bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of Anesthesia Capacity in Public Surgical Hospitals in Guatemala
Authors: Zha Yuanting , Truché Paul , Izquierdo Erick , Zimmerman Kathrin , de Izquierdo Sandra , Lipnick Michael S. , Law Tyler J. , Gelb Adrian W. , Evans Faye M. 
Published: December 2020

BACKGROUND:
International standards for safe anesthetic care have been developed by the World Federation of Societies of Anaesthesiologists (WFSA) and the World Health Organization (WHO). Whether these standards are met is unknown in many nations, including Guatemala, a country with universal health coverage. We aimed to establish an overview of anesthesia care capacity in public surgical hospitals in Guatemala to help guide public sector health care development.

METHODS:
In partnership with the Guatemalan Ministry of Public Health and Social Assistance (MSPAS), a national survey of all public hospitals providing surgical care was conducted using the WFSA anesthesia facility assessment tool (AFAT) in 2018. Each facility was assessed for infrastructure, service delivery, workforce, medications, equipment, and monitoring practices. Descriptive statistics were calculated and presented.

RESULTS:
Of the 46 public hospitals in Guatemala in 2018, 36 (78%) were found to provide surgical care, including 20 district, 14 regional, and 2 national referral hospitals. We identified 573 full-time physician surgeons, anesthesiologists, and obstetricians (SAO) in the public sector, with an estimated SAO density of 3.3/100,000 population. There were 300 full-time anesthesia providers working at public hospitals. Physician anesthesiologists made up 47% of these providers, with an estimated physician anesthesiologist density of 0.8/100,000 population. Only 10% of district hospitals reported having an anesthesia provider continuously present intraoperatively during general or neuraxial anesthesia cases. No hospitals reported assessing pain in the immediate postoperative period. While the availability of some medications such as benzodiazepines and local anesthetics was robust (100% availability across all hospitals), not all hospitals had essential medications such as ketamine, epinephrine, or atropine. There were deficiencies in the availability of essential equipment and basic intraoperative monitors, such as end-tidal carbon dioxide detectors (17% availability across all hospitals). Postoperative care and access to resuscitative equipment, such as defibrillators, were also lacking.

CONCLUSIONS:
This first countrywide, MSPAS-led assessment of anesthesia capacity at public facilities in Guatemala revealed a lack of essential materials and personnel to provide safe anesthesia and surgery. Hospitals surveyed often did not have resources regardless of hospital size or level, which may suggest multiple factors preventing availability and use. Local and national policy initiatives are needed to address these deficiencies.
A Novel Syngeneic Immunocompetent Mouse Model of Head and Neck Cancer Pain Independent of Interleukin-1 Signaling
Authors: Heussner Matthew J. , Folger Joseph K. , Dias Christina , Massri Noura , Dahdah Albert , Vermeer Paola D. , Laumet Geoffroy 
Published: December 2020

BACKGROUND:
Pain is one of the first presenting symptoms in patients with head and neck cancer, who often develop chronic and debilitating pain as the disease progresses. Pain is also an important prognostic marker for survival. Unfortunately, patients rarely receive effective pain treatment due to our limited knowledge of the mechanisms underlying head and neck cancer pain (HNCP). Pain is often associated with neuroinflammation and particularly interleukin (IL)-1 signaling. The purpose of this study is to develop a novel syngeneic model of HNCP in immunocompetent mice to examine the contribution of IL-1 signaling.

METHODS:
Male C57BL/6 mice were injected with a murine model of human papillomavirus (HPV+)–induced oropharyngeal squamous cell carcinoma in their right hindlimb to induce tumor growth. Pain sensitivity was measured via von Frey filaments. Spontaneous pain was assessed via the facial grimace scale. IL-1β was measured by quantifying gene expression via quantitative polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA).

RESULTS:
Pain hypersensitivity and spontaneous pain develop quickly after the implantation of tumor cells, a time when tumor volume is still insignificant. Spinal and circulating IL-1β levels are significantly elevated in tumor-bearing mice. Blocking IL-1 signaling either by intrathecal administration of interleukin-1 receptor antagonist (IL-1ra) or by genetic deletion (interleukin-1 receptor knockout [Il1r1
−/−]) does not alleviate HNCP.

CONCLUSIONS:
We established the first syngeneic model of HNCP in immunocompetent mice. Unlike inflammatory or nerve-injured pain, HNCP is independent of IL-1 signaling. These findings challenge the common belief that pain results from tissue compression or IL-1 signaling in patients with head and neck cancer.
Real-Time Injection Pressure Sensing and Minimal Intensity Stimulation Combination During Ultrasound-Guided Peripheral Nerve Blocks: An Exploratory Observational Trial
Authors: Varobieff Maxime , Choquet Olivier , Swisser Fabien , Coudray Adrien , Menace Cecilia , Molinari Nicolas , Bringuier Sophie , Capdevila Xavier 
Published: December 2020

BACKGROUND:
Nerve damage can occur after peripheral nerve block (PNB). Ultrasound guidance does not eliminate the risk of intraneural injection or nerve injury. Combining nerve stimulation and injection pressure (IP) monitoring with ultrasound guidance has been suggested to optimize needle tip location in PNB. In this prospective observational study, we hypothesized that measured pairs of IP and minimum intensity of stimulation (MIS) might differentiate successive needle tip locations established by high-resolution ultrasound during PNB.

METHODS:
For this exploratory study, 240 observations for 40 ultrasound-guided PNBs were studied in 28 patients scheduled for orthopedic surgery. During the progression of the needle to the nerve observed by ultrasonography, the IP was measured continuously using a computerized pressure-sensing device with a low flow rate of solution. Stimulation thresholds and electrical impedance were obtained by an impedance analyzer coupled to the nerve stimulator at 6 successive needle positions. The median (quartile) or mean (95% confidence interval [CI]) was reported. A mixed model analysis was used, and the sample was also explored using a classification and regression tree (CART) algorithm.

RESULTS:
Specific combinations of IP and MIS were measured for subcutaneous, epimysium contact, intramuscular, nerve contact (231 mm Hg [203–259 mm Hg] and 1.70 mA [1.38–2.02 mA]), intraneural location (188 mm Hg [152–224 mm Hg] and 0.58 mA [0.46–0.70 mA]), and subparaneural location (47 mm Hg [41–53 mm Hg] and 1.35 mA [1.09–1.61 mA]). The CART algorithm shows that the optimal subparaneural needle tip position might be defined by the lowest pressure (<81.3 mm Hg) and MIS (<1.5 mA) cutoffs.

CONCLUSIONS:
Our exploratory study evaluated concepts to generate hypotheses. The combinations of IP and MIS might help the physician during a PNB procedure. A low IP and low MIS might confirm a subparaneural location, and a high IP and a low MIS might be an alert for the intraneural location of the needle tip.
Making a Strong Case for Prioritizing Muscular Fitness in Youth Physical Activity Guidelines
Authors: Faigenbaum Avery D. , MacDonald James P. , Stracciolini Andrea , Rebullido Tamara Rial 
Published: December 2020

AbstractAlthough evidence indicates that muscular fitness is foundational for ongoing participation in active play, exercise and sport, current national and international youth physical activity guidelines underplay the critical importance of strength-building activities during this developmental phase of life. In view of troubling trends in muscular fitness in today's youth, specific recommendations to address neuromuscular deficiencies are required. An understanding of the multidimensional development of youth physical inactivity and the importance of muscular fitness are needed to have the most significant impact on youth physical activity at the population level. The mounting evidence of the detrimental effects of physical inactivity on youth warrant a review of existing physical activity recommendations and guidelines. The proposed pediatric activity pyramid recognizes the shared importance of strength, skill, and aerobic activities required for the successful implementation of sustainable youth physical activity interventions.
The effectiveness of three different 7 + 3 induction regimes in China: A retrospective analysis in adult patients with acute myeloid leukemia
Authors: Lin Peng , Zhou Boliang , Yao Haiying 
Published: December 2020

Objectives: In China, for economic reasons, induction regimes for acute myeloid leukemia (AML) often involve domestically produced idarubicin (IDA) rather than imported IDA. Our objective was to compare the effectiveness of induction regimens in combination with cytarabine; involving imported or domestic IDA, or daunorubicin (DNR).
Methods: The study was conducted from 1st July 2012 to 30th November 2015 at Baoding No.1 Central Hospital. This was a retrospective cohort study of patients with newly diagnosed AML admitted to Baoding First Central Hospital, China. Patients were divided into three groups according to their treatment regimen: the IA-imported group, the IA-domestic group, and the DNR group. Clinical data, complete remission (CR), partial remission (PR), non-remission (NR) rates, and side effects were compared.
Results: Total 282 patients were enrolled, including 123 patients in the IA-imported group, 98 in the IA-domestic group and 61 in the DNR group. The IA-domestic and IA-imported groups’ remission rates were similar (P=0.123) but significantly different from the DNR group (both P<0.05). Side effects were similar in all three groups and no severe side effects were reported.
Conclusion: Cytarabine induction regimens showed similar remission rates in combination with IDA produced in China compared to imported IDA and were more effective than DNR.
doi: https://doi.org/10.12669/pjms.37.1.2563
How to cite this:Lin P, Zhou B, Yao H. The effectiveness of three different 7 + 3 induction regimes in China: A retrospective analysis in adult patients with acute myeloid leukemia. Pak J Med Sci. 2021;37(1):21-27. doi: https://doi.org/10.12669/pjms.37.1.2563
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.
Predictive value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Patients with Vaginitis
Authors: Pek Eren , Beyazit Fatma , Korkmaz Nilay Sen 
Published: December 2020

Objectives: This study was conducted to evaluate the diagnostic value of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in vaginitis patients.
Methods: This cross-sectional retrospective study was performed in Afyon Dinar State Hospital between July 2016 to August 2017. A total of 64 bacterial vaginosis (BV) patients, 66 vulvovaginal candidiasis (VVC) patients and 65 age-matched control subjects were enrolled. NLR, PLR, mean platelet volume (MPV), red cell distribution width (RDW) and other conventional inflammatory marker values were recorded for all patients before and after treatment.
Results: In the BV group, NLR values were found to be elevated compared to VVC and healthy controls [2.9 (1.2-14.7), 2.1 (1.1-11.7) and 2.1 (0.8-7.0), respectively] (p=0.008). Although not found to be statistically significant, the median NLR levels of BV patients decreased from 2.9 (1.2-14.7) to 2.4 (1.2-7.0) after treatment. PLR levels did not show a statistically significant difference between the three groups (p=0.970). The cut-off value of the NLR for BV was 2.19, with 67.2% sensitivity and 63.8% specificity.
Conclusions: The present study demonstrated that NLR levels are elevated in bacterial vaginosis and NLR levels can be used as a reflection of systemic inflammatory response in vaginosis patients.
doi: https://doi.org/10.12669/pjms.37.1.2774
How to cite this:Pek E, Beyazit F, Korkmaz NS. Predictive value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Patients with Vaginitis. Pak J Med Sci. 2021;37(1):250-255. doi: https://doi.org/10.12669/pjms.37.1.2774
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.
Online Academics in Pakistan: COVID-19 and Beyond
Authors: Mumtaz Nazia , Saqulain Ghulam , Mumtaz Nadir 
Published: December 2020

COVID-19 is a menace for Pakistan’s fragile and overburdened health care system and infrastructure, insidiously permeating the socio-economic fabric. Globally complete to partial shutdown of educational institutions has been enforced, transitioning from face to face to online academics. Academic institutes are floundering to withstand the brunt. Therefore, the current study was conducted to attempt to review and highlight the impact and challenges posed by transition from conventional to online academics and how to approach them, in the wake of COVID-19 pandemic with the perspective of developing countries like Pakistan. For this purpose, search for relevant literature using search engines and websites including Google, Google Scholar and Web of Science as well as Medline database was conducted with keywords “Covid-19, academics, mental health, social impact and e-learning and combination of words”. Thirty two English language, full text articles published in the last ten years from 2010 to 2020 were selected for the literature review. With this literature review, we conclude that this lockdown has caused significant distortion in the academic world yet unequal interruption in learning with significant disruptions in internal assessments and qualification examinations with developing countries like Pakistan, compounded by a compromised educational system. However, COVID-19 is spurring the case for conversion to online academics and developing countries like Pakistan are poised to develop reliable, cost effective and secure online academic system whether it is bane or boon.
doi: https://doi.org/10.12669/pjms.37.1.2894
How to cite this:Mumtaz N, Saqulain G, Mumtaz N. Online Academics in Pakistan: COVID-19 and Beyond. Pak J Med Sci. 2021;37(1):283-287. doi: https://doi.org/10.12669/pjms.37.1.2894
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.
Analysis of risk factors for lower limb deep vein thrombosis in patients after Lumbar Fusion Surgery
Authors: Li Qiang , Yu Zongxue , Chen Xiao , Zhang Wenli 
Published: December 2020

Objective: To identify the risk factors of deep vein thrombosis (DVT) of lower limb in patients undergoing lumbar fusion surgeries, to provide a better understanding of DVT and take prophylactic measures.
Methods: This study was carried out in our hospital between January 2016 and February 2020, patients undergoing lumbar fusion surgeries were included and divided into DVT group and non-DVT group, and the medical data including basic demographics, clinical characteristics, operative data, and routine biochemical parameters were collected and analyzed.
Results: In the current study, 390 cases were included, 48 cases were enrolled in DVT group and 342 in non-DVT group. The incidence of DVT was 12.3%. There were significant differences in age, hyperlipemia, hypertension, occupation type, D-dimer level, hospital stay, and postoperative exercises (p<0.05), but no significant differences in gender, smoking status, drinking status, coronary heart disease, diabetes mellitus, fused segments, and operation time (p>0.05) between the two groups. In multivariate analysis, age>50 years, hypertension, D-dimer>500ug/L were independent risk factors, while postoperative exercises were protective factor for DVT.
Conclusion: Those patients undergoing lumbar fusion surgeries should take more prophylactic measures including postoperative exercises if they were elderly, or hypertensive, or have high D-dimer level, in order to decrease the incidence of DVT.
doi: https://doi.org/10.12669/pjms.37.1.3041
How to cite this:Li Q, Yu Z, Chen X, Zhang W. Analysis of risk factors for lower limb deep vein thrombosis in patients after Lumbar Fusion Surgery. Pak J Med Sci. 2021;37(1):239-243. doi: https://doi.org/10.12669/pjms.37.1.3041
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.
Efficacy of Platelet Rich Fibrin in Myringoplasty
Authors: Riaz Nida , Muhammad Ajmal , Khan Muhammad sheharyar 
Published: December 2020

Objective: To determine the efficacy of usage of topical autologous platelet rich fibrin (PRF) in improving outcomes of myringoplasty regarding graft uptake and hearing improvement.
Methods: This study was conducted in the ENT department of Holy Family Hospital, Rawalpindi, over a period of six months from August 2019 to January 2020. It was designed as a prospective single blinded randomized controlled trial. The study involved a total of 50 participants in whom myringoplasty was done through post auricular approach using underlay technique. In 25 patients topical drops of PRF were used. Outcomes were compared after three months with the control group (n=25), who underwent myringoplasty without PRF.
Results: After three months follow-up, graft uptake was reported 78% and 52% in cases and controls, respectively (P=0.070). Mean hearing improvement was 18 dB and 6 dB in cases and controls, respectively (P=0.014). Postoperative infection occurred in 8% of the cases, and in 32% controls (P=0.037).
Conclusion: Topical use of Platelet-Rich Fibrin during myringoplasty results in improved graft uptake. Hence, resulting in much improved hearing, significant reduction in infection rates and decrease in perforation sizes.
doi: https://doi.org/10.12669/pjms.37.1.3059
How to cite this:Riaz N, Ajmal M, Khan MS. Efficacy of Platelet Rich Fibrin in Myringoplasty. Pak J Med Sci. 2021;37(1):212-216. doi: https://doi.org/10.12669/pjms.37.1.3059
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.
To determine the frequency of stroke and common factors leading to it after coronary artery bypass grafting
Authors: Shah Sayed Mumtaz Anwar , Rehman Mujeeb Ur , Awan Nabil I , Jan Azam 
Published: December 2020

Objective: To determine the frequency of stroke and common factors leading to it after coronary artery bypass grafting.
Methods: This study was conducted at Cardiothoracic Surgery Department, Rehman Medical Institute, Peshawar. Study design was descriptive cross sectional study and the duration of the study was six months. The total sample size was 183 cases using 8.3% frequency of stroke after coronary artery bypass grafting, 95% confidence interval, 4% margin of error, using WHO sample size calculator.
Results: In this study mean age was 45 years with SD ± 1.26. Seventy five percent patients were male while 46(25%) females. Six patients (3%) patients had stroke while 177(97%) patients did not have any stroke. Among the six patients who were analyzed, all of them had Diabetes Mellitus and 50% patients had recent AMI, while only one patient had prior history of Atrial Fibrillation.
Conclusions: Diabetes Mellitus is an independent risk factor for stroke after CABG surgery. whereas, recent MI is also associated with increased incidence of stroke in post CABG patients.
Abbreviations: OPCAB: off-pump coronary artery bypass, CABG: Coronary artery bypass grafting surgery, POAF: Postoperative atrial fibrillation, MI: myocardial infarction, LMS: Left main stem, CPB: cardiopulmonary bypass, AWMI: Anterior wall myocardial infarction, AMI: Acute myocardial Infarction.
doi: https://doi.org/10.12669/pjms.37.1.3242
How to cite this:Shah SMA, Ur-Rehman M, Awan NI, Jan A. To determine the frequency of stroke and common factors leading to it after coronary artery bypass grafting. Pak J Med Sci. 2021;37(1):261-266. doi: https://doi.org/10.12669/pjms.37.1.3242
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.
Characteristics of healthcare workers who died during the fight against COVID-19 in China
Authors: Wang Yujun , Ji Yun , Wang Yuedong 
Published: December 2020

Coronavirus disease 2019 (COVID-19), first reported in December 2019 in Wuhan, China, has progressed to a pandemic associated with substantial morbidity and mortality. Little is known about the healthcare workers who died fighting the disease in China. This paper analyzed the data of 78 Chinese healthcare workers who died in the fight against COVID-19 between 23 January and 2 June, 2020, and revealed the following characteristics. First, compared to the number of deaths directly attributable to COVID-19, more healthcare workers died from pre-existing disease attack induced by excessive fatigue or died from accidents. Second, the median age of the healthcare workers who died directly from COVID-19 was younger than that of the Wuhan non- healthcare workers who died of COVID 19. Third, although more women than men were involved in fighting the pandemic, more men died. Fourth, more healthcare workers died in Hubei than in other provinces. Fifth, most of the healthcare workers who died directly from COVID-19 were non-professionals.
doi: https://doi.org/10.12669/pjms.37.1.3384
How to cite this:Wang Y, Ji Y, Wang Y. Characteristics of healthcare workers who died during the fight against COVID-19 in China. Pak J Med Sci. 2021;37(1):292-294. doi: https://doi.org/10.12669/pjms.37.1.3384
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.