bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pain management in patients with end-stage renal disease and calciphylaxis- A survey among physicians and clinical practice recommendations
Authors: Chinnadurai Rajkumar , Sinha Smeeta , Lowney Aoife , Miller Mary 
Published: June 2020

Abstract
Background Calciphylaxis is a rare condition usually seen in patients with end-stage renal disease. Pain is a hallmark of this condition and can be extremely difficult to control. Anecdotal data suggests that pain management in calciphylaxis is challenging with variable approaches across the United Kingdom (UK) and internationally. A knowledge and practice survey was conducted to establish current practice in the management of pain in patients with calciphylaxis, in the UK. Based on the results and clinical experience the authors suggest a clinical practice guideline.MethodsAn online questionnaire was circulated among physicians (renal and palliative care) involved in the management of pain in calciphylaxis. The questionnaire included a mix of open-ended questions and questions with drop down options. ResultsOne hundred and six clinicians responded to the survey of which 60 (57%) respondents were from palliative medicine; the remaining 46 (43%) were from renal medicine. 31 (30%) respondents across both specialties had not encountered any patients with a diagnosis of calciphylaxis (renal-2, palliative care-29). A referral to the palliative care team was undertaken by 18% of renal physicians, 32% referred to the pain team and 50% referred to both. Only 3% of the palliative medicine respondents indicated that they had received a referral from the renal team at the time of diagnosis. Opioids were the preferred initial drug of choice for the management of all types of pain. Paracetamol was universally selected as the preferred first-choice adjuvant agent for management of all types of pain. The importance of advance care planning was highlighted with 72% undertaking advanced care planning discussions often or most of the time.ConclusionThere was wide variation in the current practice of pain management in patients with calciphylaxis, with variation between renal specialists and palliative care specialists. Referral to specialists in pain management is not universal despite the severe nature of the pain experienced by patients with calciphylaxis. The data generated has facilitated the development of a clinical practice guideline to support complex pain management in a group of patients with multiple comorbidities.
Awareness and Attitude to the Risk of Cervical Cancer and Screening Method Among Women in the Najran Region of Southern Saudi Arabia
Authors: Alshahrani Majed Saeed , Sultan Salem Ali Alatef 
Published: June 2020

Abstract
Introduction:The aim of this study was determined the level of awareness among women regarding risk factors for cervical cancer and screening methods, their sources of information, and general attitudes toward Pap smear screening tests and human papilloma virus vaccination.Method:A cross-sectional interviewer administered an electronic questionnaire among women in Najran City during the period from March 1, 2019 to June 30, 2019. The data were analyzed using IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.Result: A total of 3,387 women participated in this study and the response rate was 100%. Less than 10% of the participants had good awareness and 70% had poor awareness about the risk factors for cervical cancer. In terms of the major barriers to taking the Pap smear test among married women, 968 (56.7%) had no knowledge of the test and 338 (19.85%) considered it unnecessary. Significant predictors of the level of awareness about cervical cancer and Pap smear testing were identified as the age of women, occupation, family history of cancer, monthly income (P < 0.001) and education level (P = 0.003).Conclusion: we detected a lack of awareness about risk factors for cervical cancer and the benefits of early detection among women in this region. Healthcare providers should implement policies or programs for cervical cancer screening and vaccination throughout all primary healthcare centers.
Zymosan exerts radiation protection on AHH-1 and HIEC cells through TLR2/4-MyD88-G-CSF/GM-CSF/IL-12/IL-6 pathway
Authors: Zhang Yue-zhi , Ge Shu-jing , Leng Qing-zhen , Ma Jian-jun , Liu Hanchen 
Published: June 2020

Abstract
Background: This study was to confirm the radiation protective effect of different doses of zymosan on AHH-1 and HIEC cells irradiated at different times and different doses, and further to explore whether zymosan exerts a radiation protection mechanism by targeting TLR2/4.Methods: AHH-1 and HIEC cells were respectively administered to Zymosan at 0, 20, 40, 80 and 160 μg/ml. CCK-8 and cell flow cytometry were used to detect the cell activity and apoptosis at 24 h, 48 h, and 72 h after administration to determine the dose-limiting toxicities of zymosan. Twelve hours before irradiation, cells were treated with zymosan at 0, 5, 10, and 20 μg/ml, and then irradiated with 4Gy X-rays. The cell activity and apoptosis were measured by CCK-8 and cell flow cytometry at 24 h to determine the optimal dose of zymosan. LPS was used as a positive control to compare the protective effect of zymosan. The cells were treated with MyD88 inhibitors to explore the protective mechanism of zymosan.Results: The activity of AHH-1 and HIEC cells treated with different concentration of zymosan at different time was not affected and the apoptosis of cells was not promoted. The radiation protection effect of Zymosan pretreated cells on cells is dose-dependent. After zymosan pre-treated the cells, its radiation protection effect on the cells was dose-dependent. The higher zymosan’s concentration was, the stronger the activities of AHH-1 cells and HIEC cells were, and the lower the apoptosis rate was. The activity of cells pretreated with zymosan was higher than that pretreated with LPS at the same dose (20 μg/ml), and the cell apoptosis rate was lower than that pretreated with LPS. After zymosan pretreated AHH-1 and HIEC cells, TLR2/4-MyD88-G-CSF/GM-CSF/IL-12/IL-6 pathway was activated.Conclusion: Zymosan is nontoxic to cells and has better radiation protection effect than LPS. Its mechanism of action is related to the activation of the TLR2/4-MyD88/G-CSF/GM-CSF/IL-12/IL-6 pathway.
Association between surgical volumes and hospital mortality in patients: a living donor liver transplantation single center experience
Authors: Hsieh Chia-En , Hsu Ya-Lan , Lin Kuo-Hua , Lin Ping-Yi , Hung Yu-Ju , Lai Yi-Chun , Weng Li-Chueh , Chen Yao-Li 
Published: June 2020

Abstract
Background: Many factors cause hospital mortality (HM) after liver transplantation (LT). Methods: We performed a retrospective research in single center from October 2005 to June 2019. The study included 466 living donor LT patients. They were divided into a no-HM group (n=436, 93.56%) and an HM group (n=30, 6.44%). Logistic regression analysis of factors affecting clinical features and surgical volume of HM. We regrouped patients into met the surgical volume periods based cutoffs of LTs, and analyze the clinical features.Results: Multivariate analysis revealed that donor age (OR= 1.049, 95% CI: 1.011– 1.090, p=0.013), blood loss (OR=1.000, 95% CI: 1.000–1.000, p=0.004), and annual surgical volumes being < 30 LTs (OR=2.521, 95% CI: 1.004–6.332, p=0.049) were significant risk factors. A comparison of years based on surgical volume found that when the annual surgical volumes were at least 30 there was significantly higher recipient age (p=0.022), donor age (p=0.024), and ABO-incompatible operations (p<0.001) and also significantly blood loss (p<0.001), operative time (p<0.001), intensive care unit days (p<0.001), length of stay (p=0.013), re-operative (p<0.001), and HM (p=0.029) compared to when the annual surgical volumes were less than 30. Conclusions: Donor age, blood loss and an annual surgical volume < 30 LTs were significant pre- and peri-operative risk factors. Hospital mortality and annual surgical volume were associated with statistically significant differences; surgical volume may impact quality of care and transplant outcomes.
The 5X2 Backward Planning Model for faculty Development
Authors: Ahmed Samar A. , Younas Ayesha , Salem Urooj , Mashhood Shama 
Published: June 2020

Abstract
Faculty are considered to be the backbone of any institute and their training and development are necessary for progressive growth of an educational organization. This necessity has been the focus of a lot of medical education research, resulting in a number of faculty development models concentrating on the methodology of program planning and implementation. Such models are mostly linear considering faculty development to be a onetime measure. However, there exists a clear distinction between faculty development and faculty training and in its true sense faculty development should emphasize on individual faculty growth over the long term synonymously with direct short-term goals related to faculty work. This idea encouraged us to develop a new model for FD to reinvent the way we approach faculty development and consider FD as a continuous cyclical process, rather than just a linear model. We conducted a qualitative study based on phenomenological observations, leading to the development of the 5x2 backward planning model. The model essentially consists of the following interchangeable stages; Decide stage (focused on decisions related to the context of the program and the kind of faculty attending it) Define stage( concerned with defining the needs of the program and its objectives); Design stage (concentrates on design of the material and the methods of delivery for the identified objectives); Direct stage ( directing both the learning and development of faculty and establishing a community of practice) lastly, the Dissect stage (focusing on scrutinizing the fulfillment of the objectives and the developmental KPIs.)
Co-infection of SARS-CoV-2 with Chlamydia or Mycoplasma pneumoniae: a case series and review of the literature
Authors: Oliva Alessandra , Siccardi Guido , Migliarini Ambra , Cancelli Francesca , Carnevalini Martina , D'Andria Maria , Attilia Ilenia , Danese Vittoria Carmela , cecchetti Veronica , Romiti Roberto , Ceccarelli Giancarlo , Mastroianni Claudio M , Palange Paolo 
Published: June 2020

Abstract
The novel coronavirus SARS-CoV-2 has spread all over the world causing a global pandemic and representing a great medical challenge. Nowadays, there is limited knowledge on the rate of co-infections with other respiratory pathogens, with viral co-infection being the most representative agents. Co-infection with Mycoplasma pneumoniae has been described both in adults and pediatrics whereas only 2 cases of Chlamydia pneumoniae have been reported in a large US study so far. In the present report, we describe a series of 7 patients where co-infection with C. pneumoniae (n=5) or M. pneumoniae (n=2) and SARS-CoV-2 was detected in a large teaching hospital in Rome. An extensive review of the updated literature regarding the co-infection between SARS-CoV-2 and these atypical pathogens is also performed.
Co-infection of SARS-CoV-2 with Chlamydia or Mycoplasma pneumoniae: a case series and review of the literature
Authors: Oliva Alessandra , Siccardi Guido , Migliarini Ambra , Cancelli Francesca , Carnevalini Martina , D'Andria Maria , Attilia Ilenia , Danese Vittoria Carmela , cecchetti Veronica , Romiti Roberto , Ceccarelli Giancarlo , Mastroianni Claudio M , Palange Paolo , Venditti M. 
Published: June 2020

Abstract
The novel coronavirus SARS-CoV-2 has spread all over the world causing a global pandemic and representing a great medical challenge. Nowadays, there is limited knowledge on the rate of co-infections with other respiratory pathogens, with viral co-infection being the most representative agents. Co-infection with Mycoplasma pneumoniae has been described both in adults and pediatrics whereas only 2 cases of Chlamydia pneumoniae have been reported in a large US study so far. In the present report, we describe a series of 7 patients where co-infection with C. pneumoniae (n=5) or M. pneumoniae (n=2) and SARS-CoV-2 was detected in a large teaching hospital in Rome. An extensive review of the updated literature regarding the co-infection between SARS-CoV-2 and these atypical pathogens is also performed.
A surprising link with unexplained infertility: a possible Covid-19 paradox?
Authors: Pacchiarotti Arianna , Frati Giacomo , Saccucci Pietro 
Published: June 2020

Abstract
Unexplained infertility has represented about 22-28 percent of infertility causes (1)The diagnosis is based on exclusion of common causes using standard fertility investigation. Over the years the causes of unexplained infertility or subfertility have been identified in pre-existing associated pathologies, such as alterations of the immune system, thyroid dysfunctions, coagulopathies, reducing the unexplained infertility to 15% of infertility causes
Outcomes of Single Bundle Arthroscopic Anterior Cruciate Ligament Reconstruction in a Limited Resource Setting.
Authors: Sherchan Binod , Rai Saroj , Dhungana Siddhartha , Tamang Nira , Sharma Laxmi Kanta , Marasini Rudra Prasad , Singh Janith Lal , Khanal Kiran 
Published: June 2020

Abstract
Purpose: Despite various challenges, orthopaedic sports surgeons are still providing the arthroscopic service in developing countries like Nepal; however, it is hardly being reported. The main purpose of this study was to compare the clinical outcomes and complications of patients undergoing arthroscopic ACLR in the Urban group and that of the Rural group. Methods: We evaluated a total of 194 patients, including 98 patients in the Urban group and 96 patients in the Rural group, undergoing arthroscopic ACLR between August 2015 and February 2018. The subjective evaluations were performed using the Tegner-Lysolm score and International Knee Documentation Committee (IKDC) form. The laxity assessments were performed using the Lachman test and the Pivot-shift test. The functional evaluation included the ROM, single-leg hop test, and overall IKDC score. Radiological assessment was performed according to the IKDC guidelines. SPSS was used for data analysis. Results: There was statistically significant differences in the subjective assessments between 2 groups. No statistically significant differences existed between 2 groups in terms of Laxity and Functional assessments. However, the proportion of laxity, in terms of Lachman test and Pivot-shift test, was higher in the young and active individuals and the proportion of abnormal and severely-abnormal in all parameters of functional outcomes was higher in the older female in the Rural group. Graft failure occurred in 19(17.6%) knees in the Urban group and 17(16.8%) knees in the Rural group. Graft failure in the urban group was higher in young and active male patients, whereas failure in the Rural group was more in female patients. Similarly, overall infection occurred in 13 (6.2%) knees, including 5 (2.3%) deep infections and 8 (3.8%) superficial infections. Conclusion: We advised the similar rehabilitation protocol for all the patients; however, the outcomes were significantly lower in patients living in rural areas as they are found to have poor compliance with the rehabilitation protocol. The overall graft failure rate was 17.2%; however, the reoperation rate was higher in the Urban group than the Rural group. The rate of deep infection was higher in the Rural group as compared to the Urban group.
Novel Coronavirus (SARS-CoV-2) Main Protease: Molecular docking of Puerarin as a Potential inhibitor
Authors: Ojo Oluwafemi Adeleke , Ojo Adebola Busola , Taiwo Odunayo Anthonia , Oluba Olarewaju M 
Published: June 2020

Abstract
SARS-CoV-2 a single stranded RNA virus which triggered the global pandemic Coronavirus Disease- 2019 (COVID-2019). It has infected about 2,844,712 patients and brought forth mortality rate to about 201,315 among 216 countries as cited by WHO. Drugs including Chloroquine and Hydroxychloroquine derivatives are being administered in most urgent cases; although, with probable side effects to people with metabolic disorders. Thus, unavailability of authorized drugs and treatment for this pandemic demands the research world to discover natural compounds with potency to cure it. This paper assesses the isoflavonoid puerarin from Pueraria lobata as a possible inhibitor of the main protease of SARS-COV-2 (Mpro) via in silico approach, for example molecular docking, Lipinski’s rule of five and toxicity prediction (ADME). Puerarin revealed high binding affinity with the target site of SARS-CoV-2 main protease. This compound slightly meets the criteria of Lipinski’s rule and does not possess properties that could cause adverse effects in humans thus, making puerarin a potential drug candidate to investigate for its usage against COVID-19.
Physiotherapy management of a patient with neck pain having block vertebra: A case report
Authors: Quais Sarah , Suhail Ammar 
Published: June 2020

Abstract
Background: Congenital fused/block vertebrae is an accidental finding in most cases. It remains asymptomatic unless struck by any traumatic event or repetitive event occurs. Symptomatic cases can present with several musculoskeletal impairments including one starting from neck pain. It should be addressed properly to help patients recover the mechanical strains on the structures.Case Presentation: A referred case of a 21-year-old male engineering student who presented with complaints of neck pain (non-radiating) for a week. The intensity of the pain had been intermittently increasing/decreasing for about a year and about 2-3 episodes in a month for approximately one year. He presented with an X-ray which showed C-3/C-4 block vertebrae. The patient was managed using pain education and exercises along with ergonomic advice.Conclusion: Patient-reported pain was decreased significantly from the initial visit. The patient was able to sit for a longer duration and had a considerable improvement in function.
Characteristics and Outcomes of Frail Patients with Suspected Infection in Intensive Care Units: A Descriptive Analysis From A Multicenter Cohort Study
Authors: Komori Akira , Abe Toshikazu , Yamakawa Kazuma , Ogura Hiroshi , Kushimoto Shigeki , Saitoh Daizoh , Fujishima Seitaro , Otomo Yasuhiro , Kotani Joji , Sakamoto Yuichiro , Sasaki Junichi , Shiino Yasukazu , Takeyama Naoshi , Tarui Takehiko , Tsuruta Ryosuke , Nakada Taka-aki , Hifumi Toru , Iriyama Hiroki , Naito Toshio , Gando Satoshi 
Published: June 2020

Abstract
Background: Frailty is associated with morbidity and mortality in patients in intensive care units (ICUs). However, the characteristics of frail patients with suspected infection, including sepsis, remain unclear. We aimed to investigate the characteristics and outcomes of frail patients with suspected infection in ICUs. Methods: This is a secondary analysis of a multicenter cohort study conducted by 22 ICUs in Japan. Adult patients (≥16 years) with newly suspected infection from December 2017 to May 2018 were included. We compared baseline patient characteristics and outcomes between three frailty groups based on the Clinical Frailty Scale (CFS) score: fit (score 1–3), vulnerable (score 4), and frail (score 5–9). We conducted subgroup analysis of patients with sepsis defined based on Sepsis-3 criteria. We also produced Kaplan–Meier survival curves for 90-day survival.Results: We enrolled 650 patients with suspected infection, including 599 (92.2%) patients with sepsis. Patients with a median rating of 3 (3–5) on the CFS were included: 337 (51.8%) were fit, 109 (16.8%) were vulnerable, and 204 were (31.4%) frail. Comorbidities were more common in frail and vulnerable patients than in fit patients. The Sequential Organ Failure Assessment scores for fit, vulnerable, and frail patients were 7 (4–10), 8 (5–11), and 7 (5–10), respectively (p = 0.59). The patients' median body temperatures were as follows: fit 37.5 (36.5–38.5)℃; vulnerable 37.5 (36.4–38.6)℃; and frail 37.0 (36.3–38.1)℃ (p < 0.01). C-reactive protein levels of fit, vulnerable, and frail patients were 13.6 (4.6–24.5), 12.1 (3.9–24.9), 10.5 (3.0–21.0) mg/dL, respectively (p < 0.01). In-hospital mortality did not statistically differ according to frailty (p = 0.19). Kaplan–Meier survival curves showed little difference in the mortality rate during the acute phase. However, more vulnerable and frail patients died after the acute phase than fit patients; this difference was not statistically significant (p = 0.25). Compared with fit or vulnerable patients, fewer frail patients were discharged.Conclusion: Frail and vulnerable patients with suspected infection, including sepsis, tend to have poor disease outcomes after the acute phase of infection.
Managing Malaria in Pregnancy Policy Interventions in A Challenging Environment: an Ethnographic Study of two Ghanaian Administrative Regions
Authors: Aberese-Ako Matilda , Magnussen Pascal , Gyapong Margaret , Ampofo Gifty Dufie , Tagbor Harry 
Published: June 2020

Abstract
Background: Malaria in pregnancy (MiP) is an important public health problem across sub Saharan Africa. Regular use of Long-Lasting Insecticide treated bed Nets (LLINs), directly observed administration (DOT) of intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) and prompt and effective case management of MiP has constituted the package of measures for its control in Ghana in the last 20 years. Unfortunately, Ghana like other sub Saharan African countries did not achieve the reset Abuja targets of 100% of pregnant women having access to IPTp and 100% use of LLINs by 2015. Methods: This ethnographic study explored how managers dealt with existing MiP policy implementation and arrangement challenges and the consequences on clients’ access to MiP interventions, using observations with conversations, in-depth interviews and case studies in eight health facilities and twelve communities for twelve months, in two Administrative regions in Ghana. The University of Health and Allied Sciences’ Research Ethics Committee approved the study [UHAS-REC/A.I Ul 17-18]. Results: Managers addressed frequent stock outs of malaria programme drugs and supplies from the National Malaria Control Programme and delayed reimbursement from the NHIS, by instituting co-payment, rationing drugs and relaxing the DOTs policy. This ensured that facilities had funds to pay creditors, purchase drugs and supplies in order to ensure continued service delivery. Clients who could afford the cost of maternal and MiP services and those who had previously benefitted from such services were happy to access uninterrupted services. Whilst clients who could not afford the cost of services resorted to health care shopping, delaying in starting ANC and skipping scheduled ANC visits. Consequently, some clients did not receive the recommended five+ doses of SP, others did not obtain LLINs early and some did not obtain recommended treatment for MiP. Frontline workers felt frustrated and demotivated, because sometimes they could not provide comprehensive care to clients who could not afford it. Conclusion: For Ghana to achieve her goal of controlling MiP, the Ministry of Health and other supporting institutions need to ensure prompt reimbursement of funds, the supply of programme drugs and medical supplies to public, faith based and private health facilities.