bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Relevance of Isolated Lupus Anticoagulant Positivity in Patients with Thrombotic Antiphospholipid Syndrome
Authors: Yin Dongmei , de Groot Philip G. , Ninivaggi Marisa , Devreese Katrien M. J. , de Laat Bas 
Published: January 2021

Abstract
Background Patients positive for all three types of antiphospholipid antibodies (aPLs; triple positivity) have been identified for having a high risk for thrombotic events. However, the clinical significance of isolated lupus anticoagulant (LAC) positivity is debated.
Objectives To investigate the clinical relevance of isolated LAC.
Methods A total of 456 patients were enrolled in this study; 66 antiphospholipid syndrome patients and 390 control patients. The control group consisted of autoimmune patients (n = 91), patients with thrombosis but without aPLs (n = 127), and normal controls (n = 172). LAC, anticardiolipin (anti-CL), and anti-β2 glycoprotein I (anti-β2GPI) immunoglobulin G (IgG) and immunoglobulin M (IgM) were determined according to the International Society on Thrombosis and Haemostasis (ISTH) guidelines. Anti-CL and anti-β2GPI were measured by four different solid-phase platforms to overcome variability between test systems. The noncriteria IgA anti-CL and anti-β2GPI, antidomain I of β2GPI IgG, and antiphosphatidylserine/prothrombin antibodies (anti-PS/PT) IgG and IgM were detected according to the ISTH guidelines for solid-phase assays.
Results In total, 70 patients were positive for LAC, of which 44 were negative for both anti-β2GPI and anti-CL antibodies. We found that isolated LAC proved to be strongly associated with vascular thrombosis (odds ratio [OR]: 7.3; 95% confidence interval [CI]: 3.3–16.1), even better than triple-positive samples (OR: 4.3; 95% CI: 1.6–12.2). The titers of the anti-PS/PT IgG and IgM were significantly higher in triple-positivity samples compared with samples with isolated LAC positivity. The majority of single LAC positives were anti-PS/PT-negative. We observed that LAC positivity was weaker in isolated LAC-positive patients compared with LAC activity in triple-positive patients.
Conclusion Isolated LAC was highly associated with thrombosis. The presence of anti-PS/PT antibodies could not explain LAC positivity in isolated LAC. Isolated LAC showed a weaker LAC activity compared with triple-positive patients.
Gain-of-Function Variant p.Pro2555Arg of von Willebrand Factor Increases Aggregate Size through Altering Stem Dynamics
Authors: Huck Volker , Chen Po-Chia , Xu Emma-Ruoqi , Tischer Alexander , Klemm Ulrike , Aponte-Santamaría Camilo , Mess Christian , Obser Tobias , Kutzki Fabian , König Gesa , Denis Cécile V. , Gräter Frauke , Wilmanns Matthias , Auton Matthew , Schneider Stefan W. , Schneppenheim Reinhard , Hennig Janosch , Brehm Maria A. 
Published: January 2021

AbstractThe multimeric plasma glycoprotein (GP) von Willebrand factor (VWF) is best known for recruiting platelets to sites of injury during primary hemostasis. Generally, mutations in the VWF gene lead to loss of hemostatic activity and thus the bleeding disorder von Willebrand disease. By employing cone and platelet aggregometry and microfluidic assays, we uncovered a platelet GPIIb/IIIa-dependent prothrombotic gain of function (GOF) for variant p.Pro2555Arg, located in the C4 domain, leading to an increase in platelet aggregate size. We performed complementary biophysical and structural investigations using circular dichroism spectra, small-angle X-ray scattering, nuclear magnetic resonance spectroscopy, molecular dynamics simulations on the single C4 domain, and dimeric wild-type and p.Pro2555Arg constructs. C4-p.Pro2555Arg retained the overall structural conformation with minor populations of alternative conformations exhibiting increased hinge flexibility and slow conformational exchange. The dimeric protein becomes disordered and more flexible. Our data suggest that the GOF does not affect the binding affinity of the C4 domain for GPIIb/IIIa. Instead, the increased VWF dimer flexibility enhances temporal accessibility of platelet-binding sites. Using an interdisciplinary approach, we revealed that p.Pro2555Arg is the first VWF variant, which increases platelet aggregate size and shows a shear-dependent function of the VWF stem region, which can become hyperactive through mutations. Prothrombotic GOF variants of VWF are a novel concept of a VWF-associated pathomechanism of thromboembolic events, which is of general interest to vascular health but not yet considered in diagnostics. Thus, awareness should be raised for the risk they pose. Furthermore, our data implicate the C4 domain as a novel antithrombotic drug target.
Medication Adherence and Its Determinants among Women of Cardiovascular Disease of Tertiary Care Hospital, Hyderabad
Authors: Arnipalli Haritha , Bala Sudha , Pandve Harshal 
Published: January 2021

Abstract

Background and Aim Adherence to long-term therapy for chronic illnesses in developed countries averages to 50%. In developing countries, the rates are even lower. Poor adherence to long-term therapies severely compromises the effectiveness of treatment making this a critical issue in population health both from the perspective of quality of life and of health economics. Cardiovascular diseases (CVDs) are the most common disorders affecting most of the productive age group. Therefore, an attempt has been made to determine medication adherence using the Morisky medication adherence scale-4 (MMAS-4) and its determinants in women patients with CVD.

Material and Methods A Hospital based cross-sectional study was conducted at outpatient block of General Medicine and Cardiology departments which included 175 women patients who were already diagnosed with CVD (with at least 3 months of medication) and those who were willing to give informed consent for participation. Semi structured questionnaire was used which consisted of sociodemographic variables, MMAS-4 to measure the level of adherence and various determinants such as socioeconomic, patient related, condition related, therapy related, and health system related.

Results Prevalence of medication adherence among women of CVDs using MMAS-4 was high, medium, and low among 39, 51, and 10%, respectively. Significant determinants found were socioeconomic, patient related, health system, and therapy related.

Conclusion Low-to-medium medication adherence was found to be high which needs to be addressed to reduce the morbidity and mortality associated with CVDs.
A Comparative In Vivo and In Vitro Study on the Effectiveness of Homoeopathic Medicines on Aquarium Zebrafish Infected with Vibrio parahaemolyticus
Authors: Aiswarya A.S. , Reshmy K.R. , Chandraja C.V. , Sisir P.R. 
Published: January 2021

Abstract
Background Human infections associated with Vibrio parahaemolyticus rank high among the pathogenic bacteria associated with fishes which causes septicaemia and gastroenteritis in humans. Humans acquire such infections by handling of infected fishes. Therefore, rather than curing the diseases in humans, it can be prevented in fishes by homoeopathic medicines.
Objectives The main objective of the study is to show the effectiveness of homoeopathic medicines in curing aquarium zebrafish infected with Vibrio parahaemolyticus.
Materials and Methods Fifteen pairs of healthy aquarium zebrafish were chosen for the study. They were inoculated with Vibrio parahaemolyticus after the acclimatisation period of 1 month. The signs were noted down in chronological order. homoeopathic medicines Sulphur 200, Arsenicum album 200 and Pyrogenium 200 was administered based on the totality obtained. An in vitro study was also done by the serial dilution of water from each tank and also by the serial dilution of the fish gut which was plated in thiosulphate-citrate-bile salts-sucrose (TCBS) agar media. A growth sensitivity study to show the growth inhibition was done on Muller Hinton agar media.
Results Although the incubation period of vibriosis was 4 days, the condition was completely cured within 10 days of administration of homoeopathic medicines. But in the case of tetracycline, the signs disappeared after 15 days. Sulphur being deep acting remedy showed cure in fishes as well as in the water. Arsenicum album showed therapeutic as well as prophylactic characters.
Conclusion From the study, it is proved that the Sulphur 200 was the most effective remedy. Homoeopathic medicines do not produce any resistant bacteria but improves the immunity of the living organism. Sulphur, the deep acting remedy ensures 100% cure, i.e., both the water and the fishes are cured of Vibrio parahaemolyticus.
Suboccipital Retrocondylar Approach for an Anterolateral Foramen Magnum Meningioma
Authors: Balașa Adrian , Gyorki Gabriel , Tamas Flaviu , Hurghis Corina , Chinezu Rares 
Published: January 2021

Abstract
Objectives This study was to demonstrate surgical technique for an anterolateral foramen magnum meningioma.
Design Present study is presented through an operative video.
Setting This study is conducted at the Department of Neurosurgery, Tîrgu Mureș, Romania.
Participants A 62-year-old female is the participant who was diagnosed with a foramen magnum meningioma.
Main Outcome Measures Complete surgical resection of the tumor with no postoperative deficits or complications.
Results A 62 years-old female was admitted for left hemilingual atrophia, dysphonia, right hemiparesis grade 2 of 5, right hemihypesthesia, and cervical pain. The magnetic resonance imaging (MRI) showed a right foramen magnum meningioma, sized approximately 2 cm in all planes (Fig. 1). This was classified with the Bernard system as an intradural foramen magnum meningioma with anterolateral insertion to the dura mater and below the vertebral artery. A suboccipital, retrocondylar, and c1 right hemilaminectomy approach was performed. Using microsurgical tumoral decompression techniques, ultrasonic aspiration, and following the natural cleavage planes, complete tumor removal was achieved (Fig. 2). The patient presented an uneventful postoperative course with no postoperative new neurological deficits and was discharged at home 7 days following surgery. Control MRI at 6 months (Fig. 1) and 2 years showed no tumor residue or recurrence. Neurologic status at 6 months was excellent, showing complete remission of symptoms.
Conclusion Retrocondylar suboccipital approach is a safe and feasible option for anterolateral foramen magnum meningiomas provided that natural corridors and dynamic retraction are used.The link to the video can be found at: https://youtu.be/jpxMcjCpN6E.
Ozonum—The Global Impact
Authors: Gajdos Petr Simeon 
Published: January 2021

AbstractThe remedy Ozonum has become the highest-ranking prescription in my practice during the coronavirus pandemic. Respiratory tract illnesses represent a smaller percentage of cases that have responded well to the remedy. Most cases I have seen were predominantly affected by the indirect impact of the pandemic. I have noticed a similar increase in Ozonum prescriptions following former global events, for example, the terrorist attack on the Twin Towers on 11th September 2001 in New York, the 2004 Indian Ocean earthquake and tsunami, the 2010 eruption of Iceland's Eyjafjallajökull volcano which paralysed flights across Europe and the severe 2017 to 2018 flu season. Ozone is a gas, called 'activated oxygen', formed by three atoms of oxygen instead of the two that we normally breathe. We are familiar with the protective function of the ozone layer in the atmosphere. The life cycle of ozone and its connection to ocean and marine life, to trees, habitat, and life in general, is less commonly known. A dynamic constellation of the homeopathic remedy becomes clear once we understand the ozone life cycle and its ecosystem in its natural and disrupted form. Ozonum—the homeopathic remedy—was used by our forefathers but has almost been forgotten until Anne Schadde's proving in nineties of the last century. Ozonum as a remedy has a wide range of applications such as pandemics, mass casualties and disasters, as well as routine clinical uses. Within different levels of context, the main feeling of Ozonum dynamic is exemplified by the statement—'I can't breathe!' It may be considered a 'polychrest' of our time evidently resonating with contemporary climatic, medical, socio-political and economic global challenges. We need to adopt a global view to keep up with the times and perceive a link between individual and global health in a broader perspective.
Study of 20 Cases of Otitis Media Successfully Treated with Homoeopathic Medicines—A Case Series
Authors: Sharma Pawan , Aggarwal Tanya , Kar Shubhadeep 
Published: January 2021

Abstract
Background Otitis is a general term for inflammation or infection of the ear. Otitis media is the presence of inflammation or infection in the middle ear. Homoeopathy is the most popular treatment among the complementary and alternative medicine therapies sought for otitis media. Several studies revealed promising role of homoeopathic treatment in otitis media. The present study comprises the role of homoeopathic medicines in the treatment of 20 cases of otitis media.
Materials and Methods It is a case series of 20 cases of otitis media which is unicentric retrospective observational study. Data was collected after consecutive appointments of patients visiting one outpatient clinic of Regional Research Institute for Homoeopathy, Guwahati, during the 12 months, January 2019 to January 2020. Individualised homoeopathic medicines were administered according to the rules of homoeopathy. In this study, outcome related to impact on daily living scale was used to assess the patient's well-being. The outcome score recorded at the last follow-up appointment per case was thus the single value analysed.
Result Among the patients (n = 20) included in the study, the number of patients belonging to female category was 10, (50%) while 10 patients (50%) were male, with a ratio of 1:1. Several medicines (n = 8) were prescribed and administered as follows: Belladonna (n = 1, 5%), Chamomilla (n = 1, 5%), Kali muriaticum (n = 2, 10%), Kali sulphuricum (n = 4, 20%), Mercurius dulcis (n = 2, 10%), Mercurius solubilis (n = 7, 35%), Pulsatilla (n = 2, 10%), Silicea (n = 1, 5%). No patient required antibiotics. Out of 20 cases, only four patients needed second prescription. Change of prescription was done in only one case among them. Higher potency was administered for the other three cases. 16 patients followed-up and 4 patients were dropped out after first prescription. Of these 16 follow-ups, there was a positive outcome in 12 (60%), negative in 2 (10%) and no change in 2 (10%) patients. In our study, outcome did not depend on the age but on medicine. Correctly chosen remedy with strict homoeopathic principle shows maximum improvement. When duration of illness was analysed, it was found that cases with complaints of short duration improve early, whereas cases with long duration of illness took much time to recover or remained status quo.
Conclusion The study reflected the importance of homoeopathic prescribing in the treatment of otitis following strict homoeopathic principles.
Entrapment of the Greater Occipital Nerve with Chronic Migraine and Severe Facial Pain: A Case Report
Authors: Son Byung-chul 
Published: January 2021

AbstractMigraine is thought to be a primary neurovascular headache due to brain dysfunction and is known to involve peripheral and central sensitization. A female patient with chronic migraine symptoms for 30 years reported severe pain in the deep ear and face. This headache always showed the same pattern and temporal progression. The sudden onset of ache and throbbing pain in the right temporo-occipital area extended to the left temporo-occipital areas. She felt sick as if the head would burst, and nausea and vomiting occurred. During the last 3 years, the patient endured sharp pain in bilateral deep ears and severe pain in the face as if all the facial bones were broken, and tears flowed. Chronic disabling headache and facial pain improved with the decompression of the greater occipital nerve. This case suggests that peripheral sensitization may be related to the pathophysiology of migraine, especially in the migraine without aura.
ACDF plus Uncovertebrectomy versus ACDF alone for the Treatment of Cervical Spondylotic Radiculopathy: Minimum 5-Year Follow-Up
Authors: Cui Yaqing , Zhou Yongchun , Liu Jun , Duan Dapeng , Gong Liqun , Li Weiwei 
Published: January 2021

Abstract
Objective The surgical approach for cervical spondylotic radiculopathy (CSR) is controversial. This study aims to investigate the effectiveness of the combined anterior cervical diskectomy and fusion (ACDF) and uncovertebrectomy for treatment of CSR.
Methods This is a retrospective case control study. One hundred and forty-six patients with CSR who underwent two different procedures (ACDF alone [group A]) and a combination of ACDF and uncovertebrectomy [group B]) from March 2008 to April 2013 were included. The operation time, blood loss, Visual Analog Scale scores of the neck (VAS-neck) and arm (VAS-arm), Neck Disability Index (NDI) score, 36-Item Short Form Health Survey (SF-36) score, fusion segment curvature, global cervical curvature, and the rate of surgical complication were evaluated.
Results There were no significant differences in the basic demographic and clinical characteristics between the two groups (p > 0.05). No significant differences were noticed in the fusion segment curvature and global cervical curvature between the two groups (p > 0.05). Whereas the operation time and blood loss in group B were greater than those in group A (p < 0.05), the VAS-neck, VAS-arm, NDI, and SF-36 scores were better in group B (p < 0.05). The surgical complication rate between the two groups was not significantly different (p > 0.05).
Conclusions Clinical efficacy of ACDF plus uncovertebrectomy for the treatment of patients with CSR may be better than that of ACDF alone, but at the expense of more operation time and blood loss.
Accuracy of Intraoperative Computed Tomography Assisted Dorsal Instrumentation in Spinal Revision Surgery
Authors: Bertram Ulf , Clusmann Hans , Geiger Matthias Florian , Riabikin Alexander , Mueller Christian-Andreas , Blume Christian 
Published: January 2021

Abstract
Purpose Instrumentation in spinal revision surgery is considered challenging. Altered or missing anatomical landmarks hinder the surgeons' intraoperative orientation. In recent history, the importance of navigated approaches to spinal screw placement is constantly increasing. A growing number of medical centers have introduced intraoperative CT (iCT) navigation as a new clinical standard. In this study, we compare the accuracy of dorsal iCT-navigated instrumentation in revision surgery versus primary interventions.
Methods Between September 2017 and January 2019, we prospectively analyzed a consecutive series of dorsal instrumentation using iCT. Patients with previous operative interventions in the relevant spinal segments were included in the revision group and compared with a previously assessed group of primary interventions (nonrevision group). Each screw was assessed individually by an independent observer, making use of a modified Gertzbein and Robbins classification.
Results In this period, 39 patients were treated in the revision group with a total amount of 269 implanted screws. We achieved an overall accuracy of 95.91% compared with 95.12% in the nonrevision group (46 patients, 287 screws). We found no significant difference in accuracy between the two groups or any anatomical region of the spine.
Conclusion In summary, iCT-navigated screw placement yields a good accuracy in spinal revision surgery, without significant difference to primary interventions.
Perception and Practices of Colonoscopy Procedure: A Nationwide Survey of Indian Gastroenterologists
Authors: Jha Jitendra Mohan , Babu Sethu 
Published: January 2021

Abstract
Introduction There is a lack of data and consensus about the practices and policies regarding performing colonoscopy in India. We surveyed gastroenterologists to assess their practices and policies of performing colonoscopy.
Methodology A questionnaire was presented to gastroenterologists all over India regarding their preference of bowel preparation and method of sedation, completeness of cecal and ileal intubation rates, preferences for inflation, use of carbon dioxide and nitrous oxide, and complications faced.
Results Of the 350 surveys, 307 had completely responded (88%). Only 18% of the centers were conducting more than 100 colonoscopies a month and 46% denied following a colon cancer screening policy. Two bottles of liquid polyethylene glycol were the most preferred preparation. A total of 21% did not prefer any sedation at all. Nitrous oxide was used by only 5.6% of doctors. Ileal intubation rate was >96% in 34% of centers and cecal intubation rate >96% in 58% of centers. Air was used for inflation by 58%, while 39% used CO2. A total of 40% of the respondents believe CO2 inflation would improve cecal intubation rate, while 9.4% believed otherwise. While one third found CO2 inflation unnecessary and 14% not cost-effective, three fourths were still interested in setting up a CO2 facility. Reasons for not using nitrous oxide were practical/administrative difficulty (46.6%), side effects (20%), and cost (16%). Still more than half surveyed would consider using Entonox in future. Perforation was the most noted complication faced by respondents.
Conclusions This survey of real-world clinical practices will help to formulate practice guideline regarding colonoscopy in India.
Pilot Implementation of Clinical Genomic Data into the Native Electronic Health Record: Challenges of Scalability
Authors: Walton Nephi A. , Johnson Darren K. , Person Thomas N. , Reynolds Jonathon C. , Williams Marc S. 
Published: January 2021

Background Recently, electronic health record (EHR) vendors have allowed for the storage of discrete genomic data within the EHR. With this new capability there remain many challenges related to adoption and implementation. Geisinger has genomic data available for approximately 145,000 patients. With the goal of integrating genetic data into the EHR for the entire sequenced population, we performed a pilot study on a subpopulation to assess the plausibility of large-scale deployment.
Objectives

Methods Discrete genomic variants were imported into the EHR. Maintenance guidelines and information resources were developed for each genetic condition and best practice alerts were built for pharmacogenomic variants. Weekly calls were held to address barriers to implementation. A list of challenges was maintained throughout the process. Solutions were proposed and categorized into short-term and long-term solutions.
Results Challenges were identified and solutions proposed for five discrete areas:
Conclusion Scaling the use of genomic data in the EHR requires the engagement of hospitals, open standards communities, laboratories, EHR vendors, and genomic information resources.
Endoscopic Management of Obstructive Jaundice in Pregnancy Due to Hepatic Hydatid Disease
Authors: Singh Aniruddha Pratap , Asif Shujaath , Lakhtakia Sundeep , Reddy D. Nageshwar 
Published: January 2021

AbstractLiver is one of the most common site of hydatid infection. Intra-biliary rupture of the hydatid cyst is a common and serious complication that can occur during course of pregnancy. Early diagnosis and treatment as mortality is high due to cholangitis. Surgical treatment is the definitive option, however but in the presence of cholangitis and pregnancy, ERCP with biliary drainage is the preferred management option.