bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Profile of Diabetic Ketoacidosis among Children in Eastern Nepal
Authors: Muktan Dipak , Tamang Ghising Lisa , Singh Rupa Rajbhandari 
Published: May 2020

Background: Diabetic ketoacidosis (DKA) is a life threatening complication which is the most common reason for hospital admission in children with Type 1 Diabetes. This study was carried out to determine the clinical characteristics of children admitted with Diabetic Ketoacidosis.
Methods: Descriptive retrospective study was conducted at B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. A total of 25 children of less than 20 years old diagnosed with Diabetic ketoacidosis who were admitted to the pediatric ward and pediatric intensive care unit from January 2013 to December 2017 were included in the study. Data were collected via hospital records of patients.
Results: The mean age at presentation was 10.5 ± 4.5 years. Sixteen (64%) children were newly diagnosed as diabetes while, nine (36%) children were known cases of diabetes. The most common precipitating factor for DKA was omission of insulin 6 (24%). Twelve (48%) children had presented with severe DKA. Polyuria 23 (92%) was the commonest symptom followed by polydipsia 22 (88%), weight loss 17 (68%), abdominal pain 13 (52%), vomiting 13 (52%) and unconsciousness 8 (32%). The mean duration of symptoms before presentation was 11.3 ± 5.7 days. Mean HbA1c at presentation was 10.4 ± 2.2.
Conclusion: Majority of the patients was newly diagnosed as diabetes who presented with Diabetic ketoacidosis. Omission of insulin was the main precipitating factor. Polyuria was the most common presenting symptom. Proper follow up care of diabetes and community awareness programs should be emphasized to reduce the incidence of Diabetic ketoacidosis.
Prevalence of Osteoporosis and Osteopenia Status among Nepalese Population using Calcaneal Ultrasonography Method
Authors: Bagudai Satyajit , Upadhayay Hari Prasad 
Published: May 2020

Background: A recent worldwide upsurge in the fracture incidence due to osteoporosis has underlined this underdiagnosed and undertreated condition. An awareness regarding the preventive, curative and rehabilitative care as well as a proper health policy is the need of hour. This requires a proper database of prevalence rate. This study aimed to find out the prevalence of osteoporosis and osteopenia by screening the bone health status in an apparently healthy population of Nepal.
Methods: A cross sectional study was conducted among 465 apparently healthy subjects of either gender in three tertiary care health centers of Nepal for bone mineral density measurement by calcaneal ultrasonography.
Results: The mean+SD of age among 465 patients was 45.47+14 years, including 43.2 % male and 56.8 % females. The prevalence of osteoporosis andosteopenia was 22.4% and 60.6% respectively. Our finding showed that prevalence of osteoporosis increases with age among either gender.
Conclusions: The prevalence of osteoporosis in Nepalese population was high in comparison to other countries. There is no significant association of osteoporosis with females in comparison to males. The prevalence was increasing with age in either gender. These findings will help in creating a proper database of this condition in Nepal, helping the population,physicians as well as policy makers to have a proper address to this global emerging health problem.
Prevalence and Epidemiological Variation of Oral Squamous Cell Carcinoma among Population of Central Nepal
Authors: Sharma Sandeep 
Published: May 2020

Background: Squamous cell carcinoma (SCC) is the most common malignant neoplasm of the oral cavity and represents about 90% of all oral malignancies. Oral squamous cell carcinoma (OSCC) is an important cause of morbidity and mortality worldwide with an incidence rate that varies widely by geographic location. The purpose of this study was to identify any trends in prevalence at specific anatomic sites or within specific age or sex groups of OSCCs in Chitwan population of Nepal.
Methods: The study covers the period between January 2016 and October 2018. OSCC cases were retrospectively analysed for site, age, gender and habits and the findings were formulated to chart the trends in Chitwan population.
Results: The study revealed a male to female ratio of 2.45:1 with the largest number of OSCCs developing in the fourth and fifth decades of life. Most commonly affected site was the buccal mucosa (66.06%), followed by retromolar area (19%), floor of the mouth (10.41%), lateral border of the tongue (1.81%), labial mucosa (2.26%), and palate (0.45%). Smokeless tobacco habit was more prevalent than smoking tobacco in both men as well as women. Chi Square test was done to show association between different variables i.e. between gender to site and gender to habit and gender to different grades of cancer, which were found to be non-significant.
Conclusions: Oral cancer is an important cause of morbidity and mortality worldwide with an incidence rate that varies widely by geographic location. Even within one geographical location, the variations are seen among groups categorized by age, sex, site or habit.
Outcome of Functional Endoscopic Sinus Surgery in Patients with Chronic Rhinisinusitis Not Responding to Medical Therapy
Authors: Pyakurel Pradeep Kumar , Paudel Deepak , Chettri Shyam Thapa 
Published: May 2020

Background: chronic rhinosinusitis (CRS) is common chronic condition and is treated with antibiotics, nasal irrigation and steroids. Patients who do not respond to medical therapy are subjected to functional endoscopic sinus surgery. The objective of the study is to assess the clinical improvement after functional endoscopic sinus surgery among the patients of chronic rhinosinusitis (CRS) who failed medical management. Methods: A Prospective longitudinal study conducted within a period of 1 year. Patient with CRS who failed with medical management were subjected functional endoscopic sinus surgery (FESS). Pre –operative symptoms score and endoscopic score were assessed and compared with that of post- operative scores at the end of 6 weeks and 12 weeks. Results: Fifty-two patients who completed three months of follow up were included in the study. The mean preoperative VAS symptoms score was 5.7 and was 2.23 after FESS and difference was significant (P <0.01). There was significant improvement of the endoscopic score (ES) after FESS, the mean ES preoperatively was 4.038 and it improved to1.31 at 6 weeks and 0.75 in the 12 postoperative weeks. Post-operative adhesion was the most common complication and occurred in 15% of patients. Conclusions: FESS is a safe procedure. Patients with CRS who don’t respond to medical therapy should undergo this safe surgical procedure FESS with good outcome.
Keywords: chronic rhinosinusitis; functional endoscopic sinus surgery; outcome.
O QUE OCORREU APÓS O EPISÓDIO DE LACI DE ARAÚJO EM 2008? A HOMOSSEXUALIDADE DISCUTIDA NAS FORÇAS ARMADAS DO BRASIL
Authors: Verbicaro Soares Douglas , Demétrio Rafaela , Morais Rafael 
Published: May 2020

O artigo versa sobre a homossexualidade nas Forças Militares do Brasil, enfatizando o notório caso de Laci de Araújo, envolvido em uma polêmica com repercussão nacional após o relato nos meios de comunicação de que o ex-militar mantinha uma relação homoafetiva com outro militar e que estariam sofrendo discriminação por parte da Instituição Militar. O episódio permitiu um questionamento social em temas de aceitação e negação de militares homossexuais servirem às Forças Armadas no/ país. Para esse tema foi trabalhado no estudo o artigo 235 do Código Penal Militar – CPC, que até a atualidade possui uma tipificação que condena e discrimina a prática da relação homoafetiva, em desacordo com as previsões constitucionais. Foi realizada uma investigação bibliográfica para a metodologia do estudo. A investigação conclui pela existência de ideais preconceituosos que vem discriminado, ao longo dos tempos, as pessoas homossexuais no âmbito militar.

Palavras-chave: Militares. Diversidade sexual. Discriminação.
Vasopressor treatment and mortality following nontraumatic subarachnoid hemorrhage: a nationwide electronic health record analysis
Authors: Williams George , Maroufy Vahed , Rasmy Laila , Brown Derek , Yu Duo , Zhu Hai , Talebi Yashar , Wang Xueying , Thomas Emy , Zhu Gen , Yaseen Ashraf , Miao Hongyu , Leon Novelo Luis , Zhi Degui , DeSantis Stacia M. , Zhu Hongjian , Yamal Jose-Miguel , Aguilar David , Wu Hulin 
Published: May 2020

OBJECTIVESubarachnoid hemorrhage (SAH) is a devastating cerebrovascular condition, not only due to the effect of initial hemorrhage, but also due to the complication of delayed cerebral ischemia (DCI). While hypertension facilitated by vasopressors is often initiated to prevent DCI, which vasopressor is most effective in improving outcomes is not known. The objective of this study was to determine associations between initial vasopressor choice and mortality in patients with nontraumatic SAH.METHODSThe authors conducted a retrospective cohort study using a large, national electronic medical record data set from 2000–2014 to identify patients with a new diagnosis of nontraumatic SAH (based on ICD-9 codes) who were treated with the vasopressors dopamine, phenylephrine, or norepinephrine. The relationship between the initial choice of vasopressor therapy and the primary outcome, which was defined as in-hospital death or discharge to hospice care, was examined.RESULTSIn total, 2634 patients were identified with nontraumatic SAH who were treated with a vasopressor. In this cohort, the average age was 56.5 years, 63.9% were female, and 36.5% of patients developed the primary outcome. The incidence of the primary outcome was higher in those initially treated with either norepinephrine (47.6%) or dopamine (50.6%) than with phenylephrine (24.5%). After adjusting for possible confounders using propensity score methods, the adjusted OR of the primary outcome was higher with dopamine (OR 2.19, 95% CI 1.70–2.81) and norepinephrine (OR 2.24, 95% CI 1.80–2.80) compared with phenylephrine. Sensitivity analyses using different variable selection procedures, causal inference models, and machine-learning methods confirmed the main findings.CONCLUSIONSIn patients with nontraumatic SAH, phenylephrine was significantly associated with reduced mortality in SAH patients compared to dopamine or norepinephrine. Prospective randomized clinical studies are warranted to confirm this finding.
What factors impact the clinical outcome of magnetic resonance imaging–guided focused ultrasound thalamotomy for essential tremor?
Authors: Fukutome Kenji , Kuga Yoshihiro , Ohnishi Hideyuki , Hirabayashi Hidehiro , Nakase Hiroyuki 
Published: May 2020

OBJECTIVE
Magnetic resonance imaging–guided focused ultrasound (MRgFUS) is a novel and useful treatment for essential tremor (ET); however, the factors impacting treatment outcome are unknown. The authors conducted this study to determine the factors affecting the outcome of MRgFUS.

METHODS
From May 2016 through August 2017, 15 patients with ET were admitted to Ohnishi Neurological Center and treated with MRgFUS. To determine the factors impacting treatment outcome, the authors retrospectively studied correlations between the Clinical Rating Scale for Tremor (CRST) improvement rate and age, disease duration, baseline CRST score, skull density ratio (SDR), skull volume, maximum delivered energy, or maximum temperature.

RESULTS
The mean CRST score was 18.5 ± 5.8 at baseline and 4.6 ± 5.7 at 1 year. The rate of improvement in the CRST score was 80% ± 22%. Younger age and lower baseline CRST score were correlated with a higher CRST improvement rate (p = 0.025 and 0.007, respectively). To obtain a CRST improvement rate ≥ 50%, a maximum temperature ≥ 55°C was necessary. There was no correlation between SDR and CRST improvement rate (p = 0.658). A lower SDR and higher skull volume required significantly higher maximum delivered energy (p = 0.014 and 0.016, respectively). A higher maximum temperature was associated with a significantly larger lesion volume (p = 0.026).

CONCLUSIONS
Younger age and lower baseline CRST score were favorable outcome factors. It is important to assess predictive factors when applying MRgFUS.
Correlation between localization of supratentorial glioma to the precentral gyrus and difficulty in identification of the motor area during awake craniotomy
Authors: Saito Taiichi , Muragaki Yoshihiro , Tamura Manabu , Maruyama Takashi , Nitta Masayuki , Tsuzuki Shunsuke , Fukui Atsushi , Kawamata Takakazu 
Published: May 2020

OBJECTIVE
Identification of the motor area during awake craniotomy is crucial for preservation of motor function when resecting gliomas located within or close to the motor area or the pyramidal tract. Nevertheless, sometimes the surgeon cannot identify the motor area during awake craniotomy. However, the factors that influence failure to identify the motor area have not been elucidated. The aim of this study was to assess whether tumor localization was correlated with a negative cortical response in motor mapping during awake craniotomy in patients with gliomas located within or close to the motor area or pyramidal tract.

METHODS
Between April 2000 and May 2019 at Tokyo Women’s Medical University, awake craniotomy was performed to preserve motor function in 137 patients with supratentorial glioma. Ninety-one of these patients underwent intraoperative cortical motor mapping for a primary glioma located within or close to the motor area or pyramidal tract and were enrolled in the study. MRI was used to evaluate whether or not the tumors were localized to or involved the precentral gyrus. The authors performed motor functional mapping with electrical stimulation during awake craniotomy and evaluated the correlation between identification of the motor area and various clinical characteristics, including localization to the precentral gyrus.

RESULTS
Thirty-four of the 91 patients had tumors that were localized to the precentral gyrus. The mean extent of resection was 89.4%. Univariate analyses revealed that identification of the motor area correlated significantly with age and localization to the precentral gyrus. Multivariate analyses showed that older age (≥ 45 years), larger tumor volume (> 35.5 cm3), and localization to the precentral gyrus were significantly correlated with failure to identify the motor area (p = 0.0021, 0.0484, and 0.0015, respectively). Localization to the precentral gyrus showed the highest odds ratio (14.135) of all regressors.

CONCLUSIONS
Identification of the motor area can be difficult when a supratentorial glioma is localized to the precentral gyrus. The authors’ findings are important when performing awake craniotomy for glioma located within or close to the motor area or the pyramidal tract. A combination of transcortical motor evoked potential monitoring and awake craniotomy including subcortical motor mapping may be needed for removal of gliomas showing negative responses in the motor area to preserve the motor-related subcortical fibers.
External validation of current prediction systems of improvement after decompression surgery in Chiari malformation type I patients: can we do better?
Authors: Feghali James , Xie Yangyiran , Chen Yuxi , Li Sean , Huang Judy 
Published: May 2020

OBJECTIVE
The Chiari Severity Index (CSI) and points-based algorithm of Thakar et al. are two prognostic tools that have been developed to predict the likelihood of improvement after suboccipital decompression in adult patients with Chiari malformation type I (CM-I). This study aimed to externally validate and critically evaluate these algorithms in the interest of guiding the development of improved prediction systems.

METHODS
A consecutive cohort of CM-I patients undergoing suboccipital decompression between September 2006 and September 2018 were included. The CSI and Thakar point score were computed for all patients, and associations with improvement were analyzed. The ability of both prediction systems to predict improvement as measured by different Chicago Chiari Outcome Scale (CCOS) cutoffs was assessed using receiver operating curve analysis. Post hoc correlations between the algorithms and different CCOS subcomponents were also assessed.

RESULTS
The surgical cohort was composed of 149 adult CM-I patients, of whom 39 (26%) had a syrinx. Most patients experienced improvement after surgery (80% CCOS ≥ 13; 96% CCOS ≥ 11). The proportion of patients improving decreased with increasing CSI, but the results were not statistically significant (p = 0.246). No statistically significant difference in the mean Thakar point score was identified between improved and nonimproved patients using both CCOS cutoffs (p = 0.246 for a cutoff of 13 and p = 0.480 for a cutoff of 11). The CSI had a poor ability in identifying improved patients at a CCOS cutoff of 13 (area under the curve [AUC] 0.582) and 11 (AUC 0.646). The Thakar point score similarly had poor discrimination at a cutoff of 13 (AUC 0.467) and 11 (AUC 0.646). Neither algorithm had significant correlation with any of the CCOS subcomponents except for CSI and nonpain symptom improvement (coefficient = −0.273, p = 0.001).

CONCLUSIONS
Previously published algorithms failed to provide prediction value with regard to clinically meaningful improvement following suboccipital decompression in adult CM-I patients. Future models and practical scoring systems are still required to improve the decision-making process.
Fusion patterns of minor lateral calvarial sutures on volume-rendered CT reconstructions
Authors: Wilkinson C. Corbett , Serrano Cesar A. , French Brooke M. , Graber Sarah J. , Schmidt-Beuchat Emily , Batista-Silverman Lígia , Hubbell Noah P. , Stence Nicholas V. 
Published: May 2020

OBJECTIVESeveral years ago, the authors treated an infant with sagittal and bilateral parietomastoid suture fusion. This made them curious about the normal course of fusion of “minor” lateral sutures (sphenoparietal, squamosal, parietomastoid). Accordingly, they investigated fusion of these sutures on 3D volume-rendered head CT reconstructions in a series of pediatric trauma patients.METHODSThe authors reviewed all volume-rendered head CT reconstructions obtained from 2010 through mid-2012 at Children’s Hospital Colorado in trauma patients aged 0–21 years. Each sphenoparietal, squamosal, and parietomastoid suture was graded as open, partially fused, or fused. In several individuals, one or more lateral sutures were fused atypically. In these patients, the cephalic index (CI) and cranial vault asymmetry index (CVAI) were calculated. In a separately reported study utilizing the same reconstructions, 21 subjects had fusion of the sagittal suture. Minor lateral sutures were assessed, including these 21 individuals, excluding them, and considering them as a separate subgroup.RESULTSAfter exclusions, 331 scans were reviewed. Typically, the earliest length of the minor lateral sutures to begin fusion was the anterior squamosal suture, often by 2 years of age. The next suture to begin fusion—and first to complete it—was the sphenoparietal. The last suture to begin and complete fusion was the parietomastoid. Six subjects (1.8%) had posterior (without anterior) fusion of one or more squamosal sutures. Six subjects (1.8%) had fusion or near-complete fusion of one squamosal and/or parietomastoid suture when the corresponding opposite suture was open or nearly open. The mean CI and CVAI values in these subjects and in age- and sex-matched controls were normal and not significantly different. No individuals had a fused parietomastoid suture with open squamosal and/or sphenoparietal sutures.CONCLUSIONSFusion and partial fusion of the sphenoparietal, squamosal, and parietomastoid sutures is common in children and adolescents. It usually does not represent craniosynostosis and does not require cranial surgery. The anterior squamosal suture is often the earliest length of these sutures to fuse. Fusion then spreads anteriorly to the sphenoparietal suture and posteriorly to the parietomastoid. The sphenoparietal suture is generally the earliest minor lateral suture to complete fusion, and the parietomastoid is the last. Atypical patterns of fusion include posterior (without anterior) squamosal suture fusion and asymmetrical squamosal and/or parietomastoid suture fusion. However, these atypical fusion patterns may not lead to atypical head shapes or a need for surgery.
Publishing is evolving, but are we? Developing talent for the future
Authors: Miller Andrew James 
Published: May 2020

At the APE 2020 Pre-Conference in Berlin, a group of talent development and HR experts from across the scientific research and publishing community came together to discuss the future of talent development in the scholarly publishing industry. We heard from an excellent group of speakers who shared with us a rich and diverse range of expertise and experience. We set ourselves the challenge of imagining what the world of scholarly academic publishing would look like in 2030, and asked ourselves the question: how can we work together to develop the talent we will need now, and for the future, in a rapidly changing world? Are we keeping pace, and are we prepared for the challenge ahead? Based on our discussion, three key themes emerged: the importance of supporting increased diversity & inclusion within scholarly publishing, interorganizational leadership development initiatives for leaders across the publishing ecosystem to exchange experiences and ideas, and greater research and publishing career mobility to encourage more fluid movement between research and publishing jobs. We believe these things are all very achievable if we commit to investing in the kind of culture change and new ways of thinking that will lead us to success in 2030.
Vietnam: en busca de una tercera vía
Authors: Rul–Lán Baudes Gaspar 
Published: May 2020

El autor pretende dar una visión positiva del moderno Vietnam, un país que después de años de dominación extranjera, y terminada una de las más sangrientas guerras del siglo XX, ha vuelto una página de su historia, y animado por su lema de “independencia–unidad–socialismo”, mira al futuro con ilusión. El artículo empieza con un breve repaso a su turbulenta historia, para analizar, seguidamente, el actual sistema político socialista de Vietnam tal como viene reflejado en su Constitución de 1992. También se estudia el proceso de profunda autocrítica del gobierno vietnamita que llevó a la adopción de la politica del “Doi Moi” (renovación) y a la introducción de un sistema de mercado libre sin renunciar al ideal socialista. Luego se analiza el papel de la empresa privada en esta nueva economía y su marco jurídico, para terminar con una rápida mirada a los derechos civiles reconocidos por la Constitución, con especial énfasis en el derecho de libertad religiosa.
"Hojas (vivas) del Derecho (de los negocios). Un ensayo sobre el mercado" (Recensión)
Authors: Paniagua Zurera Manuel 
Published: May 2020

Recensión de la obra de: JIMÉNEZ DE PARGA, R., (2001), Hojas (vivas) del Derecho (de los negocios). Un ensayo sobre el mercado, Madrid, Marcial Pons, 230 págs.