bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chirality Status Of Registered Medicines In Tanzania: A Retrospective Cross-Sectional Study
Authors: Mwamwitwa Kissa Watson , Kaibere Raphael M. , Fimbo Adam M. , Sabitii Wilber , Ntinginya Nyanda E. , Mmbaga Blandina T. , Shewiyo Danstan H. , Shearer Morven C. , Smith Andrew D. , Kaale Eliangiringa A. 
Published: June 2020

Abstract
Background

Medicines with a stereogenic center (asymmetric carbon) mainly presents as racemates with a mixture of equal amounts of enantiomers. One enantiomer may be active while the other inactive, alternatively one may produce side-effects and even toxicity. Worldwide there is no mandatory regulatory requirement to enforce the development of new chiral medicines as exclusively pure active single enantiomers. This has contributed to the existence of both single enantiomers and racemates on the market. Moreover, literature shows the tendency of regulatory approval of medicines towards the development of pure single enantiomers 60%, only 5–10% racemates and 30–35% as achiral. This status has not been established particularly in African countries including Tanzania. Therefore, we aimed to establish the chirality status of registered medicines in Tanzania.
Methodology:

A retrospective cross-sectional study was conducted by reviewing all human medicines registered in Tanzania for the past 15 years from 2003 to 2018. Data were extracted from TMDA-IMIS database to Microsoft excel for analysis. Medicines were assessed to determine if they were chiral (racemates or single enantiomers) or achiral.
Results

A total of 3,573 human medicines had valid registration. Most of these medicines 2,150 (60%) are chiral and 1,423 (40%) are achiral. Out of the chiral medicines, 1,591 (74%) and 559 (26%) were racemates and single enantiomers, respectively. The percentage of chiral medicines for anti-infective (35%) was significantly higher (p < 0.0001) than other pharmacological groups. A high proportion of chiral medicines within pharmacological groups were observed in systemic hormonal preparations (excluding reproductive hormones and insulin) 97.3% (36/37) and anti-infectives 80% (753/941).
Conclusion

The study revealed the existence of both chiral and achiral registered human medicines with chiral medicines predominating. The proportion of racemates within chiral medicines was significantly higher than that of single enantiomer medicines. The use of these racemates may cause harm to the public and may also contribute to antimicrobial resistance due to the potential existence of inactive and toxic enantiomers. In order to protect public health, regulatory bodies need to strengthen the control of chiral medicines by including an analysis of enantiomeric impurity.
The Clinical Features of Asymmetry Weakness in Childhood Guillain-Barre syndrome: The Outcome and 5-year Follow-up
Authors: Sun Rui-Di , Jiang jun 
Published: June 2020

Abstract
Objectives To compare the clinical profile and long-term outcome of children with asymmetry weakness and symmetry weakness in Guillain-Barre syndrome(GBS). Methods We retrospective analysis the clinical parameters, auxiliary examinations and long-term outcome between asymmetry weakness and symmetry weakness in childhood GBS. Results A total of 72 children were included, 12 children had asymmetry weakness. Six children were transient asymmetry weakness and six children were persistent asymmetry weakness. Compared to symmetry weakness children, asymmetry weakness had more preschool children (75% vs 25%, P=0.005), longer days on hospital(26.5(15-37) days vs 11(9-15) days, p =0.000), more mechanical ventilation in children(50% vs 8.33%, p=0.000), higher Disease severity score(DSS)at nadir of disease(4(3-5) vs 3(1-4), p=0.010), more axonal subtypes(50% vs 15%, p=0.013) and more complications(58.33% vs 8.33%, p=0.000). Eight children had sequelae and sixty-four children had good recovery. Compared to good recovery group, sequelae group had more axonal subtypes(62.5% vs 15.63%, p=0.002) and more persistent asymmetry weakness(62.5% vs 4.69%, p=0.000). Conclusions In conclusion, asymmetry weakness had two types in GBS, namely transient and persistent asymmetry weakness. Asymmetry weakness in GBS indicated more complex condition during disease than symmetry weakness. Persistent asymmetry weakness and axonal subtypes in GBS related with sequelae. Anterior horn cells in the spinal cord involvement may be the possible function in persistent asymmetry weakness combined with axonal subtypes in GBS.
A Nomogram to Predict the Probability of Relapse during Hospitalization after Minor Ischemic Stroke in Chinese Patients.
Authors: xianfeng Yu , wenwen Yin , chaojuan Huang , xin Yuan , yu Xia , wei Zhang , xia Zhou , zhongwu Sun 
Published: June 2020

Abstract
Background: Predicting the risk of recurrence during hospitalization in patients with minor ischemic stroke (MIS) is of great significance for clinical and treatment. Compared with early models and prognostic scores, nomogram is a better visualization tool for predicting clinical outcomes. It combines different factors to develop a graphical continuous scoring system, and accurately calculates the risk probability of adverse outcomes based on individual characteristics. Our goal is to develop and validate a nomogram for individualized prediction of hospitalization recurrence in patients with mild ischemic stroke in the Chinese population.Methods: Based on retrospective collection, a single center study was conducted in the first affiliated Hospital of Anhui Medical University from January 2014 to December 2019. The subjects were stroke patients with NIHSS≤5.In order to generate the nomogram, age, systolic blood pressure,previous heart disease, serum total bilirubin, ferritin and smoking were integrated into the model. The predictive accuracy of the nomogram model to predict the probability of unfavorable outcome was assessed by calculation of the area under the receiver operating characteristic curve (AUC–ROC). Calibration of the risk prediction model was assessed by the plot comparing the observed probability of unfavorable outcome against the predicted, and by using the Hosmer–Lemeshow test.Results: Age at admission (OR,0.946; 95% CI,-0.002 to 0.048), SBP (OR,0.012,95%CI,0.000 to 0.024), previous heart disease (OR,0.867,95%CI, 0.084 to 1.651), UA (OR,-0.003,95%CI,-0.006 to 0.001), serum total bilirubin (OR,-0.022,95%CI,-0.036 to -0.008), ferritin (OR,0.004,95%CI, 0.002 to 0.005), smoking (OR,0.494,95%CI,-0.115 to 1.103) are significant predictors of in-hospital recurrence in Chinese patients with minor ischemic stroke.The model shows good discrimination, the AUC-ROC value is 0.737 (95%CI:0.676-0.798), and has perfect calibration performance. Calibration was good (p=0.1457 for the Hosmer-Lemesshow test), which could predict the risk of recurrence of MIS patients during hospitalization.Conclusion: The nomogram developed and validated in this study can provide individualized, intuitive and accurate prediction of recurrence in Chinese patients with minor ischemic stroke during hospitalization.
A Web Based Dynamic MANA Nomogram for Predicting the Malignant Cerebral Edema
Authors: Sun Wenzhe , Li Guo , Song Yang , Zhu Zhou , Yang Zhaoxia , Chen Yuxi , Miao Jinfeng , Song Xiaoyan , Lan Yan , Qiu Xiuli , Zhu suiqiang , Fan Yebin 
Published: June 2020

Abstract
Background: For large hemispheric infarction (LHI), malignant cerebral edema (MCE) is a life-threatening complication with mortality approaching 80%. Establishing a convenient prediction model of MCE after LHI is vital for rapid identification of high-risk patients and understanding of the potential mechanism of MCE.Methods: 142 consecutive patients with LHI within 24h of onset from January 1, 2016 to August 31, 2019 were retrospectively collected. MCE was defined as patient death or received DHC with obvious mass effect (≥ 5mm midline shift or Basal cistern effacement). Binary logistic regression was performed to evaluated the independent predictors of MCE. Independent prognostic factors were incorporated to build dynamic MANA nomogram to predict MCE.Results: After adjustment for confounders, four independent factors were identified, including previously known atrial fibrillation (KAF), midline shift (MLS), National Institutes of Health Stroke Scale (NIHSS) and anterior cerebral artery (ACA) territory involvement. Furthermore, to facilitate the use of the nomogram for clinicians, we use “Dynnom” package to build dynamic MANA (acronym for MLS, ACA territory involvement, NIHSS and KAF) nomogram on web page (http://www.MANA-nom.com) to calculate the exact probability of developing MCE. The c-statistic of MANA nomogram was up to 0.887 ± 0.041 and AUC-ROC value in this cohort was 0.887 (95%CI, 0.828~0.934).Conclusions: Independent predictors of MCE included KAF, MLS, NIHSS, and ACA territory involvement. The dynamic MANA nomogram is a convenient, practical and effective clinical decision-making tool for predicting MCE after LHI in Chinese patients.
Detection and Characterization of Carbapenem resistant Gram-negative bacilli isolates recovered from hospitalized patients at Soba University Hospital, Sudan
Authors: Elbadawi Hana S. , Elhag Kamal M. , Mahgoub Elsheikh , Altayb Hisham N , Ntoumi Francine , Elton Linzy , McHugh Timothy D , Osman Mohamed , Tembo John , Ippolito Giuseppe , Zumla Alimuddin , Hamid Muzamil Mahdi Abdel 
Published: June 2020

Abstract
Background:Antimicrobial resistance (AMR) poses a threat to global health security. Whilst over the past decade, there has been an increase in reports of nosocomial infections globally caused by carbapenem resistant Gram-negative bacilli (GNB), data from Africa have been scanty. We performed a study of carbapenem resistance genes among GNB isolated from patients treated in hospitals in Khartoum state, Sudan.Methods:A cross-sectional study was conducted at Soba University Hospital (SUH) and Institute of Endemic Diseases, University of Khartoum for the period October 2016 to February 2017. A total of 206 GNB isolates from different clinical specimens were analyzed for carbapenem resistance genes using phenotypic tests and affirmed by genes detection. Multiplex PCR was performed for each strain to detect the carbapenemase genes, including the blaNDM, blaVIM, blaIMP, blaKPC, and blaOXA-48. In addition to blaCTXM, blaTEM and blaSHV. DNA sequencing and bioinformatics analysis were used to detect genes subtypes.Findings:Of 206 isolates, 171 (83%) were confirmed resistant phenotypically and 121 (58.7%) isolates were positive for the presence of one or more carbapenemase gene. New Delhi metallo-β-lactamase (NDM) types were the most predominant genes, blaNDM 107(88.4%). Others included blaIMP 7 (5.7%), blaOXA-48 5(4.1%), blaVIM 2 (1.6%) and blaKPC 0 (0%). Co- resistance genes with NDM producing GNB were detected in 87 (81.3%) of all blaNDM positive isolates. A significant association between phenotypic and genotypic resistance was observed (P- value < 0.001). NDM-1 was the most sub type was observed in 75 isolates (70 %), other subtypes were NDM- 5 and NDM-6. Infections due to Carbapenem resistant GNB are increasing at SUH, with the blaNDM being the prevalent genes among clinical isolates and belong to the Indian lineage.Conclusions:The frequency of carbapenemase producing bacilli was found to be improperly high in Khartoum hospitals. NDM was found to be the most prevalent carbapenemase gene among clinical isolates. Close surveillance across all hospitals in Sudan is required. The relative distribution of Carbapenemase genes among GNB in nosocomial infections in Africa needs to be defined.
Use of maternal and child health services in a community with large refugee population in Nairobi, Kenya: a cross-sectional survey
Authors: Mohamed Abdinoor Haji , Musyoka Raymond Nyoka , Dalal Warren , Burke Heather , Ahmed Jamal , Eidex Rachel 
Published: June 2020

Abstract
Background

The population of urban refugees in the Eastleigh area of Nairobi, Kenya, is estimated at 100,000 to 150,000. Limited information on access to health care is available for this population. The health care a mother receives during pregnancy, at the time of delivery, and soon after delivery is important for the survival and well-being of both the mother and her child. The disadvantages in accessing health care and vulnerabilities of immigrant and refugee women are well documented in the literature. The purpose of our study was to assess the use of maternal and child health (MCH) services among the residents of Eastleigh and sources of services sought.
Methods

In July and August 2010, we surveyed households in Eastleigh. Households were chosen using a multistage cluster sampling design. A standard questionnaire on household demographics was administered to the household caretakers. If the household included a woman who delivered a baby or had a pregnancy that lasted at least 7 months within the past year, she responded to the MCH questionnaire separately.
Results

We gathered data from 673 households with 3,005 household members. There were 981 (32.6%) women of reproductive age (15–49 years), of whom 116 (11.8%) reported having a pregnancy or delivering in the past year. Of these 116 mothers, 104 (89.7%) made at least one antenatal care (ANC) visit, and 60 (63.2%) made at least four visits. Of 104 women who made at least one ANC visit, 23 (25.4%) first visited in the first trimester; 69 (64.2%) in the second trimester; and 13 (10.4%) in the third trimester. Compared with women who attended secondary school or higher, those with religious education only were twice as likely to get ANC in the early stages of pregnancy while those with no education were 3.33 times as likely. Fewer women (24%) sought delivery services at government health facilities than the 75% who delivered at private health facilities. Only three women delivered at home.
Conclusion

Use of MCH services was high among Eastleigh residents. Women actively sought care at numerous facilities, predominantly private ones. However, the quality of care in these private facilities requires further assessment.
What’s the “Secret Sauce”? How Implementation Variation Affects the Success of Colorectal Cancer Screening Outreach
Authors: Coury Jennifer , Miech Edward J. , Styer Patricia , Petrik Amanda F. , Coates Kelly E. , Green Beverly B. , Baldwin Laura-Mae , Shapiro Jean A. , Coronado Gloria 
Published: June 2020

Abstract
Background: Mailed fecal immunochemical testing (FIT) programs can improve colorectal cancer (CRC) screening rates, but health systems often vary implementation (i.e., adapt) these programs for their organizations. A health insurance plan implemented a mailed FIT program (named BeneFIT) and allowed participating health systems to adapt the program. This mixed-methods study explored which program adaptations might have achieved higher screening rates.Methods: We used a multi-method approach. First, we conducted a descriptive analysis of CRC screening rates by key health system characteristics and program adaptations. Second, we applied Configurational Comparative Methods (CCMs) to determine potential explanatory factors consistent with higher screening rates. The main outcome measure was CRC screening rates.Results: Seventeen health systems took part in at least one year of BeneFIT. The overall screening completion rate was 20% (4%–28%) in Year 1, and 25% (12%–35%) in Year 2 of the program. Health systems that used two or more adaptations had higher screening rates, and no single adaptation clearly led to higher screening rates. In Year 1, smaller systems (having <2 clinics) with phone reminders (n=2) met the implementation success threshold (≥19% screening rate) while larger systems were successful when offering a patient incentive (n=4), scrubbing mailing lists (n=4), or allowing mailed FIT returns with no other adaptations (n=1). In Year 2, large systems (>2 clinics) were successful with a phone reminder (n=4) or a patient incentive (n=3). Of the 10 systems that implemented BeneFIT in both years, seven improved in Year 2.Conclusions: Health systems can choose between many adaptations and successfully implement a health plan’s mailed FIT program. Screening completion rates are positively associated with the number of adaptations implemented by a health system. Health system size emerged as an important contextual factor, with different solutions for larger than smaller health systems.
Socioeconomic and lifestyle determinants of prevalence of hypertension among the elderly in rural southwest China: a structural equation modeling approach
Authors: Li Xiao , Cai Le , Wang Gui-Yi , Fan Lu-Ming , Cui Wen-Long , Liu Ying-Nan , Shen Jing-Rong , Golden Allison Rabkin 
Published: June 2020

Abstract
Background: This study examines the association between socioeconomic and lifestyle factors and the prevalence of hypertension among the elderly in rural southwest China.Methods: A cross-sectional survey of 4,833 consenting adults aged ≥60 years in rural regions of Yunnan Province, China was conducted in 2017. Data on individual socioeconomic status, sleep quality, physical activity level, and family history of hypertension were collected with a standardized questionnaire. Blood pressure, fasting blood glucose, height, weight, and waist circumference were also measured. An individual socioeconomic position (SEP) index was constructed using principal component analysis. Structure equation modeling (SEM) was applied to analyze the association between socioeconomic and lifestyle factors and the prevalence of hypertension. Results: The overall prevalence of hypertension was 50.6% in the study population. The following associated factors had statistically significant effect on hypertension: body composition, including measures of obesity and central obesity, had the greatest total effect on hypertension (0.21), followed by family history of hypertension (0.14), gender (0.08), sleep quality (-0.07), SEP (-0.06), physical inactivity (0.06), and diabetes (0.06). Body composition, SEP, and family history of hypertension had both direct and indirect effects on hypertension, whereas those of physical inactivity, diabetes, and sleep quality were directly associated with prevalence of hypertension. Gender was indirectly associated with prevalence of hypertension. Conclusion: Individual SEP, body composition, physical inactivity, diabetes, and sleep quality critically influence the prevalence of hypertension. Future interventions to prevent and control hypertension should give increased attention to individuals with low SEP and should focus on controlling diabetes and obesity, increasing physical activity levels, and improving quality of sleep among older adults aged ≥60 years in rural southwest China.
Statistical distribution fitting to the number of COVID-19 deaths in South Africa
Authors: Chikobvu Delson , Sigauke Caston 
Published: June 2020

Abstract
Background: COVID-19 first detected in Wuhan; China in December 2019, is a disease caused by the coronavirus SARS-CoV-2. It has presented the greatest public health challenges globally since the 1918 influenza which was called the “mother” of all pandemics. South Africa and the rest of Africa are yet to experience the devastating effects of COVID-19. Methods: In this paper, the reported COVID-19 number of deaths in South Africa, for the period 27 March 2020 to 20 May 2020, is modeled using four statistical distributions which can be grouped under the Generalised Gamma distribution. This exploratory study also uses simple additive models to capture the underlying COVID-19 death rate. Results: Empirical results show that the Gamma distribution gives the best fit to the data. The hazard rate is still increasing, and the peak number of deaths has not been reached yet despite the lockdown and other measures to try and slow down the progression of the disease. Conclusions: The exploratory data analysis done in this study is simple and meant to complement the detailed and complex modelling done which is useful in informing policy and decision making.
Diet Quality and Mental Health Amongst Acute Inpatient Psychiatric Patients
Authors: Gill Raveena , Tyndall Sean F , Vora Darshini , Hassan Rashedul , Megna James , Leontieva Luba 
Published: June 2020

Abstract
Background: Poor diet quality has been found to be prevalent in people with mental illness [71] and even contribute to mental illness [71]. The purpose of this exploratory study is to examine the relationship between diet quality, mental health problems, socioeconomic variables, physical activity level, and body mass index amongst acute psychiatric inpatients.Method: The study sample were 100 adult inpatients. Tools administered were Eating Habit Questionnaires (Dana Farber Institute) and the KIDMed index to assess food compliance in accordance with a Mediterranean diet. The Index marks all individuals as either having an “unhealthy score” or “healthy score”. The study utilized a descriptive correlation research design.Results: The results showed that 75% of the patients displayed an unhealthy score as per the KIDMed index. The findings displayed an inverse relationship of BMI and the KIDMed score. There was a significant positive correlation between the level of education and the KIDMed score. There is a positive correlation towards increased consumption of sugar in schizophrenic patients. There was no statistical significance between age, gender, income and physical activity with regards to the KIDMed score.Conclusion: psychiatric inpatients display unhealthy eating habits which is likely both an effect of and a contributing factor to the various mental illnesses. Prospective interventional randomized controlled studies are necessary for clarification of cause-effect relationships.
The study of non-focus area in the first chest CT of different clinical types of COVID-19 pneumonia: A study on automatic machine learning of Radiomics
Authors: Tan Huibin , Xiong Fei , Jiang Yuanliang , Huang Wencai , Wang Ye , Li Hanhan , You Tao , Fu Tingting , Lu Ran , Peng Biwen 
Published: June 2020

Abstract
Objective: To explore the possibility of predicting the clinical types of Corona-Virus-Disease-2019(COVID-19) pneumonia by analyzing the non-focus area of the lung in the first chest CT image of patients with COVID-19 by using automatic machine learning (Auto-ML).Methods: 136 moderate and 83 severe patients were selected from the patients with COVID-19 pneumonia. The clinical and laboratory data were collected for statistical analysis. The texture features of the Non-focus area of the first chest CT of patients with COVID-19 pneumonia were extracted, and then the classification model of the first chest CT of COVID-19 pneumonia was constructed by using these texture features based on the Auto-ML method of radiomics, The area under curve(AUC), true positive rate(TPR), true negative rate(TNR), positive predictive value(PPV) and negative predictive value(NPV) of the operating characteristic curve (ROC) were used to evaluate the accuracy of the first chest CT image classification model in patients with COVID-19 pneumonia.Result: The TPR, TNR, PPV, NPV and AUC of the training cohort and test cohort of the moderate group and the control group, the severe group and the control group, the moderate group and the severe group were all greater than 95% and 0.95 respectively. Conclusion: The non-focus area of the first CT image of COVID-19 pneumonia has obvious difference in different clinical types. The AUTO-ML classification model of Radiomics based on this difference can be used to predict the clinical types of COVID-19 pneumonia.