bluuebunny/crossref_metadata_2025_split huggingface dataset:
Geographical access to point-of-care testing for hypertensive disorders of pregnancy as an integral part of maternal healthcare in Ghana
Authors: Kuupiel Desmond , Adu Kwame Manu , Bawontuo Vitalis , Tabong Philip T. N. , Adogboba Duncan A. , Mashamba-Thompson Tivani P. 
Published: November 2020

Abstract
Background
Hypertensive disorders of pregnancy (HDP) are associated with high maternal mortality in Ghana and globally. Evidence shows that there is poor availability of pregnancy-related point-of-care (POC) tests in Ghana’s primary healthcare (PHC) clinics (health centre or community-based health planning services facilities). Therefore, we employed geographic information systems to estimate the geographical distribution of and physical accessibility to HDP POC testing services in the Upper East Region (UER), Ghana.

Methods
We collected data on 100 out of 365 PHC clinics, public hospitals providing HDP testing, PHC clinic type, ownership, and availability of urine dipsticks and blood pressure (BP) devices. We also obtained the geo-located data of the PHC clinics and hospitals using the global positioning system. We employed ArcGIS 10.4 to measure the distance and travel time from the location of each PHC clinic without HDP POC testing services as well as from all locations of each district to the nearest hospital/clinic where the service is available. The travel time was estimated using an assumed motorised tricycle speed of 20 km/hour. We further calculated the spatial distribution of the hospitals/clinics providing HDP POC testing services using the spatial autocorrelation tool in ArcMap, and Stata version 14 for descriptive statistical analysis.

Results
Of the 100 participating PHC clinics, POC testing for HDP was available in 19% (14% health centres and 5% community-based health planning services compounds) in addition to the 10 hospitals use as referral points for the service. The findings indicated that the spatial pattern of the distribution of the health facilities providing HDP POC testing was random (z-score = -0.61; p = 0.54). About 17% of the PHC clinics without HDP POC testing service were located > 10 km to the nearest facility offering the service. The mean distance and travel time from PHC clinics without HDP POC testing to a health facility providing the service were 11.4 ± 9.9 km and 31.1 ± 29.2 min respectively. The results suggest that if every 19% of the 365 PHC clinics are offering HDP POC testing in addition to these 10 hospitals identified, then the estimated coverage (health facility-to-women in fertility age ratio) in the UER is 1: 3,869.

Conclusions
There is poor physical accessibility to HDP POC testing services from PHC clinics without HDP POC testing in the UER. Mothers who obtain maternal healthcare in about 17% of the PHC clinics travel long distances (> 10 km) to access the service when needed. Hence, there is a need to improve the availability of HDP POC diagnostic tests in Ghana’s rural clinics.
Self-enucleation of the right eye by a 38-year-old woman diagnosed with schizoaffective disorder: a case report
Authors: Chechko Natalia , Stormanns Eva , Podoll Klaus , Stickel Susanne , Neuner Irene 
Published: November 2020

Abstract
Background
Autoenucleation is a rare form of self-mutilation typically associated with psychiatric disorders such as schizophrenia, substance-induced psychosis and bipolar disorder. The act is usually unilateral, although bilateral attempts are also well documented in the literature.

Case presentation
It is a case study involving a female patient (NN) diagnosed with schizoaffective disorder who self-enucleated her right eye following sexual intercourse with a fellow patient, and was forcefully prevented by staff from enucleating the second eye. We report recurrent episodes of her illness culminating in this severe act of self-mutilation. The motivational reasons behind this form of self-harm along with differential diagnosis and potential treatment options are discussed in the context of the available literature.

Conclusion
Autoenucleation is commonly associated with religious and sexual delusions, and patients are thought to be at a greater risk of further self-harm. Timely antipsychotic treatment is likely to reduce the risk of such extreme forms of self-harm, although they can occur despite robust therapeutic intervention and treatment attempts. While self-inflicted eye injuries are rare, their prevention in what is typically a difficult patient group is fraught with challenges.
Significantly delayed polyglactin 910 suture-related pseudoinfection in a Yucatan pig
Authors: Collins Dalis , Simons Brian 
Published: November 2020

Abstract
Background
Polyglactin 910 is a synthetic braided, absorbable suture commonly used in surgery. Though polyglactin 910 suture-related pseudoinfection is well documented in the human literature, it has not been previously reported in the veterinary literature.

Case description
A 3-year-old female, ovariectomized but otherwise experimentally naïve Yucatan pig was evaluated for a several week history of bilateral multifocal abscesses in the area of the paralumbar fossa, which continued to worsen despite oral antibiotics and non-steroidal anti-inflammatory medications. The multi-focal abscesses continued to worsen and additional diagnostics were pursued including cytology, culture (aerobic, anaerobic and fungal), and bloodwork. All supported a non-infectious etiology. Biopsy results indicated a suture-related pseudoinfection. Despite treatment including parenteral antibiotics, pain medications and superficial surgical debridement, the dermatologic lesions worsened. Euthanasia was elected. Post-mortem necropsy demonstrated a suture-related pseudoinfection with extrusion of suture material from the ovarian pedicle ligatures through the body wall and skin leading to numerous sterile abscesses in the bilateral paralumbar fossa.

Conclusions
This is the first published report of a significantly delayed polyglactin 910 suture-related pseudoinfection in a Yucatan pig. While likely an isolated incident, it supports further research into this area. Additionally for critical research studies using Yucatan pigs, pre-surgical assessment with hypersensitivity patch testing may be appropriate.
Factors affecting the use of clinical practice guidelines by hospital physicians: the interplay of IT infrastructure and physician attitudes
Authors: Sasaki Noriko , Yamaguchi Naohito , Okumura Akiko , Yoshida Masahiro , Sugawara Hiroyuki , Shin Jung-ho , Kunisawa Susumu , Imanaka Yuichi 
Published: November 2020

Abstract
Background
Compliance with clinical practice guidelines (CPGs) remains insufficient around the world, despite frequent updates and continuing efforts to disseminate and implement these guidelines through a variety of strategies. We describe the current status of young resident physician practices towards CPGs and investigate the multiple factors associated with the active use of CPGs, including the physician’s knowledge, attitudes, behaviours, CPG-related education received, and the hospital’s IT infrastructures. The aim is to identify a more effective point for intervention to promote CPG implementation.

Methods
We conducted a questionnaire survey among resident physicians working at 111 hospitals across Japan in 2015 and used results with hospital IT score data collected from a prior survey. Multivariable logistic regression analysis was performed to examine the determinants of frequent use of CPGs (defined at least once per week). The independent variables were selected based on physician demographics, clinical speciality and careers, daily knowledge and behaviour items, CPG-related education received, digital preference, and hospital IT score (high/medium/low), with and without interaction terms.

Results
Responses from 535 resident physicians, at 61 hospitals, were analysed. The median hospital IT score was 6 out of a possible 10 points. Physicians who had learned about CPGs tended to work at hospitals with medium to high IT scores, had easier access to paywalled medical databases, and had better knowledge of the guideline network ‘Minds’. In addition, these physicians tended to use CPGs electronically. A physician’s behaviour towards using CPGs for therapeutic decision-making was strongly associated with frequent use of CPGs (odds ratio [95% CI] 6.1 [3.6–10.4]), which indicated that a physician’s habit strongly promotes CPG use. Moreover, CPG-related education was associated with active use of CPGs (OR1.7 [1.1–2.5]). The interaction effects between individual digital preferences and higher hospital IT score were also observed for frequent CPG use (OR2.9 [0.9–8.8]).

Conclusions
A physician’s habitual behaviours, CPG-related education, and a combination of individual digital preference and superior hospital IT infrastructure are key to bridging the gap between the use and implementation of CPGs.
Effects of Cnidium monnieri (L.) Cuss. fruit extract on sexual behaviors in male rats
Authors: Dau Thuy Duong , Le Minh Ha , Nguyen Tran Thi Giang Huong , Dang Thi Ngoc Mai , Do Thi Nguyet Que , Tran Quynh Trang 
Published: November 2020

Abstract
Background
Cnidium monnieri (L.) Cuss. has been used for a long time according to the traditional experiences and documentation in order to treat male sexual disorders. Osthole is one of the main bioactive components in Cnidium monnieri (L.) Cuss. In this study, we aimed to evaluate the effect of Cnidium monnieri (L.) Cuss. fruit extract of which osthole content was 35% (determined by HPLC method) on sexual behaviors in adult male rats.

Methods
Cnidium monnieri (L.) Cuss. fruit extract was administered orally at the dose of 150 mg/kg b.w and after 30 min, male rats were coupled with receptive adult female rats to evaluate sexual behaviors, including mounting and intromission.

Results
Cnidium monnieri (L.) Cuss. fruit extract at the dose of 150 mg/kg b.w increased the percentage of rats that mounted and intromitted; increased the intromission frequency and decreased mounting latency and intromission latency.

Conclusion
Cnidium monnieri (L.) Cuss. fruit extract increased the ability to mount and intromit in rats, and scientifically support the traditional use of Cnidium monnieri (L.) Cuss. in treatment of male sexual disorders.
The impact of alternative environmentally differentiated fairway dues systems in Sweden
Authors: Vierth Inge , Johansson Magnus 
Published: November 2020

AbstractThe Swedish system for determining fairway dues at the national level is acknowledged as being unique in attempting to consider the environmental performance of vessels. Between 1998 and 2014, vessels could get a SOX discount and between 1998 and 2017 a NOx discount, both based on certificates. In 2018, the Swedish government initiated a new system comprising more environmental impacts requiring operators that want to benefit from it, to register their vessels for a score in the Clean Shipping Index (CSI). The CSI covers performance in five categories: NOX, CO2, SOX/PM, Chemicals and Waste. Based on received scores, vessels can get 10%, 30% or 90% discount. In this paper, the short-term outcome of the new system is analysed and compared to the old NOX-based system. The comparison is based on revealed preferences of the involved vessel operators. Vessel specific data about the discounts and scores are analysed as well as the regional distribution of discounts and impacts on different vessel types. The paper shows that the Swedish Maritime Administration has succeeded in creating a system that attracts more vessel types and encompasses more environmental categories, but that the incentives to reduce NOX emissions have been reduced. Ex-post cost-benefit analyses of the earlier certificate-based systems have proven them beneficial to society. However, it is unclear how the outcome of the new system will be. The paper suggests that there are efficiency gains in harmonising the system SMA has introduced with the different systems for environmentally differentiated port fees in Sweden.
Influences of changes in obesity-related parameters on progression of arteriosclerosis in hemodialysis patients: a prospective cohort study
Authors: Iida Takeshi , Morimoto Satoshi , Okuda Hidenobu , Amari Yoshifumi , Yurugi Takatomi , Nakajima Fumitaka , Ichihara Atsuhiro 
Published: November 2020

AbstractBackgroundHemodialysis patients have a greater risk of cardiovascular disease, their major cause of death. Obesity is a risk factor for arteriosclerosis, cardiovascular disease, and mortality in the general population. Conversely, an increased body mass index (BMI) is known to be associated with better survival of hemodialysis patients. However, the influences of changes in parameters associated with obesity on arteriosclerosis in these patients have not been evaluated. Here, we evaluated the relationship between changes in parameters associated with obesity and brachial-ankle pulse wave velocity (baPWV), as an index of arteriosclerosis, in hemodialysis patients.MethodsTwo hundred and fifty-eight subjects were selected from patients undergoing stable hemodialysis. BMI, abdominal circumference (AC), visceral fat area (VFA) and subcutaneous fat areas (SFA), and baPWV were assessed at baseline and 4 years later. Ankle-brachial index and baPWV were measured on a non-dialysis day using volume-plethysmographic apparatus. Abdominal circumference was measured at the level of umbilicus by computed tomography (CT). Body fat distribution was determined using CT. All CT scans were performed on a non-dialysis day with the subject in a supine position.ResultsSixty-one patients died during the 4-year period. Abdominal circumference, BMI, VFA, and SFA were higher, and baPWV was lower in patients who survived than in those who died. During the study period, baPWV increased and was positively correlated with the change in visceral plus subcutaneous fat area in patients whose initial VFA was > 100 cm2. There were negative correlations between the change in baPWV and changes in AC, and SFA in individuals whose VFA was < 100 cm2.ConclusionsThese data suggest that patients with a large VFA should adopt strategies aimed at reducing body weight, while patients with a small VFA should avoid undernutrition.
Occurrence, sociodemographic, and clinical correlates of eating disorders among a sample of secondary school students in Egypt
Authors: Sabry Walaa , ElMahlawy Naglaa , Essawy Heba , Al-Saleet Gamalat , Saad Mohamed , Morsy Mahmoud 
Published: November 2020

AbstractBackgroundEating disorders are common in adolescents. Data on occurrence rates, sociodemographic correlates, and risk factors in Egyptian population are needed along with better screening tools to inform future research and service development. We aimed to estimate the occurrence of eating disorders in a representative sample of Egyptian adolescent students and to examine the sociodemographic and clinical risk factors associated with eating disorders. So, a multistage random selection of 407 adolescent students from public and private secondary schools in Eastern Tanta, Egypt, was carried out. All participants were subjected to screening using the Eating Attitude Test (EAT) and the eating disorders section of the clinician version of the Structured Clinical Interview for DSM-IV axis-I disordersResultsOccurrence estimates of anorexia nervosa and bulimia nervosa were 6.1% and 3.2%, respectively. Being female, overweight (BMI = 25–29.9 kg/m2), low self-esteem, and high body shape preoccupation were significantly associated with eating disorders risk among adolescents.ConclusionsEating disorders are prevalent in the general adolescent population. The unmet treatment needs in the adolescent population place these disorders as important public health concerns.
Trans-thoracic versus trans-hiatal resection for oesophageal carcinoma: a retrospective comparative study of a single-centre case series
Authors: Baram Aram , Sherzad Hiwa 
Published: November 2020

Abstract
Background
Oesophageal carcinoma (EC) is the eighth most common cancer. Surgery is the cornerstone of management for resectable EC. Trans-thoracic oesophagectomy (TTE) and trans-hiatal oesophagectomy (THE) are the two most widely practised procedures. Most of the related controversies are centred on both early and late post-operative complications and mortality (in terms of overall survival and cancer-free survival).
This was a single-centre, retrospective, comparative study analysing the outcomes of two EC resection methods. All 87 patients underwent surgery by the same surgical team over 13 years. Consequently, 87 oesophagectomies with curative intent were performed and divided into the TTE group (group A = 47) and the THE group (group B = 40).

Results
The mean patient age was 65.60 ± 6.30 years in the TTE group and 63.48 ± 9.34 years in the THE group. No significant difference was found in operative time, blood loss or duration of stay in the intensive care unit. The duration of hospital stay was significantly different between the THE and TTE groups (17.25 ± 5.92 vs. 12.93 ± 3.44, respectively; P ≤ 0.001). In-hospital mortality was higher in the TTE group (9/47, 19.14%) than in the THE group (5/40, 12.5%) (P = 0.400). The mean survival rate from our series showed the superiority of group A (TTE) (65.56 months) over group B (THE) (45.01 months), with P = 0.146.

Conclusion
No high level of evidence suggests the superiority of one surgical procedure over another. The THE procedure is less time-consuming concerning care and follow-up, and most patients were more satisfied and experienced less pain than with the TTE procedure. Both THE and TTE have comparable post-operative anastomotic complications, and they have no significant long-term survival differences.
Voice problem in a patient with chronic renal failure
Authors: Zaky Effat Ahmed , Mamdouh Haytham , Esmat Olivia , Khalaf Zeinab 
Published: November 2020

AbstractBackgroundChronic kidney failure is an irreversible medical condition that impairs the kidney’s ability to function. When CRF reaches a sophisticated stage, dangerous levels of fluid, electrolytes, and wastes can accumulate within the body. Dysphonia detected within the CRF patients was due to affection of the chronic kidney failure on the system and phonatory system. Patients with CRF treated by hemodialysis are exposed to continuous pulmonary insults of multifactorial origin: Fluid retention predisposes them to pulmonary edema which occurs more frequently within the presence of concomitant cardiovascular disease. Also, the spirit of the kidney failure patients can induce psychogenic dysphonia. The aim of this work is to see and analyzed voice problems in patients with chronic kidney failure to ascertain baseline data about the scale and distribution of the probable voice disorder in these patients for early detection and proper management.ResultsThe results obtained from this study showed that there have been statistically significant differences between chronic kidney failure patients G1 and control G2 regarding first harmonic, jitter %, shimmer dB and noise harmonic ratio dB, presence of dysphonia, and also the total score of VHI. The results of the study revealed statistical correlation between the quantity of years of hemodialysis and total acoustic measures.ConclusionThe results of our study revealed that subjects with chronic failure exhibit a clinical evidence of voice disorders and proving that there is interplay of different body systems and the larynx. The voice problems can vary between CRF patients depending on duration of hemodialysis and leading causes of chronic kidney failure.
A case report of unilateral conductive hearing loss as a consequence of malignant sinonasal melanoma: the importance of completing a full clinical history and examination
Authors: Blackabey Victoria , Kenyon Olivia , Talwar Rishi 
Published: November 2020

Abstract
Background
Sinonasal melanoma is a rare head and neck tumour. It is associated with a poor prognosis, high rates of loco-regional recurrence and distant metastasis. Treatment of the disease is therefore complicated, and because of limited data regarding the cancer, management is frequently tailored to the individual patient. We describe an unusual presentation of sinonasal melanoma with relevant histology, radiology and clinical photography.

Case presentation
The case report describes the presentation of a 64-year-old man to the Ear, Nose and Throat department with progressive right-sided hearing loss. A thorough history highlighted other clinical symptoms including unilateral nasal obstruction and epistaxis. Clinical examination showed a right middle ear effusion with a polypoidal lesion in the right nasal cavity. Relevant imaging demonstrated a destructive process that required further assessment. An endoscopic sinus procedure was performed to obtain histological diagnosis as well as providing symptomatic relief. Histology confirmed malignant mucosal melanoma. The patient underwent maxillectomy and orbital exenteration (due to further progression of disease) at a tertiary centre with a plan for subsequent immunotherapy. This however has been delayed due to further surgery to excise a metastatic lesion to the right femur.

Conclusions
This case report highlights the importance of a thorough clinical history and examination. An unusual presentation of a sinonasal tumour can easily be missed leading to a significant delay in treatment. The case report also describes the use of functional endoscopic sinus surgery in order to obtain histological diagnosis and to debulk the tumour, providing symptomatic relief. The current literature regarding management will be discussed as well as current developments guiding future treatment.
Adult Gliomas
Authors: Colman Howard 
Published: November 2020

ABSTRACT

PURPOSE OF REVIEW
This article highlights important aspects of the evaluation, diagnosis, and treatment of adult gliomas, including lower-grade astrocytomas and oligodendrogliomas, glioblastomas, and ependymomas.

RECENT FINDINGS
The appropriate initial evaluation and accurate diagnosis of gliomas require an understanding of the spectrum of clinical and radiographic presentations. Recent advances in the understanding of distinct molecular prognostic subtypes have led to major revisions in the diagnostic classification of gliomas. Integration of these new diagnostic and molecular classifications is an important part of the modern management of gliomas and facilitates better understanding and interpretation of the efficacy of different therapies in specific glioma subtypes.

SUMMARY
The management of adult gliomas is a multidisciplinary endeavor. However, despite recent molecular and treatment advances, the majority of diffuse gliomas remain incurable, and efforts aimed at the development and testing of new therapies in clinical trials are ongoing.