bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiomyopathies in children: classification, diagnosis and treatment
Authors: De Angelis Giulia , Bobbo Marco , Paldino Alessia , D’Agata Mottolese Biancamaria , Altinier Alessandro , Dal Ferro Matteo , Merlo Marco , Sinagra Gianfranco 
Published: May 2020

Purpose of review
Cardiomyopathies are rare in the pediatric population, but significantly impact on morbidity and mortality. The present review aims to provide an overview of cardiomyopathies in children and some practical guidelines for their prognostic stratification and management.

Recent findings
Pediatric cardiomyopathies may present as isolated cardiac muscle disease or in the context of complex clinical syndromes. The etiologic characterization represents an important step in the diagnosis and treatment of cardiomyopathies because of its impact on prognosis and on therapeutic measures. Indeed, replacement therapy is nowadays widely available and changes the natural history of the disease. More complex is the management of isolated cardiomyopathies, which lack specific therapies, mainly aimed at symptomatic relief. In this context, heart transplantation shows excellent outcomes in children, but wait-list mortality is still very high. Device therapy for sudden cardiac death prevention and the use of mechanical assist devices are becoming more common in the clinical practice and may help to reduce mortality.

Summary
Providing insight into pediatric cardiomyopathies classification helps in the prognostication and management of such diseases. Recent years witnessed a significant improvement in mortality, but future research is still needed to improve quality of life and life expectations in the pediatric population.
War in the Middle East and the Incidence of Cleft Lip and Palate
Authors: Aldaghir Osamah M. , Aljumaily Hassanien A. , Al-khannaq Yassir R. 
Published: May 2020

Purpose:
The aim of this retrospective study was to study the effects of the war against ISIS during period (2014–2018) on the incidence of cleft lip and palate and the appearance of different congenital anomalies.

Materials and Methods:
The collected sample consists of 320 newborn babies (160 patients and 160 infants as a control). The examined patients and controls were all included in this study, while the authors exclude those who born to relative parents, and if the mothers had taken any medications during pregnancy.
All newborn cases and controls were physically examined by the research team, and a questionnaire was completed after obtaining the informed consent of mothers and/or fathers.

Results:
In this study, the authors found that 160 patients out of 40,500 live births were born with cleft lip and/or cleft palate, so their percentage was 0.39% from population, that is mean approximately 4 infants affected per each 1000 live births. The risk of cleft development among children who born to fathers who participated in long fighting against the terrorists was (OR = 44.333, 95% CI: 20.176–97.417). The associated combined anomalies were found in 88 patients (79%) especially among those whom fathers participated in the war

Conclusion:
From this study the authors can conclude that the dramatic increase in the incidence of cleft lip and palate and the appearance of different associated anomalies in the south of Iraq is due to the direct effect and impact of the war and the used toxic bombs on the chromosomal changes of the parents and the developing fetus.
Simultaneous Placement of Endosseous Implants in Free Fibula Flap for Reconstruction of Mandibular Resection Defects
Authors: Datarkar Abhay N. , Daware Surendra , Kothe Sudhanshu , Oren Peleg , Eitan Mijiritsky 
Published: May 2020

Abstract
Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. Large bone defects in the mandible due to ablation for tumors may generate a series of problems, as far as function and esthetics of the patient is concerned. The use of free bone flaps for mandibular reconstruction has the obvious advantage of being a well vascularized tissue that can withstand the hostile environment of the oral cavity. Fibular bone presents favorable conditions for implant-supported prosthetic rehabilitation, due to its diameter and the good quality of its cortical bone. The outcome of current study supports the use of simultaneous placement of endosseous implants in free fibula flap for reconstruction of mandibular resection defects with better clinical, aesthetic, and functional outcomes.
Evacuation of Vulnerable and Critical Patients
Authors: Gray Megan M. , Thomas Anita Anne , Burns Brian , Umoren Rachel A. 
Published: May 2020

Introduction
Virtual simulation (VS) is an adaptable medium for teaching critical disaster management skills such as efficient hospital evacuation. We aimed to compare VS and prerecorded narrated multimedia lecture–based training of pediatric nurses for evacuation of a sick newborn in the neonatal intensive care unit and pediatric emergency department (ED) using live evacuation simulations.

Methods
Thirty neonatal intensive care unit and 30 ED nurses enrolled with 30 randomized to multimedia lecture and 30 randomized to VS, with equal block distribution of nurses from each unit. Pretraining/posttraining surveys were administered, and live evacuation simulations were scored for time to evacuation, items collected, and communication.

Results
Overall, disaster preparation and communication improved within the VS group as compared with the multimedia lecture group. Virtual simulation rated more immersive (P < 0.001), better at safety threat identification (P < 0.05), and better at evacuation preparation compared with multimedia lecture (P < 0.01). Virtual simulation participants felt more prepared in disaster response (P < 0.001) and patient evacuation (P < 0.001). Both groups packed equal essential items, but VS participants packed more equipment (mean, 19 vs. 15, P < 0.01) with no significant evacuation time difference between the VS group (145 ± 58 seconds) and multimedia lecture group (152 ± 59 seconds, P = not significant). Virtual simulation participants had better communication ratings with the charge nurse (P < 0.05) and family (P < 0.001).

Conclusions
Virtual simulation was well received by nurses compared with multimedia lecture and may be an effective adjunct for training nurses on infant patient evacuation during a disaster.
COVID-19 Related Mortality: Is the BCG Vaccine Truly Effective?
Authors: Paredes Jan A. , Garduño Valeria , Torres Julian 
Published: May 2020

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has become a worldwide emergency. In the attempt to search for interventions that would improve outcomes, some studies have looked at the potential benefit of BCG vaccination. These past studies have found a statistically significant reduction in COVID-19 related mortality in countries with a current universal bacille Calmette-Guérin (BCG) vaccination policy. However, just as the authors themselves noted, the nature of ecological studies make them very prone to the presence of several confounders. This paper took into account demographic differences, economic differences and the different stages of the pandemic in each country; gathering data from publicly available sources. It was found that no statistically significant difference exists in mortality rates between countries with a current or prior BCG vaccination policy when compared to those that never had such a program. Nevertheless, the immunostimulatory potential of the BCG vaccine might still prove useful in the development of future vaccines or other prophylactic measures.
Development and Validation of a Convolutional Neural Network Model for ICU Acute Kidney Injury Prediction
Authors: Le Sidney , Allen Angier , Calvert Jacob , Palevsky Paul M. , Braden Gregory , Patel Sharad , Pellegrini Emily , Green-Saxena Abigail , Hoffman Jana , Das Ritankar 
Published: May 2020

ABSTRACTRationale and objectivesAcute kidney injury (AKI) is common among hospitalized patients and has a significant impact on morbidity and mortality. While early prediction of AKI has the potential to reduce adverse patient outcomes, it remains a difficult condition to predict and diagnose. The purpose of this study was to evaluate the ability of a machine learning algorithm to predict for AKI KDIGO Stage 2 or 3 up to 72 hours in advance of onset using convolutional recurrent neural nets (CNN) and patient Electronic Health Record (EHR) data.MethodsA CNN prediction system was developed to continuously and automatically monitor for incipient AKI. 7122 patient encounters were retrospectively analyzed from the Medical Information Mart for Intensive Care III (MIMIC-III) database.New Predictors and Established PredictorsNew predictor - CNN machine learning-based AKI prediction model. Established predictors - XGBoost AKI prediction model and the Sequential Organ Failure Assessment (SOFA) scoring system.OutcomesAKI onset.Analytical ApproachThe model was trained on routinely-collected patient EHR data. Measurements included Area Under the Receiver Operating Characteristic (AUROC) curve, positive predictive value (PPV), and a battery of additional performance metrics for 72 hour advance prediction of AKI onset.ResultsOn a hold-out test set, the algorithm attained an AUROC of 0.85 and PPV of 0.25, relative to a cohort AKI prevalence of 5.21%, for long-horizon AKI prediction at a 72-hour window prior to onset.ConclusionsA CNN machine learning-based AKI prediction model outperforms XGBoost and the SOFA scoring system, demonstrating superior performance in predicting acute kidney injury 72 hours prior to onset, without reliance on changes in serum creatinine.
Time-adjusted Analysis Shows Weak Associations Between BCG Vaccination Policy and COVID-19 Disease Progression
Authors: Bod’ová Katarína , Boža Vladimír , Brejová Broňa , Kollár Richard , Mikušová Katarína , Vinař Tomáš 
Published: May 2020

AbstractIn this study, we ascertain the associations between BCG vaccination policies and progression of COVID-19 through analysis of various time-adjusted indicators either directly extracted from the incidence and death reports, or estimated as parameters of disease progression models. We observe weak correlation between BCG vaccination status and indicators related to disease reproduction characteristics. We did not find any associations with case fatality rates (CFR), but the differences in CFR estimates are at present likely dominated by differences in testing and case reporting between countries.
Internet search patterns reveal clinical course of COVID-19 disease progression and pandemic spread across 32 countries
Authors: Lu Tina , Reis Ben Y. 
Published: May 2020

AbstractEffective public health response to novel pandemics relies on accurate and timely surveillance of pandemic spread, as well as characterization of the clinical course of the disease in affected individuals. We sought to determine whether Internet search patterns can be useful for tracking COVID-19 spread, and whether these data could also be useful in understanding the clinical progression of the disease in 32 countries across six continents. Temporal correlation analyses were conducted to characterize the relationships between a range of COVID-19 symptom-specific search terms and reported COVID-19 cases and deaths for each country during the period of January 1 through April 20, 2020. Increases in COVID-19 symptom-related searches preceded increases in reported COVID-19 cases and deaths by an average of 18.53 days (95% confidence interval 15.98 to 21.08) and 22.16 days (20.33 to 23.99), respectively. Cross-country ensemble averaging was used to derive average temporal profiles for each search term, which were combined to create a search-data-based view of the clinical course of disease progression. Internet search patterns revealed a clear temporal pattern of disease progression for COVID-19: Initial symptoms of fever, dry cough, sore throat and chills were followed by shortness of breath an average of 5.22 days (95% confidence interval 3.30 to 7.14) after initial symptom onset, matching the clinical course reported in the medical literature. This is the first study to show that Internet search data can be useful for characterizing the detailed clinical course of a disease. These data are available in real-time and at population scale, providing important benefits as a complementary resource for tracking the spread of pandemics, especially during the early stages before widespread laboratory testing is available.
Post-exposure Prophylaxis or Preemptive Therapy for SARS-Coronavirus-2: Study Protocol for a Pragmatic Randomized Controlled Trial
Authors: Lother Sylvain A , Abassi Mahsa , Agostinis Alyssa , Bangdiwala Ananta S , Cheng Matthew P , Drobot Glen , Engen Nicole , Hullsiek Kathy H , Kelly Lauren E , Lee Todd C , Lofgren Sarah M , MacKenzie Lauren J , Marten Nicole , McDonald Emily G , Okafor Elizabeth C , Pastick Katelyn A , Pullen Matthew F , Rajasingham Radha , Schwartz Ilan , Skipper Caleb P , Turgeon Alexis F , Zarychanski Ryan , Boulware David R 
Published: May 2020

AbstractBackgroundThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 causing the coronavirus disease 2019 (COVID-19) pandemic. Currently, there are a lack of evidence-based therapies to prevent COVID-19 following exposure, or to prevent worsening of symptoms following confirmed infection. We describe the design of a clinical trial of hydroxychloroquine for post-exposure prophylaxis and pre-emptive therapy for COVID-19.MethodsWe will conduct two nested multicenter international double-blind randomized placebo-controlled clinical trials of hydroxychloroquine for: 1) post-exposure prophylaxis (PEP) of asymptomatic household contacts or healthcare workers exposed to COVID-19 within the past four days, and 2) pre-emptive therapy (PET) for symptomatic outpatients with COVID-19 with a total symptom duration of less than 4 days. We will recruit 1500 patients for each the PEP and PET trials. Participants will be randomized 1:1 to receive 5 days of hydroxychloroquine or placebo. The primary PEP trial outcome will be the incidence of symptomatic COVID-19 disease. The primary PET trial outcome will be an ordinal scale of disease severity (not hospitalized; hospitalized without intensive care, hospitalization with intensive care, or death). Participant screening, informed consent, and follow up will be exclusively internet-based with appropriate regulatory and research ethics board approvals in Canada and the United States.DiscussionThese complementary randomized control trials are innovatively designed and adequately powered to rapidly answer urgent questions regarding the effectiveness of hydroxychloroquine to reduce transmission and disease severity of COVID-19 during a pandemic. In-person participant follow-up will not be conducted in order to facilitate social distancing strategies and reduce risks of exposure to study personnel. Innovative trial approaches are needed to urgently assess therapeutic options to mitigate the global impact of this pandemic.Trials Registrationclinicaltrials.gov (NCT04308668); 16 March 2020.
Psychophysical Olfactory Findings of Mild-to-moderate COVID-19 Patients: Preliminary Report
Authors: Lechien Jerome R. , Cabaraux Pierre , Chiesa-Estomba Carlos M. , Khalife Mohamad , Hans Stéphane , Martiny Delphine , Saussez Sven 
Published: May 2020

AbstractSince the onset of the COVID-19 infection, many patients reported sudden loss of smell (SLS). However, due to the lack of psychophysical testings, it remains difficult to know if these patients really have hyposmia or anosmia. Our group investigated the prevalence of anosmia and hyposmia in 28 COVID-19 patients and the potential association with nasal complaints.
Accounting for underreporting in mathematical modelling of transmission and control of COVID-19 in Iran
Authors: Saberi Meead , Hamedmoghadam Homayoun , Madani Kaveh , Dolk Helen M. , Morgan Andrei S. , Morris Joan K. , Khoshnood Kaveh , Khoshnood Babak 
Published: May 2020

SUMMARYBackgroundIran has been the hardest hit country by the outbreak of SARS-CoV-2 in the Middle East with 74,877 confirmed cases and 4,683 deaths as of 15 April 2020. With a relatively high case fatality ratio and limited testing capacity, the number of confirmed cases reported is suspected to suffer from significant under-reporting. Therefore, understanding the transmission dynamics of COVID-19 and assessing the effectiveness of the interventions that have taken place in Iran while accounting for the uncertain level of underreporting is of critical importance. We use a mathematical epidemic model utilizing official confirmed data and estimates of underreporting to understand how transmission in Iran has been changing between February and April 2020.MethodsWe developed a compartmental transmission model to estimate the effective reproduction number and its fluctuations since the beginning of the outbreak in Iran. We associate the variations in the effective reproduction number with a timeline of interventions and national events. The estimation method also accounts for the underreporting due to low case ascertainment by estimating the percentage of symptomatic cases using delay-adjusted case fatality ratio based on the distribution of the delay from hospitalization-to-death.FindingsOur estimates of the effective reproduction number ranged from 0.66 to 1.73 between February and April 2020, with a median of 1.16. We estimate a reduction in the effective reproduction number during this period, from 1.73 (95% CI 1.60 – 1.87) on 1 March 2020 to 0.69 (95% CI 0.68-0.70) on 15 April 2020, due to various non-pharmaceutical interventions including school closures, a ban on public gatherings including sports and religious events, and full or partial closure of non-essential businesses. Based on these estimates and given that a near complete containment is no longer feasible, it is likely that the outbreak may continue until the end of the 2020 if the current level of physical distancing and interventions continue and no effective vaccination or therapeutic are developed and made widely available.InterpretationThe series of non-pharmaceutical interventions and the public compliance that took place in Iran are found to be effective in slowing down the speed of the spread of COVID-19 within the studied time period. However, we argue that if the impact of underreporting is overlooked, the estimated transmission and control dynamics could mislead the public health decisions, policy makers, and general public especially in the earlier stages of the outbreak.FundingNil.
Treatment effect variation in brain stimulation across psychiatric disorders
Authors: Winkelbeiner Stephanie , Muscat Whitney , Joanlanne Andrea , Marousis Nikolaos , Vetter Stefan , Seifritz Erich , Dierks Thomas , Homan Philipp 
Published: May 2020

Noninvasive brain stimulation methods such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are promising add-on treatments for a number of psychiatric conditions. Yet, some of the initial excitement is wearing off. Randomized controlled trials (RCT) have found inconsistent results. This inconsistency is suspected to be the consequence of variation in treatment effects and solvable by identifying responders in RCTs and individualizing treatment. However, is there enough evidence from RCTs that patients do indeed respond differently to treatment? This question can be addressed by comparing the variability in the active stimulation group with the variability in the sham group across studies.We searched MEDLINE/PubMed and included all double-blinded, sham-controlled RCTs and crossover trials that used TMS or tDCS in adults with a unipolar or bipolar depression, bipolar disorder, schizophrenia spectrum disorder, or obsessive compulsive disorder. In accordance with the PRISMA guidelines to ensure data quality and validity, we extracted a measure of variability of the primary outcome.A total of 114 studies with 5005 patients were considered in the analysis. We calculated variance-weighted variability ratios for each comparison of active versus sham stimulation and entered them into a random-effects model. We hypothesized that treatment effect variation in TMS or tDCS would be reflected by increased variability after active compared with sham stimulation, or in other words, a variability ratio greater than one.Across diagnoses, we found a slight increase in variability after active stimulation compared with sham (variability ratio = 1.05; 95% CI, 1.01-1.11, P = 0.012). This effect was likely driven by studies in patients with schizophrenia who received rTMS compared with sham (variability ratio = 1.11; 95% CI, 1.03-1.2, P = 0.007).In conclusion, this study found evidence for treatment effect variation in brain stimulation, particularly for studies in schizophrenia. The extent of this variation, however, was modest, suggesting that the need for personalized or stratified medicine is still an open question.
Prevalence of Diversified Antibiotic Resistant Bacteria within Sanitation Related Facilities of Human Populated Workplaces in Abbottabad
Authors: Ali Jawad , Ullah Awan Malik Owais , Akca Gulcin , Zeb Iftikhar , Amin Bilal AZ , Ahmed Rafiq , Shah Muhammad Maroof , Nazir Rashid 
Published: May 2020

AbstractAntibiotics discovery was a significant breakthrough in the field of therapeutic medicines, but the over (mis)use of such antibiotics (n parallel) caused the increasing number of resistant bacterial species at an ever-higher rate. This study was thus devised to assess the multi-drug resistant bacteria present in sanitation-related facilities in human workplaces. In this regard, samples were collected from different gender, location, and source-based facilities, and subsequent antibiotic sensitivity testing was performed on isolated bacterial strains. Four classes of the most commonly used antibiotics i.e., β-lactam, Aminoglycosides, Macrolides, and Sulphonamides, were evaluated against the isolated bacteria.The antibiotic resistance profile of different (70) bacterial strains showed that the antibiotic resistance-based clusters also followed the grouping based on their isolation sources, mainly the gender. Twenty-three bacterial strains were further selected for their 16s rRNA gene based molecular identification and for phylogenetic analysis to evaluate the taxonomic evolution of antibiotic resistant bacteria. Moreover, the bacterial resistance to Sulphonamides and beta lactam was observed to be the most and to Aminoglycosides and macrolides as the least. Plasmid curing was also performed for MDR bacterial strains, which significantly abolished the resistance potential of bacterial strains for different antibiotics. These curing results suggested that the antibiotic resistance determinants in these purified bacterial strains are present on respective plasmids. Altogether, the data suggested that the human workplaces are the hotspot for the prevalence of MDR bacteria and thus may serve the source of horizontal gene transfer and further transmission to other environments.