib , Usman Talha , Nisar Kottakkaran Sooppy , Baleanu Dumitru
Published: September 2020

In the present paper, we aim to extend the Hurwitz–Lerch zeta function $\varPhi _{\delta ,\varsigma ;\gamma }(\xi ,s,\upsilon ;p)$

Φ

δ
,
ς
;
γ

(
ξ
,
s
,
υ
;
p
)
involving the extension of the beta function (Choi et al. in Honam Math. J. 36(2):357–385, 2014). We also study the basic properties of this extended Hurwitz–Lerch zeta function which comprises various integral formulas, a derivative formula, the Mellin transform, and the generating relation. The fractional kinetic equation for an extended Hurwitz–Lerch zeta function is also obtained from an application point of view. Furthermore, we obtain certain interesting relations in the form of particular cases.
The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal–fetal transmission: a systematic review and meta-analysis
Authors: Diriba Kuma , Awulachew Ephrem , Getu Eyob
Published: September 2020

Background

Coronavirus is challenging the global health care system from time to time. The pregnant state, with alterations in hormone levels and decreased lung volumes due to a gravid uterus and slightly immunocompromised state may predispose patients to a more rapidly deteriorating clinical course and can get a greater risk of harm for both the mother and fetus. Therefore, this systematic review was aimed to assess the effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and its possibility of vertical maternal–fetal transmission.

Methods

A systematic search was conducted on PubMed, Web of Science, Embase, Google Scholar and the Cochrane Library until the end of April. All authors independently extracted all necessary data using excel spreadsheet form. Only published articles with fully accessible data on pregnant women infected with SARS-CoV, MARS-CoV, and SARS-CoV-2 were included. Data on clinical manifestations, maternal and perinatal outcomes were extracted and analyzed.

Result

Out of 879 articles reviewed, 39 studies involving 1316 pregnant women were included. The most common clinical features were fever, cough, and myalgia with prevalence ranging from 30 to 97%, while lymphocytopenia and C-reactive protein were the most common abnormal laboratory findings (55–100%). Pneumonia was the most diagnosed clinical symptom of COVID-19 and non-COVID-19 infection with prevalence ranged from 71 to 89%. Bilateral pneumonia (57.9%) and ground-glass opacity (65.8%) were the most common CT imaging reported. The most common treatment options used were hydroxychloroquine (79.7%), ribavirin (65.2%), and oxygen therapy (78.8%). Regarding maternal outcome, the rate of preterm birth < 37 weeks of gestation was 14.3%, preeclampsia (5.9%), miscarriage (14.5%, preterm premature rupture of membranes (9.2%) and fetal growth restriction (2.8%). From the total coronavirus infected pregnant women, 56.9% delivered by cesarean, 31.3% admitted to ICU, while 2.7% were died. Among the perinatal outcomes, fetal distress rated (26.5%), neonatal asphyxia rated (1.4%). Only, 1.2% of neonates had apgar score < 7 at 5 min. Neonate admitted to ICU was rated 11.3%, while the rate of perinatal death was 2.2%. In the current review, none of the studies reported transmission of CoV from the mother to the fetus in utero during the study period.

Conclusion

Coronavirus infection is more likely to affect pregnant women. Respiratory infectious diseases have demonstrated an increased risk of adverse maternal obstetrical complications than the general population due to physiological changes occurred during pregnancy. None of the studies reported transmission of CoV from the mother to the fetus in utero, which may be due to a very low expression of angiotensin-converting enzyme-2 in early maternal–fetal interface cells.
Homozygous expression of the myofibrillar myopathy-associated p.W2710X filamin C variant reveals major pathomechanisms of sarcomeric lesion formation
Authors: Schuld Julia , Orfanos Zacharias , Chevessier Frédéric , Eggers Britta , Heil Lorena , Uszkoreit Julian , Unger Andreas , Kirfel Gregor , van der Ven Peter F. M. , Marcus Katrin , Linke Wolfgang A. , Clemen Christoph S. , Schröder Rolf , Fürst Dieter O.
Published: September 2020

Filamin C (FLNc) is mainly expressed in striated muscle cells where it localizes to Z-discs, myotendinous junctions and intercalated discs. Recent studies have revealed numerous mutations in theFLNCgene causing familial and sporadic myopathies and cardiomyopathies with marked clinical variability. The most frequent myopathic mutation, p.W2710X, which is associated with myofibrillar myopathy, deletes the carboxy-terminal 16 amino acids from FLNc and abolishes the dimerization property of Ig-like domain 24. We previously characterized “knock-in” mice heterozygous for this mutation (p.W2711X), and have now investigated homozygous mice using protein and mRNA expression analyses, mass spectrometry, and extensive immunolocalization and ultrastructural studies. Although the latter mice display a relatively mild myopathy under normal conditions, our analyses identified major mechanisms causing the pathophysiology of this disease: in comparison to wildtype animals (i) the expression level of FLNc protein is drastically reduced; (ii) mutant FLNc is relocalized from Z-discs to particularly mechanically strained parts of muscle cells, i.e. myotendinous junctions and myofibrillar lesions; (iii) the number of lesions is greatly increased and these lesions lack Bcl2-associated athanogene 3 (BAG3) protein; (iv) the expression of heat shock protein beta-7 (HSPB7) is almost completely abolished. These findings indicate grave disturbances of BAG3-dependent and -independent autophagy pathways that are required for efficient lesion repair. In addition, our studies reveal general mechanisms of lesion formation and demonstrate that defective FLNc dimerization via its carboxy-terminal domain does not disturb assembly and basic function of myofibrils. An alternative, more amino-terminally located dimerization site might compensate for that loss. Since filamins function as stress sensors, our data further substantiate that FLNc is important for mechanosensing in the context of Z-disc stabilization and maintenance.
Deregulated expression of a longevity gene, Klotho, in the C9orf72 deletion mice with impaired synaptic plasticity and adult hippocampal neurogenesis
Authors: Ho Wan Yun , Navakkode Sheeja , Liu Fujia , Soong Tuck Wah , Ling Shuo-Chien
Published: September 2020

Hexanucleotide repeat expansion of C9ORF72 is the most common genetic cause of amyotrophic lateral sclerosis and frontotemporal dementia. Synergies between loss of C9ORF72 functions and gain of toxicities from the repeat expansions contribute to C9ORF72-mediated pathogenesis. However, how loss of C9orf72 impacts neuronal and synaptic functions remains undetermined. Here, we showed that long-term potentiation at the dentate granule cells and long-term depression at the Schaffer collateral/commissural synapses at the area CA1 were reduced in the hippocampus of C9orf72 knockout mice. Using unbiased transcriptomic analysis, we identified that Klotho, a longevity gene, was selectively dysregulated in an age-dependent manner. Specifically, Klotho protein expression in the hippocampus of C9orf72 knockout mice was incorrectly enriched in the dendritic regions of CA1 with concomitant reduction in granule cell layer of dentate gyrus at 3-month of age followed by an accelerating decline during aging. Furthermore, adult hippocampal neurogenesis was reduced in C9orf72 knockout mice. Taken together, our data suggest that C9ORF72 is required for synaptic plasticity and adult neurogenesis in the hippocampus and Klotho deregulations may be part of C9ORF72-mediated toxicity.
Stability of anterior open bite treatment with molar intrusion using skeletal anchorage: a systematic review and meta-analysis
Authors: González Espinosa Daybelis , de Oliveira Moreira Paulo Eliezer , da Sousa Amanda Silva , Flores-Mir Carlos , Normando David
Published: September 2020

Objectives

The aim of this systematic review and meta-analysis is to assess the degree of stability of anterior open bite (AOB) treatment performed through the molar intrusion supported with skeletal anchorage at least 1 year posttreatment.

Methods

This study was registered in PROSPERO (CRD42016037513). A literature search was conducted to identify randomized (RCT) or non-randomized clinical trials based including those considering before and after design. Data sources were electronic databases including PubMed, Cochrane Library, Science Direct, Google Scholar, Scopus, Lilacs, OpenGrey, Web of Science, and ClinicalTrials.gov. The quality of evidence was assessed through the JBI tool and certainty of evidence was evaluated through the GRADE tool. Random effects meta-analysis was conducted when appropriate.

Results

Six hundred twenty-four articles met the initial inclusion criteria. From these, only 6 remained. The mean posttreatment follow-up time was 2.5 years (SD = 1.04). The overbite showed a standardized mean relapse of − 1.23 mm (95% CI − 1.64, − 0.81, p < 0.0001). Maxillary and mandibular incisors presented a non-significant mean relapse, U1-PP − 0.04 mm (95% CI − 0.55, 0.48) and L1-MP − 0.10 mm (95% CI − 0.57, 0.37). Molar intrusion showed a relapse rate around 12% for the maxillary molars and a 27.2% for mandibular molars.

Conclusion

The stability of AOB through molar intrusion using TADs can be considered relatively similar to that reported to surgical approaches, since 10 to 30% of relapse occurs both in maxillary and mandibular molars. The level of certainty ranged between very low and low. RCTs reporting dropout during the follow-up are in dire need.
The burden, admission, and outcomes of COVID-19 among asthmatic patients in Africa: protocol for a systematic review and meta-analysis
Authors: Hailay Abrha , Aberhe Woldu , Zereabruk Kidane , Mebrahtom Guesh , Haile Teklehaimanot , Bahrey Degena , Mariye Teklewoini
Published: September 2020

Background

Coronavirus disease 2019 outbreak is the first reported case in Wuhan, China in December 2019 and suddenly became a major global health concern. According to the European Centre for Disease Prevention and Control, on August 4, 2020 the reported cases of coronavirus disease 2019 were 18,456,952 cases worldwide, 11,691,229 recovered with 697,719 deaths. Evidence on Burden, admission and outcome of Coronavirus Disease in 2019 among Asthmatic patients has not been published in Africa. This research protocol will, therefore, be driven to conduct systematic review and meta-analysis of the Coronavirus Disease in 2019 burden, admission and outcome among Asthmatic patients in Africa.

Methods

All observational studies among Asthmatic patients in Africa and written without language limitation will be included. A search technique was applied using Databases (PubMed / MEDLINE, EMBASE, HINARI, Cochrane Library, World Health Organization COVID-19 database, Africa Wide Knowledge and Web of Science). Two independent authors carried out data extraction and assess the risk of bias using a predetermined and structured method of data collection. We will use random-effects to estimate the overall pooled burden, admission and outcome of COVID-19 Asthmatic patients in Africa. To assess possible publication bias, funnel plot test and Egger’s test methods will be used. This systematic and meta-analysis review protocol will be reported based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis protocol guidelines.

Discussion

The description will be used to show the COVID-19 distribution data by interest variables such as residence, setting, and person-level characteristics. The findings of this review will notify health care professionals about the burden, admission and outcome of COVID − 19 in asthmatic patient, while providing evidence to bring about the requisite improvements in clinical practice for asthmatic patients.

Systematic review registration

This review is registered in the PROSPERO International Prospective Register of Systematic reviews with the registration number of CRD42020202049.
A review of cyber security risks of power systems: from static to dynamic false data attacks
Authors: Xu Yan
Published: September 2020

With the rapid development of the smart grid and increasingly integrated communication networks, power grids are facing serious cyber-security problems. This paper reviews existing studies on the impact of false data injection attacks on power systems from three aspects. First, false data injection can adversely affect economic dispatch by increasing the operational cost of the power system or causing sequential overloads and even outages. Second, attackers can inject false data to the power system state estimator, and this will prevent the operators from obtaining the true operating conditions of the system. Third, false data injection attacks can degrade the distributed control of distributed generators or microgrids inducing a power imbalance between supply and demand. This paper fully covers the potential vulnerabilities of power systems to cyber-attacks to help system operators understand the system vulnerability and take effective countermeasures.