bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and Factors Associated With Liver Fibrosis Among Adult HIV-Infected Patients Attending Urban and Rural Care Clinics in Uganda
Authors: Wekesa Clara , Kirk Gregory D , Aizire Jim , Benson Eve-Marie , Karabarinde Alex , Parkes-Ratanshi Rosalind , Ocama Ponsiano 
Published: October 2020

Abstract

Background
Liver fibrosis is common among HIV-infected patients. Risk factors vary by location. Understanding this variation may inform prevention strategies. We compared the prevalence and correlates of liver fibrosis among HIV-infected patients attending care clinics in Uganda.

Methods
This was a cross-sectional study involving 2030 HIV-infected patients attending care clinics in urban and rural Uganda. Liver fibrosis was defined as liver stiffness measurement (LSM) &gt;7.1 KPa. Proportions and correlates of liver fibrosis were assessed and compared using logistic regression stratified by gender and site.

Results
Prevalence of liver fibrosis was higher among participants in the rural clinic (15% vs 11%; P = .017). History of tobacco use (urban P = .022; rural P = .035) and serologic evidence of hepatitis C infection (HCV; urban P = .028; rural P = .03) was associated with liver fibrosis in all men. Elevated liver transaminases (urban P = .002; rural P = .028) and increasing age (urban P = .008; rural P = .052) were risk factors among all women. Tobacco use among women was only a risk factor in those attending the rural clinic (P = .003), and detectable HIV viral load (P = .002) for men in the urban clinic.

Conclusions
Liver fibrosis is prevalent among HIV-infected persons in Uganda. HIV viral suppression and avoiding tobacco may be strategies to prevent liver fibrosis and cancer risk.
Cannabis Significantly Reduces the Use of Prescription Opioids and Improves Quality of Life in Authorized Patients: Results of a Large Prospective Study
Authors: Lucas Philippe , Boyd Susan , Milloy M.-J. , Walsh Zach 
Published: October 2020

AbstractObjectivesThis article presents findings from a large prospective examination of Canadian medical cannabis patients, with a focus on the impacts of cannabis on prescription opioid use and quality of life over a 6-month period.MethodsThe Tilray Observational Patient Study took place at 21 medical clinics throughout Canada. This analysis includes 1,145 patients who had at least one postbaseline visit, with follow-up at 1, 3, and 6 months. Instruments included a comprehensive cannabis use inventory, the World Health Organization Quality of Life Short Form (WHOQOL-BREF), and a detailed prescription drug questionnaire.ResultsParticipants were 57.6% female, with a median age of 52 years. Baseline opioid use was reported by 28% of participants, dropping to 11% at 6 months. Daily opioid use went from 152 mg morphine milligram equivalent (MME) at baseline to 32.2 mg MME at 6 months, a 78% reduction in mean opioid dosage. Similar reductions were also seen in the other four primary prescription drug classes identified by participants, and statistically significant improvements were reported in all four domains of the WHOQOL-BREF.ConclusionsThis study provides an individual-level perspective of cannabis substitution for opioids and other prescription drugs, as well as associated improvement in quality of life over 6 months. The high rate of cannabis use for chronic pain and the subsequent reductions in opioid use suggest that cannabis may play a harm reduction role in the opioid overdose crisis, potentially improving the quality of life of patients and overall public health.
The protective effect of daytime sleep on planning and risk-related decision-making in emerging adults
Authors: Mark Lawrence Wong , Esther Yuet Ying Lau , Yeuk Ching Lam , Benjamin Rusak , Chia-huei Tseng , Tatia Mei Chun Lee , Yun Kwok Wing 
Published: October 2020

AbstractWe assessed the effect of a daytime sleep opportunity on planning and risk-related decision-making in emerging adults using multiple neurobehavioral assessments. A total of 136 healthy emerging adults (20.0 ± 1.5 years), 65% female, performed the Risky-Gains Task and the Tower of London test twice. Between these assessments, they were randomized to either have a sleep opportunity monitored by polysomnography (Sleep group, n = 101) or to stay awake (Wake group, n = 35). During Test 2, in comparison to the Sleep group, the Wake group showed increased sleepiness, worse planning ability and more decrease in reaction times when selecting risky choices. Changes in Tower of London test steps used and Risky-Gains Task response time correlated with the number of central and frontal fast sleep spindles, respectively. These results indicate that among emerging adults who commonly have poor sleep patterns, a daytime sleep opportunity was related to better planning ability, better psychomotor vigilance and stable response speeds in risk-related decision-making. Changes in planning and risk-related decision-making correlated with the number of sleep spindles during the nap, supporting a specific role for sleep in modulating planning and potentially other higher-order cognitive functions.
Individual differences in light sensitivity affect sleep and circadian rhythms
Authors: Chellappa Sarah L 
Published: October 2020

AbstractArtificial lighting is omnipresent in contemporary society with disruptive consequences for human sleep and circadian rhythms because of overexposure to light, particularly in the evening/night hours. Recent evidence shows large individual variations in circadian photosensitivity, such as melatonin suppression, due to artificial light exposure. Despite the emerging body of research indicating that the effects of light on sleep and circadian rhythms vary dramatically across individuals, recommendations for appropriate light exposure in real-life settings rarely consider such individual effects. This review addresses recently identified links among individual traits, for example, age, sex, chronotype, genetic haplotypes, and the effects of evening/night light on sleep and circadian hallmarks, based on human laboratory and field studies. Target biological mechanisms for individual differences in light sensitivity include differences occurring within the retina and downstream, such as the central circadian clock. This review also highlights that there are wide gaps of uncertainty, despite the growing awareness that individual differences shape the effects of evening/night light on sleep and circadian physiology. These include (1) why do certain individual traits differentially affect the influence of light on sleep and circadian rhythms; (2) what is the translational value of individual differences in light sensitivity in populations typically exposed to light at night, such as night shift workers; and (3) what is the magnitude of individual differences in light sensitivity in population-based studies? Collectively, the current findings provide strong support for considering individual differences when defining optimal lighting specifications, thus allowing for personalized lighting solutions that promote quality of life and health.
Effects of coated and noncoated steroidal implants on growth performance, carcass characteristics, and serum estradiol-17β concentrations of finishing Holstein steers
Authors: Carvalho Pedro H V , Westphalen Mariana F , Campbell Jonathan A , Felix Tara L 
Published: October 2020

Abstract
The objectives of the study were to determine the effect of coated or noncoated hormone implants on growth performance, carcass characteristics, and serum estradiol-17β (E2) concentrations of Holstein steers fed a grain-based diet for 112 d. Seventy-nine Holstein steers [average initial body weight (BW) = 452 ± 5.5 kg] were stratified by BW and allotted to one of two treatments: 1) Holstein steers implanted with a coated implant containing 200 mg of trenbolone acetate (TBA) and 40 mg E2 (Revalor-XS (Merck Animal Health; Summit, NJ)] on day 0 (XS) or 2) Holstein steers implanted two times (days 0 and 56) with a noncoated implant containing 80 mg of TBA and 16 mg of E2 [(2IS) Revalor-IS (Merck Animal Health)]. Data were analyzed using the MIXED procedure of SAS (SAS Inst. Inc., Cary, NC). There was no effect (P ≥ 0.71) of implant strategy on initial, middle, and final BW. No effect (P ≥ 0.12) of implant strategy was observed on average daily gain, dry matter intake, or gain-to-feed ratio. There were no effects (P ≥ 0.11) of implant strategy on carcass characteristics. There was an implant × day interaction (P &lt; 0.01) for the circulation of serum E2 concentrations. Serum E2 concentration increased similarly 14 d after Holstein steers were implanted, regardless of implant strategy. At 28 d, after steers were implanted, steers in the XS group had less serum E2 concentration than Holstein steers in the 2IS group. However, at 56 d after the first implantation, both groups, once again, had similar serum E2 concentrations and E2 concentrations were less on day 56 than day 28 for both strategies. Holstein steers implanted with 2IS had greater serum E2 concentration on day 70 and E2 concentrations remained greater than serum E2 of Holstein steers implanted XS for the duration of the trial (day 112). In summary, there was no effect of coated or two doses of noncoated implant on growth performance or carcass characteristics of Holstein steers.
Recognition of oral potentially malignant disorders and transformation to oral cancer
Authors: Vail Marianne , Robinson Sean , Condon Heather 
Published: October 2020

ABSTRACT
Oral potentially malignant disorders refer to oral mucosal disorders with increased risk for malignant transformation, primarily to oral squamous cell carcinoma (SCC). Leukoplakia and erythroplakia are the most common of these disorders, but others have been identified. Transformation rates to oral cancer vary based on multiple factors. Healthcare providers should be aware of risk factors and clinical manifestations of these disorders and should intervene early to monitor and/or treat them to reduce the potential for malignant transformation.
Myocardial Dysfunction Is Independently Associated With Mortality in Pediatric Septic Shock
Authors: Lautz Andrew J. , Wong Hector R. , Ryan Thomas D. , Statile Christopher J. 
Published: October 2020

Objectives:
Circulatory dysfunction has been associated with mortality in children with septic shock. However, the mortality risk attributable to myocardial dysfunction per se has not been established, and the association between myocardial dysfunction and mortality is confounded by illness severity. The objective was to determine if sepsis-associated myocardial dysfunction defined by low left ventricular ejection fraction or global longitudinal strain is associated with mortality in pediatric septic shock after adjusting for baseline mortality probability.

Design:
Retrospective, observational study.

Setting:
Single-center, quaternary-care PICU.

Patients:
Children less than 18 years old admitted to the PICU from 2003 to 2018 who had an echocardiogram performed within 48 hours of septic shock identification and Pediatric Sepsis Biomarker Risk Model II data available.

Interventions:
None.

Measurements and Main Results:
All echocardiograms were reread by a cardiologist blinded to patient data for left ventricular ejection fraction and global longitudinal strain. Low left ventricular ejection fraction was defined as less than 45%, and low global longitudinal strain was defined as greater than z score of –2 for body surface area. Multivariable logistic regression separately analyzed the associations of low left ventricular ejection fraction and low global longitudinal strain with mortality, adjusting for Pediatric Sepsis Biomarker Risk Model II mortality risk. A post hoc logistic regression analyzed the association of left ventricular ejection fraction as a continuous variable with mortality, where linearity was maintained for left ventricular ejection fraction less than 65%. Eighteen percent of 181 children had low left ventricular ejection fraction. After adjusting for baseline mortality risk, low left ventricular ejection fraction remained independently associated with mortality (odds ratio, 4.4 [1.0–19.8]; p = 0.0497). Likewise, left ventricular ejection fraction was associated with mortality (odds ratio, 0.96 [0.93–0.99]; p = 0.037) on multivariable analysis for left ventricular ejection fraction less than 65%. Thirty-six percent of 169 children had low global longitudinal strain, and low global longitudinal strain was also independently associated with mortality (odds ratio, 4.6 [1.2–18.0]; p = 0.027).

Conclusions:
Sepsis-associated myocardial dysfunction, whether defined by low left ventricular ejection fraction or low global longitudinal strain, is an independent risk factor for mortality in pediatric septic shock after accounting for the confounding effects of septic shock severity.
Effect of Nonsedation on Cognitive Function in Survivors of Critical Illness
Authors: Nedergaard Helene Korvenius , Jensen Hanne Irene , Stylsvig Mette , Olsen Hanne Tanghus , Korkmaz Serkan , Strøm Thomas , Toft Palle 
Published: October 2020

Objectives:
Critical illness can cause severe cognitive impairments. The objective of this trial was to assess the effect of nonsedation versus sedation with a daily wake-up call during mechanical ventilation on cognitive function in adult survivors of critical illness.

Design:
Single-center substudy of the multicenter, randomized Non-sedation Versus Sedation With a Daily Wake-up Trial in Critically Ill Patients Receiving Mechanical Ventilation trial. Three months after ICU-discharge participants were tested for cognitive function by a neuropsychologist.

Setting:
Mixed 14-bed ICU in teaching hospital.

Patients:
A total of 205 critically ill, orally intubated, and mechanically ventilated adults.

Interventions:
Patients were randomized within the first 24 hours from intubation to either nonsedation with sufficient analgesia or light sedation with a daily wake-up call during mechanical ventilation.

Measurements and Main Results:
A total of 118 patients survived to follow-up and 89 participated (75%). The participating survivors in the two groups did not differ regarding baseline data or premorbid cognitive impairments. Sedated patients had received more sedatives, whereas doses of morphine and antipsychotics were equal. The primary outcome was that no significant difference was found in the number of patients with mild/moderate cognitive impairments (six nonsedated patients vs four sedated patients) or severe cognitive impairments (16 nonsedated patients vs 17 sedated patients; p = 0.71). Secondary outcomes were cognitive test scores, and no differences were found between the scores in nonsedated and sedated patients. Hypothetical worst case scenarios where all patients, who had not participated in follow-up assessment, were assumed to have severe cognitive impairments were analyzed, but still no difference between the groups was found. We found more patients with delirium in the sedated group (96% vs 69% of patients; p = 0.002) and increased duration of delirium in sedated patients (median 5 vs 1 d; p < 0.001). Delirium subtypes were equally distributed between the groups, with hypoactive delirium most frequent (61%), followed by mixed delirium (39%).

Conclusions:
Nonsedation did not affect cognitive function 3 months after ICU-discharge.
Effect of Nurse-Led Consultations on Post-Traumatic Stress and Sense of Coherence in Discharged ICU Patients With Clinically Relevant Post-Traumatic Stress Symptoms—A Randomized Controlled Trial
Authors: Valsø Åse , Rustøen Tone , Småstuen Milada Cvancarova , Ekeberg Øivind , Skogstad Laila , Schou-Bredal Inger , Myhren Hilde , Sunde Kjetil , Tøien Kirsti 
Published: October 2020

Objectives:To investigate the effect of nurse-led consultations on reducing post-traumatic stress symptoms and increasing sense of coherence in discharged ICU patients with clinically relevant post-traumatic stress symptoms and to identify variables associated with symptoms 12 months later.Design:A pragmatic nonblinded randomized controlled trial.Settings:Five surgical and medical ICUs at Oslo University Hospital.Patients:Adult patients treated in the ICU greater than or equal to 24 hours were screened with Post-Traumatic Stress Scale 10 intensive part B after ICU discharge. Those scoring greater than or equal to 25 were included in the study.Intervention:Patients randomized to intervention group were offered three nurse-led consultations within 2 months, and patients in the control group received standard care.Measurements and Main Results:Sense of Coherence Scale 13 and Post-Traumatic Stress Scale 10 intensive part B were completed after inclusion, and reevaluated after 3, 6, and 12 months. Linear mixed model for repeated measures and linear regression analyses were performed. Among 523 screened patients, 111 and 113 were randomized to intervention group and control group, respectively. Mean Post-Traumatic Stress Scale 10 intensive part B score was 37 (±10) before randomization. No differences in post-traumatic stress symptoms or sense of coherence were found between intervention group versus control group, with a mean Post-Traumatic Stress Scale 10 intensive part B score 39 (95% CI, 37–41) versus 37 (95% CI, 35–39), 32 (95% CI, 28–35) versus 32 (95% CI, 29–35), 31 (95% CI, 28–34) versus 30 (95% CI, 27–33), and 31 (95% CI, 28–34) versus 29 (95% CI, 26–33) at baseline, 3, 6, and 12 months, respectively. There was a significantly reduced Post-Traumatic Stress Scale 10 intensive part B score for both groups during the year (p= 0.001). Low sense of coherence, pain, and previous psychiatric problems were associated with increased level of post-traumatic stress symptoms at 12 months.Conclusions:Nurse-led consultations did not reveal any significant effect on post-traumatic stress symptoms or sense of coherence after ICU discharge in patients with clinically relevant symptoms.
The Effects of Melatonin Supplementation on Sleep Quality and Assessment of the Serum Melatonin in ICU Patients: A Randomized Controlled Trial
Authors: Gandolfi Joelma Villafanha , Di Bernardo Ana Paula Altimari , Chanes Débora Augusto Valverde , Martin Danilo Fernando , Joles Vanessa Bonafim , Amendola Cristina Prata , Sanches Luciana Coelho , Ciorlia Gustavo Larsen , Lobo Suzana Margareth 
Published: October 2020

Objectives:To evaluate whether the use of exogenous melatonin affects sleep, reduces the prevalence of delirium, and decreases the need for analgosedation and to assess whether serum melatonin indices correlate with exogenous administration in critically ill patients.Design:Double-blind, randomized, placebo-controlled study.Setting:Multicenter ICUs of two tertiary hospitals.Patients:A total of 203 adult patients who were admitted to the ICU and administered with analgesics and/or sedatives.Interventions:Oral melatonin (10 mg) or placebo for up to seven consecutive nights.Measurements and Main Results:The number of observed sleeping hours at night was assessed by the bedside nurse. Sleep quality was evaluated using the Richards Campbell Questionnaire Sleep (RCSQ). The prevalence of delirium, pain, anxiety, adverse reactions, duration of mechanical ventilation, length of ICU and hospital stays, and doses of sedative and analgesic drugs administered were recorded. The use of analgesics and sedatives was assessed daily. Melatonin levels were determined by enzyme-linked immunosorbent assay. Based on the RCSQ results, sleep quality was assessed to be better in the melatonin group than that in the placebo group with a mean (sd) of 69.7 (21.2) and 60.7 (26.3), respectively (p= 0.029). About 45.8% and 34.4% of participants in the melatonin and placebo groups had very good sleep (risk ratio, 1.33; 95% CI, 0.94–1.89), whereas 3.1% and 14.6% had very poor sleep (risk ratio, 0.21; 95% CI, 0.06–0.71), respectively. No significant difference was observed regarding the days free of analgesics or sedatives, the duration of night sleep, and the occurrence of delirium, pain, and anxiety. Melatonin serum peak levels at 2amwere 150 pg/mL (range, 125–2,125 pg/mL) in the melatonin group and 32.5 pg/mL (range, 18.5–35 pg/mL) in the placebo group (p< 0.001).Conclusions:Melatonin was associated with better sleep quality, which suggests its possible role in the routine care of critically ill patients in the future.
Prevalence of symptoms and associated factors across menopause status in Taiwanese women
Authors: Lee Pei-Shan , Lee Chyi-Long 
Published: October 2020

Abstract

Objective:
To investigate the prevalence of symptoms and associated factors in Taiwanese women calling a menopause hotline.

Methods:
A cross-sectional, descriptive, epidemiological study was performed on 20,882 women aged 40 to 89 years registered in the menopause consultation database of the nationwide toll-free consultation hotline for menopause-related issues from January 2006 to December 2016. The data included demography, sources of menopausal health care, and menopause/midlife symptoms scale.

Results:
The mean menopausal age was 49.6 ± 4 years. The prevalence of the symptoms increased with the progress of the menopausal stages, and the differences between stages were significant. The top five symptoms reported on a menopause hot line were memory loss (66.9%), fatigue (66.5%), insomnia (59.6%), depressed mood (58.5%), and back pain (58.2%). Of the women, 23.5% did visit a medical facility for menopausal problems mainly the department of gynecology. More than half of the women (56.4%) opted for medical personnel as the preferred channel for obtaining information concerning menopause. Women who had a higher education level, were single, had no children, were not experiencing the empty-nest phenomenon, were employed, had no chronic disease, were premenopausal, had never received hormone therapy, and had not visited medical facilities scored the lowest in menopause/midlife symptoms.

Conclusions:
Compared with premenopausal and perimenopausal women, postmenopausal women experience the most severe symptoms. Therefore, establishing a menopause consultation hotline answered by medical personnel and implementing support for postmenopausal women to obtain strategies to alleviate symptoms are required and necessary.

Video Summary:

http://links.lww.com/MENO/A651.
Recurrent gelatinous Salzmann-like nodular lesion with prior history of astigmatic keratotomy: October consultation #1
Authors: Moshirfar Majid , Shmunes Margaret H. 
Published: October 2020

A 67-year-old woman was referred to our facility with declining vision in the right eye that has been present since her cataract surgery in 2016. The patient has a history of an 8-cut radial keratotomy (RK) with 2-cut astigmatic keratotomy (AK) along the vertical meridian in both eyes since 1993. She underwent superficial keratectomy of the right eye 3 times in 3 consecutive years after her cataract extraction with toric intraocular lens (IOL) implantation. She is hoping to improve her vision in the right eye with a corrected distance visual acuity (CDVA) of 20/50 with a manifest refraction of +2.00 −5.50 × 65. Keratometry readings are 39.4 @ 87/43.3 @ 177. Slitlamp examination shows a persistent raised white gelatinous tissue overlying the inferior AK at the 6 o'clock position (Figures 1, 2, and 3

JOURNAL/jcrs/04.03/02158034-202010000-00021/figure1/v/2023-08-19T002554Z/r/image-tiff

JOURNAL/jcrs/04.03/02158034-202010000-00021/figure2/v/2023-08-19T002554Z/r/image-tiff

JOURNAL/jcrs/04.03/02158034-202010000-00021/figure3/v/2023-08-19T002554Z/r/image-tiff

). The patient had attempted several failed trials of scleral lens and rigid gas-permeable (RGP) lens-fitting after each corneal scraping with intolerance and lack of improvement in her vision. Her left eye is an asymptomatic pseudophakic eye with uncorrected distance visual acuity (UDVA) and CDVA of 20/25.
What would be your next step? Would you request additional diagnostic workup? What medical and surgical interventions would you recommend?