bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antimicrobial resistance and conflict in the Middle East: A systematic review
Authors: Truppa Claudia , Abo-Shehada Mahmoud N. 
Published: February 2020

Abstract
Background: In spite of the evident general negative effects of armed conflict on countries’ health systems and populations’ health outcomes, little is known about similar impacts of conflicts on the spread of antimicrobial resistances (AMR). This review was to address this evidence gap and describe:1. Patterns of AMR in the Middle East (ME) and resistance profiles of pathogens included in the Global AMR Surveillance System (GLASS) supported by the World Health Organization;2. Differences in proportions of AMR isolates between conflict and non-conflict countries. Methods: A systematic literature review was conducted following PRISMA guidelines and searching five electronic databases. Subject heading and free text were searched for “antimicrobial resistances” and “Middle East”, to identify observational studies on AMR published from January 2011 to June 2018. Data were extracted from included articles on a predefined set of variables. Percentages of AMR were analysed as median and interquartile ranges. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results: A total of 132 articles met the inclusion criteria. Included studies showed heterogeneity in study design, laboratory methods and standards for interpretation of results, and an overall high risk of bias. Main findings were the following:1. High proportions of carbapenem resistance in Acinetobacter spp. (median 74.2%: range), and both carbapenem resistance (median 8.1% and 15.4% for E. coli and K. pneumoniae respectively) and ESBL-production (median 32.3% and 27.9% for E. coli and K. pneumoniae respectively) amongst Enterobacteriaceae. S. aureus isolates showed a median methicillin resistance percentage of 45.1%, while vancomycin resistance was almost absent. A median of 50% of the strains of S. pneumoniae showed non-susceptibility to penicillin. 2. Similar trends were observed in conflict and non-conflict affected countries.Conclusions: There is a lack of standardization in the methodological approach to AMR research in the Middle East. The proportion of antibiotic resistances among specific GLASS pathogens is high, particularly among Acinetobacter spp.
Unemployment Rate and Cohort Size: New Insights from Nigeria
Authors: YOUNG ADEMOLA OBAFEMI 
Published: February 2020

Abstract
The nature of the relationship between unemployment rate and the size of a specifically defined age group, or cohort, notably the young workers in the working-age population, has been a subject of an intense debate, widely studied and generated a sizable body of literature. However, while the debate is still inconclusive, an in-depth reading of these expansive extant and crescive literatures suggests that besides the contradictory findings, one of the major drawbacks with these literatures is that hardly any studies have been reported exclusively for African countries, as most of the extant literature principally focused on European, Asian, and American economies. Moreover, generalized studies across countries employing pooled data appears to dominate the literature. Thus, using annual time series secondary data spanning between the period 1970 and 2019, this study employs bounds testing approach to co-integration to examine the nature of the aforementioned relationship in Nigeria. Empirical results obtained revealed that cohort size has an overwhelming positive and statistically significant impact on unemployment rate both in the short- and long-run, suggesting that the size of one’s generation, has repercussions not only on (un)employment outcomes of that particular group but also on other age groups in Nigeria.
A novel high performance metagenome-derived alkali-thermostable endo-β-1,4-glucanase for lignocellulosic biomass hydrolysis in the harsh conditions
Authors: Ariaeenejad Shohreh , Sheykhabdolahzadeh Atefeh , Maleki Morteza , Kavousi Kaveh , Shahraki Mehdi Foroozandeh , Salekdeh Ghasem Hosseini 
Published: February 2020

Abstract
Background: Lignocellulosic biomass, is a great resource for the production of bio-energy and bio-based material since it is largely abundant, inexpensive and renewable. The requirement of new energy sources has led to a wide search for novel effective enzymes to improve the exploitation of lignocellulose, among which the importance of thermostable and halotolerant cellulase enzymes with high pH performance is significant. Results: The primary aim of this study was to discover a novel alkali-thermostable endo-β-1,4-glucanase from the sheep rumen metagenome. Using a multi-step in-silico analysis, primary candidates with desired properties were found and subjected to cloning, expression, and purification followed by functional and structural characterization. The enzymes' kinetic parameters, including V max , Km, and specific activity, were calculated. The PersiCel4 demonstrated its optimum activity at pH 8.5 and a temperature of 85°C and was able to retain more than 70% of its activity after 150 hours of storage at 85°C. Furthermore, this enzyme was able to maintain its catalytic activity in the presence of different concentrations of NaCl, MgCl 2 , CaCl 2 , and MnCl 2 . Our results showed that treatment with MnCl 2 could enhance the enzyme’s activity by 89%. PersiCel4 was ultimately used for enzymatic hydrolysis of autoclave pretreated rice straw, the most abundant agricultural waste with rich cellulose content. In autoclave treated rice straw, enzymatic hydrolysis with the PersiCel4 increased the release of reducing sugar up to 260% after 72 hours in the harsh condition ( T= 85°C, pH = 8.5). Conclusion: Considering the urgent demand for stable cellulases that are operational on extreme temperature and pH conditions and due to several proposed distinctive characteristics of PersiCel4, it can be used in the harsh condition for bioconversion of lignocellulosic biomass.
Prevalence Of Staphylococcus Aureus Colonization In Patients For Total Joint Arthroplasty In South Africa
Authors: Pietrzak Jurek Rafal Tomasz , Maharaj Zia , Mokete Lipalo 
Published: February 2020

Abstract
Background: Periprosthetic joint infections are a major source of morbidity and mortality for patients undergoing Total Joint Arthroplasty. Staphylococcus aureus colonization is an independent, modifiable risk factor for periprosthetic joint infections. Post-operative infections are reported to be ten times greater in Staphylococcus aureus carriers than in non-carriers in developed countries though recorded data is lacking for the developing world. This study aims to determine the prevalence of Staphylococcus aureus colonization in patients awaiting Total Joint Arthroplasty in South Africa. Methods: We prospectively assessed 119 patients awaiting Total Knee Arthroplasty and Total Hip Arthroplasty between May and October 2016. We screened three separate anatomical sites on each patient for Staphylococcus aureus. Patients with positive cultures were treated with intranasal mupirocin ointment and chlorhexidine body wash. Univariate and comparative statistical analyses to determine risk factors for colonization was conducted using t-tests, Fisher’s exact tests, and chi square analyses. Results: The overall prevalence of Methicillin Sensitive Staphylococcus aureus colonization was 31.9% (n = 38). There were no patients colonized with Methicillin Resistant Staphylococcus aureus . Nasal swabs returned a yield of 81.6%(n=31), with groin swabs and axillary swabs at 39.5% (n=15) and 28.9% (n=11) respectively. Eradication was successful in 94.74% (n=36) after five days treatment. All patients (100%) were decolonized after counseling and repeat eradication treatment. The overall complication rate was 7.6% (n=9). The 30-day readmission rate in the Staphylococcus aureus -colonized group was 7.9% (n=3) as opposed to 7.4% (n=6) in the non-colonized cohort. There were no 60- and 90-day readmissions and no cases were revised at a mean follow-up of 2.26 years. Conclusions: The rate of Staphylococcus aureus colonization in patients undergoing elective Total Joint Arthroplasty in a developing country was 31.9% and is equivalent to reported rates in developed countries. Eradication treatment with combined intranasal mupirocin ointment and chlorhexidine body wash is a successful treatment modality. A larger cohort of patients is recommended to determine risk factors and post-operative septic sequelae in this population group.
Predictive value of lymphocyte ratio and CRP level for early detection of surgical site infection following lumbar spinal surgery
Authors: wei wenbo , Dang Shajie , Duan Dapeng , Gong Liqun , Wang Jue , Wei Ling 
Published: February 2020

Abstract
Objective To investigate the predictive value of laboratory predictors, such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, and WBC differential count, for the early diagnosis of surgical site infection (SSI) after lumbar spinal surgery. We also sought to determine the diagnostic thresholds for these markers. Methods A total of 112 patients participated in the study: 11 patients who developed SSI after lumbar spinal surgery (SSI group) and 91 non-SSI patients as controls (non-SSI group). White blood cell (WBC) count, WBC differential count, CRP level, and ESR were determined 1 day before surgery and on postoperative day (POD) 1, POD3, and POD7. The diagnostic thresholds for these markers were determined with the receiver operating characteristic curve. Results CRP, ESR, and WBC were significantly higher in the SSI group than in the non-SSI group on POD3 and POD7 ( P < 0.05). The lymphocyte ratio was significantly lower in the SSI group, compared with the non-SSI group, on POD3 ( P < 0.05). Analysis of the receiver operating characteristic curve revealed that lymphocyte ratio < 11.5% on POD3 (sensitivity 90.9%, specificity 75.4%, area under the curve [AUC] 0.919), and C-reactive protein level > 26 mg/dL on POD7 (sensitivity 90.9%, specificity 87.7%, area under the curve [AUC] 0.954) were significant laboratory predictors for the early detection of SSI. Conclusion Lymphocyte ratio < 11.5% on POD3 and CRP levels > 26.5 mg/dL on POD7 are reliable predictors for SSI after lumbar spinal surgery.
Favorable efficacy of rituximab in ANCA-associated vasculitis patients with excessive B cell differentiation
Authors: Miyazaki Yusuke , Nakayamada Shingo , Kubo Satoshi , Ishikawa Yuichi , Yoshikawa Maiko , Sakata Kei , Iwata Shigeru , Miyagawa Ippei , Nakano Kazuhisa , Tanaka Yoshiya 
Published: February 2020

Abstract
Objectives: B-cell depletion by rituximab (RTX) is an effective treatment for anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV). However, peripheral B cell phenotypes and the selection criteria for RTX therapy in AAV remain unclear.Methods: Phenotypic characterization of circulating B cells was performed by 8-color flow cytometric analysis in 54 newly diagnosed AAV patients (20 granulomatosis with polyangiitis and 34 microscopic polyangiitis). Patients were considered eligible to receive intravenous cyclophosphamide pulse (IV-CY) or RTX. All patients also received high-dose glucocorticoids (GC). We assessed circulating B cell phenotypes and evaluated the efficacy after 6 months of treatment. Results: There were no significant differences in the rate of clinical improvement, relapses, or serious adverse events between patients receiving RTX and IV-CY. The proportion of effector or class-switched memory B cells increased in 24 out of 54 patients (44%). The proportions of peripheral T and B cell phenotypes did not correlate with BVAS at baseline. However, among peripheral B cells, the proportion of class-switched memory B cells negatively correlated with the rate of improvement in BVAS at 6 months after treatment initiation (r = -0.28, p = 0.04). Patients with excessive B cell differentiation were defined as those in whom the proportion of class-switched memory B cells or IgD-CD- B cells among all B cells was >2 SDs higher than the mean in the HCs. The rate of Birmingham Vasculitis Activity Score (BVAS) remission in patients with excessive B cell differentiation was significantly lower than that in patients without. In patients with excessive B cell differentiation, the survival rate, the rate of BVAS remission, and dose reduction of GC were significantly improved in the RTX group compared to those in the IV-CY group after 6 months of treatment. Conclusions: The presence of excessive B cell differentiation was associated with treatment resistance. However, in patients with circulating B cell abnormality, RTX was effective and increased survival compared to IV-CY. The results suggest that multi-color flow cytometry may be useful to determine the selection criteria for RTX therapy in AAV patients.
Sickle cell disease in Sri Lanka: Clinical and molecular basis and the unanswered questions about disease severeity.
Authors: Darshana Thamal , Bandara Dayananda , Nawarathne Upul , de Silva Udaya , Costa Yasinta , Pushpakumara Kalavitigoda , Pathirage Sumithra , Basnayake Seuwandi , Epa Chamila , Dilrukshi Pradeepa , Wijayawardena Maheshaka , Anthony Angela A. , Rodrigo Rexan , Manamperi Aresha , Smith Frances , Allen Angela , Menzel Stephan , Rees David , Premawardhena Anuja 
Published: February 2020

Abstract
Background Though case reports and limited case series of Sickle cell disease in Sri Lanka have been reported previously, no attempt has been made hitherto to undertake a comprehensive genotypic-phenotypic analysis of this “rare” group of patients.Results All accessible Sickle cell disease patients, totaling 60, including, 51 Sickle β-thalassaemia and 9 homozygous sickle patients were enrolled from seven thalassaemia treatment centres between December 2016 - March 2019. The majority of patients were of Sinhalese ethnicity (n=52, 86.67%). Geographically, two prominent clusters were identified and the distribution of Sickle haemoglobin in the island contrasted markedly with the other haemoglobinopathies. 3/ 9 homozygous sickle patients and 3/ 51 Sickle β-thalassaemia patients were receiving regular transfusion. Joint pain was the commonest clinical presentation among all sickle cell disease patients (n=39, 65.0%). Dactylitis was significantly more common in homozygous sickle patients compared with the Sickle β-thalassaemia group ( p 0.034). Two genetic backgrounds sickle mutation were identified namely, Arab Indian and Benin. Among the regulators of Foetal hemoglobin in Sickle patients of the present study rs1427407 G>T seemed to be the most prominent modifier, with a significant association with Foetal haemoglobin levels ( p 0.04).Conclusions Overall, the clinical course of the Asian version of Sickle cell disease in Sri Lanka appears to be milder than that described in India.
Multidrug resistant tuberculosis conversion rate after initiation on standardised short regimen: Retrospective study
Authors: Somfongo Nomawethu , Mupindu Wiseman , mangi nozuko 
Published: February 2020

Abstract
Background Multi Drug Resistance (MDR) Tuberculosis (TB) is a global risk. Several suboptimal results were noticed which resulted to introduction of a standardised short regimen of 9-12 to optimise favourable outcomes. This new intervention has not been evaluated for effectiveness since inception in the Eastern Cape Province. Objective: T o evaluate multidrug resistant tuberculosis conversion rate following initiation on short regimen. Methods A retrospective study using a descriptive design was used to collect data from conveniently sampled 71 documents at Nkqubela TB and Duncan Village Day hospitals. Data were collected using a self-designed structured questionnaire and analysed using Statistical Packages for Social Sciences (SPSS) version 24. Results Sixteen percent (n=19) of 71 records had no consecutive smear results. Demographic findings showed that the majority of the affected age group was between the ages of 36-45 years in both genders (34.7%, n=47) with males being highly affected more than females. The majority of participants were unemployed (51.7%), people living with HIV/AIDS (62.7%), use alcohol and smoking. Conversion rate was 68, 5%. Conclusion There is a need to review EDR web to accommodate sputum results irrespective of TB treatment start date. An extensive, ongoing counselling, support and health education needs to be provided for patients and families until the completion of treatment to emphasize the importance of monthly sputum collection and importance of treatment adherence. Clinicians need to strengthen their counselling and education skills. The introduction of short regimen to treat MDR has shown an improved sputum conversion rate in RR/MDR TB.
Health information systems in developing countries: Case of African countries
Authors: KOUMAMBA Aimé Patrice , BISVIGOU Ulrick Jolhy , NGOUNGOU Edgard Brice , DIALLO Gayo 
Published: February 2020

Abstract
Background: In developing countries, health information systems (HIS) is experiencing more and more difficult to produce quality data. The lack of reliable health information makes it difficult to develop effective health policies. In order to understand the organization of HIS in African countries, we undertook a literature review.Methods: Our study was conducted using the PubMed and Scopus bibliographic search engines. Our inclusion criteria were: (i) all articles published between 2005 and 2019, (ii) including in their titles the keywords "health", "information", "systems", "system", "africa", "developing countries", "santé", "pays en développement", "Afrique", (iii) written in English and French, (iv) dealing with organizational and technical issues of HIS in African countries.Results: Fourteen articles out of 2492 retrieved were included in the study, of which 13 (92.9%) were qualitative. All of them dealt with issues related to HIS in 12 African countries. All 12 countries (100.0%) had opted for a data warehouse approach to improve their HIS. This approach, supported by the DHIS2 application, had provided them with reliable data. However, 11 of the 12 countries (92.0%) were aligned with donor strategies and lacked a national strategy. Conclusion: This study helped us to understand that the lack of a national health information management strategy will always be a threat to HIS performance in African countries. Ideally, rigorous upstream thinking to strengthen HIS governance should be undertaken by defining and proposing a coherent conceptual framework to analyze and guide the development and integration of digital applications into HIS over the long term.
Best practice guidelines for management of spinal disorders in skeletal dysplasia
Authors: White Klane , Bober Michael B , Cho Tae-Joon , Goldberg Michael J , Hoover-Fong Julie , Irving Melita , Kamps Shawn , Mackenzie William G , Raggio Cathleen , Spencer Samantha S , Bompadre Viviana , Savarirayan Ravi 
Published: February 2020

Abstract
Background: Disorders of the spine present a common and difficult management concern in patients with skeletal dysplasia. Due to the rarity of these conditions however, the literature, largely consisting of small, single institution case series, is sparse in regard to well-designed studies to support clinical decision making in these situations. Methods: Using the Delphi method, an international, multi-disciplinary group of individuals, with significant experience in the care of patients with skeletal dysplasia, convened to develop multi-disciplinary, “best practice” guidelines in the care of spinal disorders in patients with skeletal dysplasia. Results: Starting with 33 statements, the group a developed a list of 31 “best practice” guidelines. Conclusions: The guidelines are presented and discussed to provide context for clinicians in their decision making in this often-challenging realm of care.
Transit Time and Recovery in Prehospital Emergency Care: Meta-analysis
Authors: fu xing , Wilson Philip , Chung Wing Sun Faith 
Published: February 2020

Abstract
Background: People living in rural areas usually suffer comparatively disadvantaged emergency health care than those living in urban areas, reasons including long transit time due to geographic factors. Implementation of technology is suggested to improve the access to medical care for the rural population, such as remotely-supported ultrasound and satellite/cellular communications. Methods: Screening of eligible studies were conducted based on inclusion an exclusion criteria. A comprehensive search was conducted by using following database: EMBASE, Medline, Cochrane library and Scopus. Quality assessment tool for observational cohort and cross-sectional study is used for assessing the risk of bias. Transit time was mostly classified into two-stage time symptom onset-balloon time and door-balloon time. In symptom onset-balloon time, we divided into short time group and long time group in our study. The time group were defined based on the median or mean transit time among patients and we also used same way to set up time groups among door-balloon time. The collected data were used for quantitative analysis, they were inputted into Review Manager Software (v5.3) to produce summary results. Results: Ten studies representing 71099 patients were included in the meta-analysis. All studies were retrospective and prospective observational studies and RCTs in which patients experienced ST-elevation myocardial infarction (STEMI) and were treated with percutaneous coronary intervention (PCI). Combined in meta-analysis the odds ratio for mortality in onset-balloon and door-balloon time was 0.82 (CI 0.70, 0.96) and 0.62 (CI 0.53, 0.74) respectively. The forest plot of both onset-balloon time and door-balloon time showed a moderate heterogeneity, with I2 = 31%, P =0.18 and I2 = 67%, P <0.05 respectively. Conclusion: Results from Meta-analysis report less mortality in shorter transit time than that in longer transit time. The demographic characteristics and the sample size of the difference between the long time and short time groups may be the reasons for heterogeneity. The result of the review may potentially support the application of remotely-supported ultrasound and satellite/cellular in prehospital emergency for better health outcome in long transit time.
Enrichment differentiation of human induced pluripotent stem cells into sinoatrial node-like cells by combined modulation of BMP, FGF and RA signaling pathways
Authors: Liu Feng , Fang YiBing , Hou XiaoJie , Yan Ying , Xiao HaiYing , Zuo DongChuan , Wen Jing , Wang LinLi , Dang XiTong , Zhou Rui , Liao Bin 
Published: February 2020

Abstract
Background : Biological pacemakers derived from pluripotent stem cell (PSC) have been considered as a potential therapeutic surrogate for sick sinus syndrome. So it’s essential to develop high efficient strategies for enrichment of sinoatrial node-like cells (SANLC) as seed cells for biological pacemakers. It has reported that BMP, FGF and RA signaling pathways were involved specification of different cardiomyocyte subtypes, pacemaker, ventricle, and atria cells. Methods : During the differentiation process from human induced pluripotent stem cell (hiPSC) to cardiomyocyte through small molecule based temporal modulation of the Wnt signaling pathway, signaling of BMP, FGF and RA was manipulated at cardiac mesoderm stage. The methods of qRT-PCR, immunofluorescence, flow cytometry and whole cell patch clamp were used to identify the SANLC.Results : qRT-PCR results showed that manipulating each one of BMP, FGF and RA signaling was effective for the upregulation of SANLC markers. Moreover, combined modulation of such three pathways displayed the best efficiency for the expression of SANLC markers, which was further confirmed at protein level using immunofluorescence, flow cytometry. Finally, the electrophysiological characteristics of induced SANLC were verified by patch clamp method. Conclusion : An efficient transgene-independent differentiation protocol for generating SANLC from hPSC was developed, in which combined modulating BMP, FGF and RA signaling at cardiac mesoderm stage generates SANLC at high efficiency. It may serve as a potential approach for biological pacemaker construction.