bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of serial lactate measurement to predict 28-day mortality in patients undergoing emergency laparotomy for perforation peritonitis: prospective observational study
Authors: Jobin S. P. , Maitra Souvik , Baidya Dalim Kumar , Subramaniam Rajeshwari , Prasad Ganga , Seenu Vathulru 
Published: December 2019

Abstract
Background
Serial lactate measurement is found to predict mortality in septic shock. Majority of patients with perforation peritonitis for emergency laparotomy are in sepsis and mortality rate is substantial. However, lactate dynamics has not been studied in this patient population.

Methods
After institutional ethics clearance and informed written consent, 113 patients with suspected or proven perforation peritonitis presenting for emergency laparotomy were recruited in this prospective observational trial. Baseline Mannheim peritonitis index (MPI), SOFA and APACHE II score were calculated. Lactate values were obtained at baseline, immediate and 24-h postoperative period. Primary outcome was 28-day mortality.

Results
Mortality was 15.04% at 28 days. Age, SOFA, qSOFA, APACHE, preoperative lactate, MPI and site of perforation were significantly different between survivors and non-survivors. Arterial lactate values at preoperative (cut off 2.75 mmol/L), immediate postoperative (cut off 2.8 mmol/L) and 24 h-postoperative period (cut off 2.45 mmol/L) independently predicted mortality at day 28. Combination of MPI and 24-h lactate value was best predictor of mortality with AUC 0.99.

Conclusion
Preoperative, immediate postoperative and 24-h postoperative lactate value independently predict 28-day mortality in perforation peritonitis patients undergoing emergency laparotomy. Combination of MPI and 24-h lactate value is the most accurate predictor of mortality.

Trial registration
Clinical Trial Registry of India - CTRI/2018/01/011103
Emergency laparoscopic cholecystectomy for intraabdominal hemorrhage in a patient with a left ventricular assist device: a case report
Authors: Takagi Akihiko , Nagai Erina , Toda Takeo , Kosaka Hayato , Ishimatsu Hisato , Kyoden Yusuke , Akimoto Takehide , Kanemoto Hideyuki , Oba Noriyuki 
Published: December 2019

Abstract
Background
Continuous-flow left ventricular assist devices (LVADs), called “second generation LVADs,” have significantly improved the survival and quality of life outcomes. Accordingly, non-cardiac surgery in a patient with LVADs has required for conditions not directly related to their LVADs. And the management of bleeding in non-cardiac site remains one of long-term critical topics. Laparoscopic approach is useful in a patient with LVADs; however, there have been only few clinical reports. This report describes the first case of laparoscopic cholecystectomy (LC) for intraabdominal hemorrhage from the gallbladder serosa in a patient with LVADs.

Case presentation
A 56-year-old man with an LVAD had undergone LVAD (Jarvik 2000™; Jarvik Heart, Inc., New York, NY, USA) implantation at 53 years of age. He was in shock, and contrast-enhanced computed tomography revealed abdominal hemorrhage from the gallbladder serosa. Emergency laparoscopic cholecystectomy was performed. We could avoid injury of the LVADs driveline, which was located across the upper abdominal midline, near the right hypochondriac region, by laparoscopic approach. LVADs (Jarvik 2000) did not disturb the operating field because of its smaller size. There were no intra- and postoperative complications.

Conclusions
Laparoscopic approach is useful and safe in a patient with LVADs for abdominal surgery. We could perform LC for intraabdominal hemorrhage from gallbladder serosa safety.
The potential for an outbreak of glanders in Nepal
Authors: Adhikari Niran , Acharya Krishna Prasad , Wilson Richard Trevor 
Published: December 2019

AbstractConfirmation of glanders has not been possible in suspected cases submitted by field veterinarians, mainly due to the lack of diagnostic tools in Nepal. In view, however, of the re-emergence of glanders in India and the unrestricted migration of equines from there in to Nepal, an outbreak of Glanders in the short term is a distinct possibility. Such an event would affect the rural, marginalized community, and brick kiln industries. Therefore, due attention on the national epidemiological study and strengthened animal quarantine system with holding yards and laboratory backups are highly requested. Besides, the government’s timely action on disease prevalence, monitoring, and disease reporting is utmost important besides widespread public awareness to prevent the entry and control the disease.
Exploring health workforce regulation practices and gaps in Ethiopia: a national cross-sectional study
Authors: Dejene Daniel , Yigzaw Tegbar , Mengistu Samuel , Ayalew Firew , Kahsaye Manuel , Woldemariam Damtew 
Published: December 2019

Abstract
Background
Health workforce regulation plays key roles in ensuring the availability of competent health workers and improving performance of the health system. In 2010, Ethiopia established a national authority aiming to ensure competence and ethics of health professionals. Subsequently, subnational regulators were established and regulatory frameworks were developed. Although there were anecdotal reports of implementation gaps, there was lack of empirical evidence to corroborate the reports. We conducted a national study to explore health professional regulation practices and gaps focusing on registration, licensing, ethics, scope of practice, and continuing professional development.

Methods
We conducted a mixed methods cross-sectional survey using structured interview with a national representative sample of health professionals and key informant interviews with health regulators and managers. We used two stage stratified cluster sampling to select health professionals. The quantitative data were subjected to descriptive and multivariable logistic regression analysis. We conducted thematic analysis of the qualitative data.

Results
We interviewed 554 health professionals in the quantitative survey. And 31 key informants participated in the qualitative part. Nearly one third of the respondents (32.5%) were not registered. Many of them (72.8%) did not renew their licenses. About one fifth of them (19.7%) did nothing against ethical breaches encountered during their clinical practices. Significant of them ever practiced beyond their scope limits (22.0%); and didn’t engage in CPD in the past 1 year (40.8%). Majority of them (97.8%) never identified their own CPD needs. Health regulators and managers stressed that regulatory bodies had shortage of skilled staff, budget and infrastructure to enforce regulation. Regulatory frameworks were not fully implemented.

Conclusions
Health professionals were not regulated well due to limited capacity of regulators. This might have affected quality of patient care. To ensure effective implementation of health professional regulation, legislations should be translated into actions. Draft guidelines, directives and tools should be finalized and endorsed. Capacity of the regulators and health facilities needs to be built. Reinstituting health professionals’ council and regulation enforcement strategies require attention. Future studies are recommended for assessing effects and costs of weak regulation.
Detection of heroin metabolites at different developmental stages of Lucilia cuprina (Diptera: Calliphoridae) reared in heroin-treated meat: a preliminary analysis
Authors: Ishak Nooratiny , Ahmad Abu Hassan , Mohamad Noor Siti Azizah , Ahmad Azwandi 
Published: December 2019

AbstractBackgroundBlowfly larvae and pupae collected during post-mortem forensic investigation can be analysed to detect drugs or toxins in a dead body. Drug or toxin-contaminated tissues of human remains consumed by blowfly larvae are stored in the crop even after a body has decomposed to the point where no fluid or tissues are retrievable. Therefore, blowfly larva and pupa are favourable specimens under conditions in which host tissues or blood samples are not available.MethodologyWe carried out a study to detect heroin metabolites inLucilia cuprina(Weidemann, 1830) immatures fed on different concentrations of heroin-treated meat: 500, 1000, 2500, 5000, and 10,000 ng/μl. Heroin metabolites detection was performed by a gas chromatography mass spectrophotometry (GCMS) analysis.ResultsThis study indicates thatL. cuprinacan be utilized in a toxicological analysis to detect heroin in a host. However, the expected complete metabolites of heroin were not detected in the first instar larvae and pupa, while the second and third instar larvae contributed to a complete heroin metabolite which was morphine. This was subject to the heroin concentration given. Morphine was detected in the third instar larvae treated with 5000 and 10,000 ng/μl heroin, while in the second instar, it was detected only at 10,000 ng/μl. Heroin metabolites detected in the second and third instar larvae proves that biochemical conversions occur in the fly larvae.ConclusionThe absence of heroin metabolites in the first instar larvae and pupa does not necessarily mean that the drug was not present in the host. Therefore, the limitations of heroin detection capability during these stages should be always kept in mind, as this could contribute to a false-negative result in a forensic analysis. If all stages are available during sample collection, it is crucial to prioritize the third instar larvae in a toxicological analysis.
A variety of Helicobacter pylori strains colonize the stomach of non-bleeding Egyptian patients with upper gastrointestinal disorders
Authors: Tag Eldeen Loaa A. , Mohamed Mohamed A. , Awad Mohamed M. , Sheir Mohamed I. , Shams Tahany M. , Ragheb Mustafa M. 
Published: December 2019

Abstract
Background
Chronic infection with Helicobacter pylori is associated with protean manifestations, which vary from no symptoms to multiple gastric diseases. Other H. pylori infections could provide protection against reflux esophagitis, and lower esophageal cancer. The current study aims to scan H. pylori strains that colonize the stomach of Egyptian patients with upper gastrointestinal disorders and its association with the endoscopic outcomes. Identification of H. pylori strains was done by PCR amplification of the 16s rRNA gene from gastric biopsies, proved to be positive for H. pylori by both Giemsa stain and histopathology. PCR products were purified, sequenced, and aligned to GenBank.

Results
BLAST results of H. pylori 16s rRNA gene sequences showed identity between Egyptian H. pylori isolates and four H. pylori strain subpopulations: hspSAfrica, hspEAsia, hpEurope, hspWAfrica. The frequency of H. pylori isolates that showed identity to hspEAsia subpopulation was significantly higher in Ulcerative lesions. H. pylori isolates from ulcerative and neoplasm specimens illustrate base substitutions in 16s rRNA gene variable 9 region compared to the consensus sequence of H. pylori 43504 16s rRNA.

Conclusion
Different H. pylori strains may be associated with differences in the clinical manifestations and could be used as a prognostic marker to predict the outcome of the H. pylori-associated diseases.
Post-harvest assessment of fruit quality and shelf life of two elite tomato varieties cultivated in Bangladesh
Authors: Sinha Shata Rupa , Singha Ashutus , Faruquee Muhiuddin , Jiku Md. Abu Sayem , Rahaman Md. Arifur , Alam Md. Ashraful , Kader Mohammad Abdul 
Published: December 2019

AbstractBackgroundTomatoes are now one of the most popular nutrient-dense vegetables in terms of acreage, production, yield, commercial use, and consumption that add to the Bangladesh economy and ultimately reduce poverty. With this view, a lab investigation was carried out to analyze the effects of tomato (Sofol and Roma VF) verities on different post-harvest managements to extend shelf life as well as reduce post-harvest losses.ResultsThis study confirmed that the fruit quality attributes (color, firmness, weight loss, chilling injury, total soluble solids, pH, disease incidence, disease severity, and dry matter content) were increased whereas moisture content, vitamin C, and titratable acidity decreased with the increases in storage duration. The high quality attributes such as color, firmness, weight loss, chilling injury, total soluble solids, pH, disease incidence, disease severity, and dry matter content increased, whereas moisture content, vitamin C and titratable acidity decrease of tomato were observed in Roma VF while Sofol variety had high weight loss, moisture content, titratable acidity, and vitamin C. Moreover, the highest shelf life (17 days) was recorded in Sofol than Roma VF (15 days). On the 16th day of storage, maximum disease severity (41%) and disease incidence (71%) were observed at an earthen cooling pot, whereas a significant reduction in disease severity (1%) and disease incidence (8%) were recorded in tomatoes stored at 10oC temperature. Weight loss was the lowest (4%) in Sofol when kept at unperforated low-density polyethylene (LDPL) plastic bag as compared to Roma VF treatment (11%). Considering the physiological process, held at the low temperature (10°C and 15°C) and increased shelf life as well as reduced the diseases of tomatoes.ConclusionsThe investigator concluded that the findings of this study will be helpful with specific regard to long and medium-term storage, quality control, transportation, and advertising, and will also be beneficial to tomato growers of Bangladesh.
Relation between magnesium and calcium and parameters of pain, quality of life and depression in women with fibromyalgia
Authors: Andretta Aline , Dias Batista Emmanuelle , Madalozzo Schieferdecker Maria Eliana , Rasmussen Petterle Ricardo , Boguszewski César Luiz , dos Santos Paiva Eduardo 
Published: December 2019

Abstract
Objective
Determine food intake and levels of serum magnesium (Mg) and calcium (Ca) and correlate these minerals with pain, quality of life and depression risk in women with and without fibromyalgia (FM).

Patients and methods
Fifty-three women diagnosed with FM and 50 healthy women participated in the study, where all of them had equivalent age and body mass index (BMI). All women underwent anthropometric assessment, physical exams of pain perception threshold and tender point (TP) count, blood sample collection, and filling out of FM impact questionnaire (FIQ), Patient Health Questionnaire-9 (PHQ-9), and 3-day dietary record (DR).

Results
Dietary intake of Mg and Ca was substantially lower by women with FM. There were no differences in levels of serum Mg and Ca in the groups under analysis. For the FM group, dietary intake of Mg and Ca had inverse correlation with TP and direct relation with the pain threshold.

Conclusions
Although women with FM had lower dietary intake of Mg and Ca, serum levels for these nutrients were not different between the groups. Low dietary intake of minerals correlated with worsened pain threshold parameters.
Review of assisted reproduction techniques, laws, and regulations in Muslim countries
Authors: Kooli Chokri 
Published: December 2019

AbstractBackgroundFourteen Muslim countries were explored for available national laws, regulations, and guidelines concerning assisted reproduction techniques (ART). These documents were studied with total consideration of the ethical and religious principles followed by Islamic religion. This study found different types of legal documents issued by legislatives authorities, ethical committees, or professional bodies. Documents reviewed are directly related to assisted reproduction techniques medical use, access, or research in the field of ART.Main body of the abstractMost of the studied documents showed various degrees of deficiencies concerning legal or ethical protections and considerations. Certain documents that were examined need to be updated or amended in order to follow the continuous medical progress. The research also showed certain difficulty of legislating in countries characterized by multiculturalism and different ethical and religious traits and beliefs. Recently, Muslim legislators have made many efforts. However, the spread of legal documents among the Muslim countries is partial in volume and nature.Short conclusionThe comparison of the content with international documents shows us that most of assisted reproductions legal documents in use in the studied countries demonstrate numerous deficiencies in term of structure, nature, and the coverage of controversial subjects.
P450 Oxidoreductase Deficiency: A Systematic Review and Meta-analysis of Genotypes, Phenotypes, and Their Relationships
Authors: Dean Benjamin , Chrisp Georgina L , Quartararo Maria , Maguire Ann M , Hameed Shihab , King Bruce R , Munns Craig F , Torpy David J , Falhammar Henrik , Rushworth R Louise 
Published: December 2019

AbstractContextP450 oxidoreductase deficiency (PORD) is a rare genetic disorder that is associated with significant morbidity. However there has been limited analysis of reported PORD cases.ObjectiveTo determine, based on the cohort of reported PORD cases, genotype-phenotype relationships for skeletal malformations, maternal virilisation in pregnancy, adrenal insufficiency, and disorders of sexual development (DSD).Data SourcesPubMed and Web of Science from January 2004 to February 2018.Study SelectionPublished case reports/series of patients with PORD. Eligible patients were unique, had biallelic mutations, and their clinical features were reported.Data ExtractionPatient data were manually extracted from the text of case reports/series. A malformation score, representing the severity of skeletal malformations, was calculated for each patient.Data SynthesisOf the 211 patients published in the literature, 90 were eligible for inclusion. More than 60 unique mutations were identified in this cohort. Four groups of mutations were identified, through regression modeling, as having significantly different skeletal malformation scores. Maternal virilization in pregnancy, reported for 21% of patients, was most common for R457H mutations. Adrenal insufficiency occurred for the majority of patients (78%) and was typically mild, with homozygous R457H mutations being the least deficient. DSD affected most patients (72%), but were less common for males (46XY) with homozygous R457H mutations.ConclusionsPORD is a complex disorder with many possible mutations affecting a large number of enzymes. By analyzing the cohort of reported PORD cases, this study identified clear relationships between genotype and several important phenotypic features.
Determination of optimal virtual monochromatic energy level for target delineation of brain metastases in radiosurgery using dual-energy CT
Authors: Karino Tsukasa , Ohira Shingo , Kanayama Naoyuki , Wada Kentaro , Ikawa Toshiki , Nitta Yuya , Washio Hayate , Miyazaki Masayoshi , Teshima Teruki 
Published: December 2019

Objective:
Determination of the optimal energy level of virtual monochromatic image (VMI) for brain metastases in contrast-enhanced dual-energy CT (DECT) for radiosurgery and assessment of the subjective and objective image quality of VMI at the optimal energy level.

Methods:
20 patients (total of 42 metastases) underwent contrast-enhanced DECT. Spectral image analysis of VMIs at energy levels ranging from 40 to 140 keV in 1 keV increments was performed to determine the optimal VMI (VMIopt) as the one corresponding to the highest contrast-to-noise ratio (CNR) between brain parenchyma and the metastases. The objective and subjective values of VMIopt were compared to those of the VMI with 120 kVp equivalent, defined as reference VMI (VMIref, 77 keV). The objective measurement parameters included mean HU value and SD of tumor and brain parenchyma, absolute lesion contrast (LC), and CNR. The subjective measurements included five-point scale assessment of “overall image quality” and “tumor delineation” by three radiation oncologists.

Results:
The VMI at 63 keV was defined as VMIopt. The LC and CNR of VMIopt were significantly (p &lt; 0.01) higher than those of VMIref (LC: 37.4 HU vs 24.7 HU; CNR: 1.1 vs 0.8, respectively). Subjective analysis rated VMIopt significantly (p &lt; 0.01) superior to VMIref with respect to the overall image quality (3.2 vs 2.9, respectively) and tumor delineation (3.5 vs 2.9, respectively).

Conclusion:
The VMI at 63 keV derived from contrast-enhanced DECT yielded the highest CNR and improved the objective and subjective image quality for radiosurgery, compared to VMIref.

Advances in knowledge:
This paper investigated for the first time the optimal energy level of VMI in DECT for brain metastases. The findings will lead to improvement in tumor visibility with optimal VMI and consequently supplement accuracy delineation of brain metastases.
Post-operative radiation therapy with or without chemotherapy for anal squamous cell carcinoma incidentally discovered after local excision: a propensity score matched analysis of retrospective multicenter study
Authors: Kim Kyung Su , Chang Ah Ram , Kim Kyubo , Koh Hyeon Kang , Jang Won Il , Park Hae Jin , Chang Ji Hyun , Kim Mi-Sook 
Published: December 2019

Objective:
To evaluate the results of post-operative radiation therapy (RT) for anal squamous cell carcinoma (ASCC) incidentally detected after excision, and compare these outcomes with those of definitive RT without excision for exploring the possibility of treatment de-intensification

Methods and materials:
A total of 25 patients with T1–2N0-1 ASCC who underwent RT following incidental tumor resection were selected from multicenter retrospective database. And, we selected one-to-one matched 25 patients receiving definitive RT from the same database using propensity score matching method, and the outcomes were compared.

Results:
Median age was 60 years (range, 30–76), and 18 patients (72%) were female. 19 patients (76%) had T0/1 tumors and four patients (16%) had regional lymph node metastases. Hemorrhoidectomy was performed in eight patients (32%) and the others underwent local excision. 12 patients (48%) had microscopic or gross residual diseases. Median RT dose to the primary lesion was 50.4 Gy (range, 40–60). Concurrent chemotherapy was delivered to 23 patients (92%). Median follow-up period was 71 months (range, 4.5–203.1 months). None of the patients showed recurrence during follow-up. However, one patient died after 6 months due to the chemotherapy-related hematologic toxicity. When compared with those patients receiving definitive RT, clinicopathological variables were well-balanced between the two groups. While matched paired patients treated with definitive RT received a higher median RT dose of 54 Gy (range, 45–61.2) and concurrent chemotherapy was given to 22 patients (88%), overall survival was not significantly different (p = 0.262).

Conclusion:
Patients treated with RT for early stage ASCC after local excision showed favorable treatment outcomes. Further study is warranted to justify the de-intensification of the treatment for these patients.

Advances in knowledge:
Post-operative RT can achieve favorable treatment outcomes in incidental ASCC with residual diseases after local excision.