bluuebunny/crossref_metadata_2025_split huggingface dataset:
A trip of peptides to the brain
Authors: Matsui Toshiro , Yoshino Atsuko , Tanaka Mitsuru 
Published: December 2020

Abstract
Dietary di/tripeptides elicit preventive effects against lifestyle-related diseases such as hypertension, and hypercholesterolemia, etc. Although there have been evidential reports that the intake of protein hydrolysate improved impaired memory in human, limited studies on bioavailability, in particular, beyond the blood-brain barrier (BBB) of candidates in hydrolysate may prevent their extensive physiological studies. Thus, this review discusses the updated studies on BBB transport of peptides showing improved cognitive decline. Furthermore, their accumulation in the brain cerebral parenchyma is also introduced.

Graphical abstract
Development of nitazoxanide-loaded colon-targeted formulation for intestinal parasitic infections: centre composite design-based optimization and characterization
Authors: Bharti Charu , Nagaich Upendra , Pandey Jaya , Jain Suman , Jain Neha 
Published: December 2020

Abstract
Background
The current investigation is focused on the development and characterization of Eudragit S100 coated nitazoxanide-loaded microbeads as colon-targeted system utilizing central composite design (CCD) and desirability function. The study initiated with the selection of a BCS class II drug nitazoxanide and its preformulation screening with excipients, selection of polymer and identification of concentration for CCD, selection of optimized formulation based on desirability function, and in vitro release studies in simulated gastric and colonic media and stability studies. A two-factor, three-level CCD was employed with two independent variables, i.e. X1 (chitosan % w/v) and X2 (sodium tripolyphosphate % w/v), and three dependent variables, i.e. Y1 (particle size in micrometres), Y2 (percentage yield) and Y3 (percent entrapment efficiency), were chosen. Additionally, surface morphology, mucoadhesion and in vitro drug release studies were also conducted.

Result
Chitosan concentration showing maximum entrapment and optimum particle size was selected to formulate chitosan beads. The polynomial equation and model graphs obtained from the Design-Expert were utilized to examine the effect of independent variables on responses. The effect of formulation composition was found to be significant (p ˂ 0.05). Based on the desirability function, the optimized formulation was found to have 910.14 μm ± 1.03 particle size, 91.84% ± 0.64 percentage yield and 84.75% ± 0.38 entrapment efficiency with a desirability of 0.961. Furthermore, the formulations were characterized for in vitro drug release in simulated colonic media (2% rat caecal content) and have shown a sustained release of ∼ 92% up to 24 h as compared to in vitro release in simulated gastric fluid.

Conclusion
The possibility of formulation in enhancing percentage yield and entrapment efficiency of nitazoxanide and the utilization of CCD helps to effectively integrate nitazoxanide microbeads into a potential pharmaceutical dosage form for sustained release.
Emerging challenges in meeting physiotherapy needs during COVID-19 through telerehabilitation
Authors: Aderonmu Joseph Ayotunde 
Published: December 2020

Abstract
Background
Physiotherapy plays a significant role in rehabilitation. However, the emergence of the coronavirus disease 2019 (COVID-19) has posed a big challenge to its practice, especially regarding the level of contact with patients. There is a dire need for the exploration of rehabilitation options, other than in-person contacts, to limit the spread of the virus. This article explores telerehabilitation, its outcomes, and the challenges involved in the continuum of care of patients by physiotherapists in the face of the pandemic.

Body
Telerehabilitation is a vital tool which utilizes technology to link practitioners to patients. With its previous history of favorable outcomes for the rehabilitation of certain conditions, telerehabilitation has been widely recommended. However, issues exist on how well it can bridge the gap of physical touch in physiotherapy, its effectiveness in terms of outcomes and satisfaction across various conditions and large population sizes, and finally, its cost and effects, especially in developing countries.

Conclusion
Telerehabilitation is a necessary adaptation to ensure continued physiotherapy service delivery during the pandemic. However, more quality studies are recommended to evaluate its effectiveness and outcomes. Also, measures to ensure that developing countries are catered for in meeting the rising demands for physiotherapy services using telerehabilitation should be carried out.
Neuromuscular and Clinical Recovery in Thoracic Surgical Patients Reversed With Neostigmine or Sugammadex
Authors: Murphy Glenn S. , Avram Michael J. , Greenberg Steven B. , Bilimoria Sara , Benson Jessica , Maher Colleen E. , Teister Kevin J. , Szokol Joseph W. 
Published: December 2020

BACKGROUND:
Patients undergoing thoracoscopic procedures may be at high-risk for incomplete neuromuscular recovery and associated complications. The aim of this clinical investigation was to assess the incidence of postoperative residual neuromuscular blockade in adult thoracic surgical patients administered neostigmine or sugammadex when optimal dosing and reversal strategies for these agents were used. The effect of choice of reversal agent on hypoxemic events and signs and symptoms of muscle weakness were also determined. Additionally, operative conditions in each group were graded by surgeons performing the procedures.

METHODS:
Two hundred patients undergoing thoracoscopic surgical procedures were enrolled in this nonrandomized controlled trial. One hundred consecutive patients maintained at moderate levels of neuromuscular blockade were reversed with neostigmine (neostigmine group) followed by 100 consecutive patients given sugammadex to antagonize deeper levels of neuromuscular blockade (sugammadex group). Anesthetic and neuromuscular management were standardized. Surgeons rated operative conditions at the conclusion of the procedure on a 4-point scale (grade 1 = excellent to grade 4 = poor). Train-of-four ratios were measured immediately before extubation and at PACU admission (primary outcomes). Postoperatively, patients were assessed for adverse respiratory events and 11 signs and 16 symptoms of muscle weakness.

RESULTS:
The 2 groups were similar in intraoperative management characteristics. The percentage of patients with residual neuromuscular blockade, defined as a normalized train-of-four ratio <0.9, was significantly greater in the neostigmine group than the sugammadex group at both tracheal extubation (80% vs 6%, respectively, P < .0001) and PACU admission (61% vs 1%, respectively, P < .0001). Patients in the neostigmine group had less optimal operative conditions (median score 2 [good] versus 1 [excellent] in the sugammadex group; P < .0001), and more symptoms of muscle weakness were present in these subjects (median number [interquartile range] 4 [1–8] vs 1 [0–2] in the sugammadex group, P < .0001). No differences between groups in adverse airway events were observed.

CONCLUSIONS:
Despite the application of strategies documented to reduce the risk of residual neuromuscular blockade, a high percentage of thoracoscopic patients whose neuromuscular blockade was reversed with neostigmine were admitted to the PACU with clinical evidence of residual paralysis. In contrast, muscle weakness was rarely observed in patients whose neuromuscular blockade was antagonized with sugammadex.
Gamer's Health Guide: Optimizing Performance, Recognizing Hazards, and Promoting Wellness in Esports
Authors: Emara Ahmed K. , Ng Mitchell K. , Cruickshank Jason A. , Kampert Matthew W. , Piuzzi Nicolas S. , Schaffer Jonathan L. , King Dominic 
Published: December 2020

Abstract
Electronic sports (esports), or competitive video gaming, is a rapidly growing industry and phenomenon. While around 90% of American children play video games recreationally, the average professional esports athlete spends 5.5 to 10 h gaming daily. These times and efforts parallel those of traditional sports activities where individuals can participate at the casual to the professional level with the respective time commitments. Given the rapid growth in esports, greater emphasis has been placed on identification, management, and prevention of common health hazards that are associated with esports participation while also focusing on the importance of health promotion for this group of athletes. This review outlines a three-point framework for sports medicine providers, trainers, and coaches to provide a holistic approach for the care of the esports athlete. This esports framework includes awareness and management of common musculoskeletal and health hazards, opportunities for health promotion, and recommendations for performance optimization.
Kolb’s Learning Style Inventory 4.0 and its association with traditional and problem based learning teaching methodologies in medical students
Authors: Hydrie Muhammad Zafar Iqbal , Naqvi Syed Muhammad Zulfiqar Hyder , Alam Shams Nadeem , Jafry Syed Imtiaz Ahmed 
Published: December 2020

Objectives: To assess learning styles and the association of various teaching methodologies of medical students.
Methods: A cross-sectional study was carried out amongst 523 medical students of Baqai Medical College, Baqai Medical University, Karachi, from July 2019 to October 2019. All students from first to final year, who attended the undergraduate MBBS program were included. The study instrument was a questionnaire containing students’ demographic details, David Kolb’s Learning Style Inventory 4.0 and traditional and PBL teaching methodologies were asked. The association of various learning styles and preferred teaching methodologies with year of study was also assessed by using Pearson’s chi-square test.
Results: Out of 523 students, 518 returned the completed questionnaire. A majority of the students had either imagining or experiencing learning style. No change in learning style was observed between years of study. A significant association between the teaching methodologies and year of study was found in the imagining (p=0.033) and experiencing (p=0.044) learning style groups.
Conclusion: Students from different years of study at medical school did not have significantly different learning styles though the student’s preferences to teaching methodologies seem to change over time in the respective learning style groups. Longitudinal studies are necessary to identify the factors influencing such change and explore the association between learning styles over time on teaching methodologies in medical education.
doi: https://doi.org/10.12669/pjms.37.1.2275
How to cite this:Hydrie MZI, Naqvi SMZH, Alam SN, Jafry SIA. Kolb’s Learning Style Inventory 4.0 and its association with traditional and problem based learning teaching methodologies in medical students. Pak J Med Sci. 2021;37(1):146-150. doi: https://doi.org/10.12669/pjms.37.1.2275
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Medical Students’ perceptions and attitudes toward Medical Leadership and Management
Authors: Alzahrani Sami Hamdan , Baig Mukhtiar , Omer Anoud R. , Algethami Mohammed R. 
Published: December 2020

Objectives: To find out medical students’ perceptions and attitudes toward medical leadership and management (MLM).
Methods: A total of 336 medical students from the 2nd to 6th academic years from King Abdulaziz University (KAU), Jeddah, Kingdom of Saudi Arabia (KSA), were included in this cross-sectional study. This study was conducted in January-February 2020. The students were asked about their perceptions, attitudes, and interests in the leadership of medical care and clinicians. A four-part questionnaire was used for collecting data. SPSS-21 was used for analysis.
Results: The participants included 172 (51.2%) males and 164 (48.8%) females. In total, 105 (31.3%) participants agreed that they had been very well educated about their perception, behavior, and interest in the field of medical leadership and clinic management, and 175 (52.1%) students agreed that clinicians should influence management decisions in a healthcare setting. Overall, 167 (49.7%) students agreed that management/leadership skills are important for clinicians. In total, 145 students (43.2%) desired to have more leadership training in medical school, and 129 (38.4%) students agreed to seek additional leadership/management training in their postgraduate research studies. When asked about their self-perception of good leadership skills, the students indicated that good leadership skills included integrity (47.9%), conflict resolution (46.7%), organization (44.4%), confidence (41.9%), communication (40.5%), self-reflection (40.2%), time management (33.6%), the ability to motivate others (36.9%), and the ability to keep calm under stress (33.3%).
Conclusion: Many students were well aware of the MLM concepts. However, students agreed that management/leadership skills are important for clinicians, and there should be more leadership training in medical schools.
doi: https://doi.org/10.12669/pjms.37.1.2406
How to cite this:Alzahrani SH, Baig M, Omer AR, Algethami MR. Medical Students’ Perceptions and Attitudes Toward Medical Leadership and Management. Pak J Med Sci. 2021;37(1):223-228. doi: https://doi.org/10.12669/pjms.37.1.2406
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Comparison of robotic and open radical prostatectomy: Initial experience of a single surgeon
Authors: Şimşir Adnan , Kızılay Fuat , Aliyev Bayram , Kalemci Serdar 
Published: December 2020

Objective: In this study, we aimed to make a comprehensive comparison of the first hundred robot-assisted radical prostatectomy (RARP) and open retropubic radical prostatectomy (RRP) cases of a single surgeon in a high-volume center.
Methods: Preoperative, perioperative and postoperative data were collected retrospectively. Perioperative, oncological data and functional results in the first year were compared between the two groups. There were 204 RARPs between January 1, 2014 and December 31, 2019, and 755 RRPs between April 1, 2007 and December 31, 2019.
Results: While the operation time was in favor of the open group (117 vs 188 min, p<0.001), the estimated blood loss (328 vs 150 ml, p<0.001), blood transfusion rate (12 vs 2, p=0.021), and re-operation rate (6 vs 0, p=0.001) were in favor of the robotic group. Mean length of hospital stay (5.4 vs 3.1, p<0.001), urine leak rate (11 vs 2, p=0.033), complication rate (37 vs 16, p=0.018), and the 12th month continence rate (67 vs 85, p=0.002) were better in the robotic group.
Conclusions: RARP may provide better perioperative outcomes and lower complication rates after the surgeon factor is eliminated in the early period. Since our case group includes the initial 100 patients, studies with larger patient groups with longer follow-up are needed to adapt these early results to general outcomes.\
doi: https://doi.org/10.12669/pjms.37.1.2719
How to cite this:Simsir A, Kizilay F, Aliyev B, Kalemci S. Comparison of robotic and open radical prostatectomy: Initial experience of a single surgeon. Pak J Med Sci. 2021;37(1):167-174. doi: https://doi.org/10.12669/pjms.37.1.2719
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A study skills course for First-Year Medical Students: Experience of a Private Medical School in Pakistan
Authors: Ali Sobia , Tabassum Afifa , Hashmi Muhammad Suleman Sadiq , Huda Nighat 
Published: December 2020

Objectives: To share the experience of study skill module development and implementation for first year MBBS students at Liaquat National Hospital and Medical College (LNH&MC). To compare the change in students’ self- assessment of their knowledge of study skills before and after the course.
Methods: This quasi-experimental study was conducted from November 2019 to April 2020. A structured study skills course was offered to 100 first year MBBS students of Liaquat National Hospital & Medical College, Karachi. Steps involved in the development included identification of outcomes, instructional objectives, content and instructional strategies. Students were given two questionnaires. In the first questionnaire, students rated their interest in implementing the learning techniques learnt. In the second questionnaire, students rated their level of knowledge of effective study skills before and after the course. Analysis included computing percentages for students’ preferred study skill technique. Change in knowledge was assessed by comparing retrospective pre-post self-rating using Wilcoxon Signed Ranks Test (two-tailed).
Results: Analysis of survey forms showed that more than 50% of the students were willing to implement active listening techniques, metacognitive note taking and writing reflections in their future study practice.There was also a statistically significant change in students’ self-rating of their knowledge about study skills (pre-test median 3, post-test median 4, p0.00).
Conclusion: This study provides an insight of structured study skills course development and implementation in early medical college studies that could help them in combating academic stress. In addition, students’ response about their preferred technique and their feedback comparison concluded their positive attitude towards the course.
doi: https://doi.org/10.12669/pjms.37.1.2772
How to cite this:Ali S, Tabassum A, Hashmi MSS, Huda N. A study skills course for First-Year Medical Students: Experience of a Private Medical School in Pakistan. Pak J Med Sci. 2021;37(1):65-70. doi: https://doi.org/10.12669/pjms.37.1.2772
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
High frequency of simultaneous presence of ESBL and carbapenemase producers among nosocomial coliform isolates in Faisalabad, Pakistan
Authors: Irfan Sofia , Azhar Aysha , Awan Asad Bashir , Ahmad Salman , Haque Abdul 
Published: December 2020

Objectives: The objective of the current study was to find prevalence of relevant ESBL and carbapenemase producing genes in nosocomial E. coli and K. pneumoniae isolates and to check phenotypic susceptibility of all ESBL positive isolates to carbapenems.
Methods: Forty ESBL producing clinical isolates of Escherichia coli (n=33) and Klebsiella pneumoniae (n=7) were examined for the presence of β-lactamase genes (CTX-M, CTX-M-1, 2, 3, 4 and TEM). Carbapenem resistance was checked phenotypically and by presence of blaNDM-1 gene.
Results: Nine (27%) were positive for CTX-M genes, and 10 (30%) for TEM among E. coli isolates. Importantly, six isolates showed co-existence of CTX-M and TEM genes. In K. pneumoniae, two (28%) isolates were positive for CTX-M and one (14%) for TEM genes. Eight (24%) E. coli and one (14%) K. pneumoniae isolates were positive for CTX-M-1. Respective figures for CTX-M-4 were three (10%) and one (14%). CTX-M-2 and CTX-M-3 groups were not represented. Twenty (50%) isolates were resistant to both imipenem and meropenem out of which only four isolates expressed blaNDM-1 gene.
Conclusions: The significant presence of both ESBL and carbapenemase producers and co-existence of ESBL and carbapenemases in the same isolates is worrisome.
Abbreviations: ESBL: Extended spectrum β-lactamase. MBL: Metallo-betlactamase. PCR: Polymerase chain reaction.
doi: https://doi.org/10.12669/pjms.37.1.3192
How to cite this:Irfan S, Azhar A, Bashir A, Ahmed S, Haque A. High frequency of simultaneous presence of ESBL and carbapenemase producers among nosocomial coliform isolates in Faisalabad, Pakistan. Pak J Med Sci. 2021;37(1):34-39. doi: https://doi.org/10.12669/pjms.37.1.3192
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Presentation and outcome of femoral infected non-unions in children and adolescents
Authors: Bakhsh Karim , Zimri Faridullah Khan , Mohammad Eid , -Ur-Rehman Atiq , Saaiq Muhammad 
Published: December 2020

Objectives: To document the presentation of infected non-unions of femur in pediatric and adolescent population and evaluate the outcome of segmental bone transport with the Ilizarov method.
Methods: This prospective case series study was carried out over a period of five years, from January 01, 2015 to December 31, 2019. The study included all children and adolescent patients who presented with femoral infected non unions. The study excluded patients above the age of 16 years and those who had pathological fractures secondary to bone pathologies such as cysts, tumors or metabolic bone diseases.
Results: Out of 31 patients, 27(87.09%) were males and 4(12.90%) were females. The mean age was 13.48±1.98 years. The underlying mechanisms that lead to the causation of fractures included road traffic accidents (n=23;74.19%), fall from height (n=7;22.58%) and firearm injuries (n=1;3.22%). The bone gaps ranged from 3-5 cm with a mean of 4.00± 0.856 cm. Bone union was achieved among 28(90.32%) patients. Infection was eradicated among 27(87.09%) patients whereas the remaining patients continued to suffer persistent infection. The most common complications included pin tract inflammation/ infection among (n=31;100%) patients and stiffness of knee joint among (n=19;61.29%) patients.
Conclusion: Majority of the patients were males, aged 9-16 years. Road traffic accidents were the commonest cause of the fractures. The Ilizarov method of segmental bone transport was effective in treating the majority of infected non-unions.
doi: https://doi.org/10.12669/pjms.37.1.3354
How to cite this:Bakhsh K, Zimri FK, Mohammad E, Atiq-Ur-Rehman, Saaiq M. Presentation and outcome of femoral infected non-unions in children and adolescents. Pak J Med Sci. 2021;37(1):201-205. doi: https://doi.org/10.12669/pjms.37.1.3354
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.