bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceptions on preeclampsia and eclampsia among older women in rural southwestern Uganda
Authors: Nabulo Harriet , Ruzaaza Gad , Mugabi Francis , Bajunirwe Francis 
Published: August 2020

Abstract
Background: Eclampsia is among the leading causes of maternal mortality. It is a serious hypertensive (HT) complication of pregnancy and increases the risk of cardiovascular disease (CVD) in later life. Pregnancy-related HT complications predispose to chronic hypertension and premature heart attacks. A significant proportion of women with preeclampsia/eclampsia does not reach the formal healthcare system or arrive too late because of certain traditional or cultural beliefs about the condition. The older senior women in the community are knowledgeable and play a significant role in decision making regarding where mothers should seek maternal health care. Therefore, the purpose of this study was to explore the perceptions of older women regarding the manifestation of, risk factors and possible causes of preeclampsia/eclampsia. Methods: We conducted a qualitative study in a rural area in southwestern Uganda. The key informants were older women including community elders, village health team members and traditional birth attendants who were believed to hold local knowledge and influence on birth and delivery. We purposively selected key informants (KI) and data were collected till we reached saturation point. We analyzed data using a combined inductive and deductive approach to identify themes. Analysis was completed using N-Vivo version 12. Results: We interviewed 20 key informants. Four themes emerged namely: local name, causes and risk factors, remedies, and effects of preeclampsia/eclampsia. There was no identifiable local name from the interviews. Women carried several myths regarding the cause and these included little blood, witchcraft, stress from relations including marital tension and ghost attacks. The remedies identified included corrective nutrition, herbal treatment and prayers. Women were generally aware of the outcomes of eclampsia; mainly that it kills. Conclusion: Eclampsia is associated with significant myths and misconceptions in this rural community. We recommend interventions to increase awareness and dispel the myths and misconceptions regarding eclampsia, increase access to antenatal preeclampsia surveillance, and facilitate timely referral for basic maternity care as means for early detection and management of preeclampsia.
Parents' Multi-layered Expectations when Requesting an Autism Spectrum Disorder Assessment of their Young Child: an In-Depth Interview Study
Authors: Jacobs Delphine , Steyaert Jean , Dierickx Kris , Hens Kristien 
Published: August 2020

Abstract
BackgroundParents are valued stakeholders in research, clinical practice and policy development concerning autism spectrum disorder (ASD). However, little is known about what drives and moves parents besides their obvious worries and help request when they ask for a diagnostic ASD assessment of their child.MethodsSeventeen Flemish parents of 11 young children participated in a longitudinal study consisting of three in-depth interviews before and after their child’s diagnostic ASD assessment. Data were analysed in Nvivo 11 according to the procedures of Interpretative Phenomenological Analysis.ResultsIn this paper we report the results of the first series of interviews which were conducted after parents had asked for an ASD assessment of their young child, and before this assessment started. The pre-assessment experiences of the parents were dominated by the anticipation of various implications of an ASD diagnosis, comprising both positive and negative expectations. The theme of positive expectations consisted of two equally prominent subthemes: treatment-related implications but also expectations pertaining to their psychological and relational experiences.ConclusionsThis study suggests important issues for clinicians to bear in mind during a consultation with parents who request an ASD assessment of their young child. We argue that attending to and communicating about parents’ expectations prior to their child’s ASD assessment may help clinicians to better understand parents’ requests for help, and to address their needs more effectively.
Treatment of Severe COVID-19 with Human Umbilical&nbsp;Cord&nbsp;Mesenchymal Stem&nbsp;Cells
Authors: Shu Lei , Niu Changming , Li Ruyou , Huang Tingrong , Wang Yan , Huang Mao , Ji Ningfei , Zheng You , Chen Xiaolin , Shi Lei , Wu Mingjing , Deng Kaili , Wei Jing , Wang Xueli , Cao Yang , Yan Jiaxin , feng ganzhu 
Published: August 2020

Abstract
Background: COVID-19 is a highly infectious respiratory disease. No therapeutics have yet been proven effective for treating severe COVID-19. Objectives: To determine whether human umbilical cord mesenchymal stem cell infusion may be effective and safe for the treatment of severe COVID-19. Methods: Patients with severe COVID-19 were randomly divided into 2 groups: the standard treatment group and the standard treatment plus hUC-MSC infusion group. The incidence of progression from severe to critical illness, 28-day mortality, clinical symptom improvement, time to clinical symptom improvement, hematologic indicators including C-reactive protein, lymphocyte number, and interleukin 6, and imaging changes were observed and compared between the two groups. Measurements and Main Results: The incidence of progression from severe to critical illness and the 28-day mortality rate were 0 in the hUC-MSC treatment group, while 4 patients in the control group deteriorated to critical condition and received invasive ventilation; 3 of them died, and the 28-day mortality rate was 10.34% . In the hUC-MSC treatment group, the time to clinical improvement was shorter than that in the control group. Clinical symptoms of weakness and fatigue, shortness of breath, and low oxygen saturation obviously improved beginning on the third day of stem cell infusion and reached a significant difference on day 7. CRP and IL-6 levels were significantly lower from day 3 of infusion, the time for the lymphocyte count to return to the normal range was significantly faster, and lung inflammation absorption was significantly shorter on CT imaging in the hUC-MSC group than in the control group. Conclusions: Intravenous transplantation of hUC-MSCs is a safe and effective method that can be considered a salvage and priority treatment option for severe COVID-19.
Primary and secondary three-month outcomes of a cluster-randomized trial of home-based postpartum contraceptive delivery in Southwest Trifinio, Guatemala
Authors: Harrison Margo , Bunge-Montes Saskia , Rivera Claudia , Jimenez-Zambrano Andrea , Heinrichs Gretchen , Bolanos Antonio , Asturias Edwin , Berman Stephen , Sheeder Jeanelle 
Published: August 2020

Abstract
Design: This a cluster-randomized parallel arm pragmatic trial to observe the association of home-based postpartum contraceptive provision, including the contraceptive implant, with implant utilization rates at 3 months post-enrollment.Methods: In a region of rural Guatemala referred to as the Southwest Trifinio, twelve communities are served by a community-based antenatal and postnatal care program. The communities were combined into eight clusters based on 2017 birth rates and randomized to receive the home-based contraceptive delivery (condoms, pills, injection, implant) during the routine 40-day postpartum visit. All participants receive comprehensive contraceptive counseling beginning at the first antenatal visit, so control clusters received this as part of routine care; this education preceded the study intervention. Results: Once the 12 communities were combined into 8 clusters by expected birth volume and nurse team, which we expected to translate to eventual postpartum visits, the allocation sequence was generated in SAS. Of 208 women enrolled in the study, 108 were in four intervention and 100 in four control clusters. We used descriptive statistics to produce counts and percentages of characteristics of the study population overall and by intervention arm followed by univariate modeling using a mixed effects regression adjusted for cluster. Three-month contraceptive initiation rates were 56.0% in the control clusters compared to 76.8% in the intervention clusters, p < 0.001. Women in control clusters overwhelmingly opted for the injectable contraceptive (94.6%) while women in intervention clusters chose both the injection (61.5%) and the implant (33.7%), p < 0.001. Implant use by 3 months, the primary outcome of the study, was significantly higher in the intervention arm (25.9%) compared to the control arm (3.6%), p < 0.001, RR 1.3 CI [1.2, 1.4]. Conclusion: Our study was designed to respond to previously identified barriers to contraceptive uptake, and it was successful. Not only did it increase overall use of contraception by 3 months, but it shifted that contraceptive use away from short-acting methods in favor of longer-acting methods, with high continuation and satisfaction rates and no adverse outcomes reported.Registration: clinicaltrials.gov, NCT04005391; Retrospectively Registered 7/2/2019, https://clinicaltrials.gov/ct2/show/NCT04005391Protocol: https://doi.org/10.1186/s13063-019-3735-3
Feasibility and Efficacy of Lung Ultrasound to Investigate Pulmonary Complications in Patients Who Developed Postoperative Hypoxaemia-A Prospective Study
Authors: Xie Chen , Sun Kai , You Yueyang , Ming Yue , Yu Xiaoling , Yu Lina , Huang Jiapeng , Yan Min 
Published: August 2020

Abstract
Background: Postoperative pulmonary complications (PPCs) and hypoxaemia is associated with morbidity and mortality. We aim to evaluate the feasibility and efficacy of lung ultrasound (LUS) to diagnose PPCs in patients suffering from hypoxemia after general anesthesia and compare the results to those of thoracic computed tomography (CT). Methods: Adult patients who received general anesthesia and suffered from hypoxaemia in the postanaesthesia care unit (PACU) were analyzed. Hypoxaemia was defined as an oxygen saturation measured by pulse oximetry (SPO 2 ) less than 92% for more than 30 seconds under ambient air conditions. LUS was performed by two trained anaesthesiologists once hypoxaemia occurred. After LUS examination, each patient was transported to the radiology department for thoracic CT scan within 1 hour before returning to the ward. Results: From January 2019 to May 2019, 113 patients (61 men) undergoing abdominal surgery (45 patients, 39.8%), video-assisted thoracic surgery (31 patients, 27.4%), major orthopaedic surgery (17 patients, 15.0%), neurosurgery (10 patients, 8.8%) or other surgery (10 patients, 8.8%) were included. CT diagnosed 327 of 1356 lung zones as atelectasis, while LUS revealed atelectasis in 311 of the CT-confirmed zones. Pneumothorax was detected by CT scan in 75 quadrants, 72 of which were detected by LUS. Pleural effusion was diagnosed in 144 zones on CT scan, and LUS detected 131 of these zones. LUS was reliable in diagnosing atelectasis (sensitivity 98.0%, specificity 96.7% and diagnostic accuracy 97.2%), pneumothorax (sensitivity 90.0%, specificity 98.9% and diagnostic accuracy 96.7%) and pleural effusion (sensitivity 92.9%, specificity 96.0% and diagnostic accuracy 95.1%). Conclusions: Lung ultrasound is feasible, efficient and accurate in diagnosing different aetiologies of postoperative hypoxia in healthy-weight patients in the PACU.
Dynamic RMST Curves for Survival Analysis in Clinical Trials
Authors: Liao Jason , Liu G. Frank , Wu Wen-Chi 
Published: August 2020

Abstract
Background: The data from immuno-oncology (IO) therapy trials often show delayed effects, cure rate, crossing hazards, or some mixture of these phenomena. Thus, the proportional hazards (PH) assumption is often violated such that the commonly used log-rank test can be very underpowered. In these trials, the conventional hazard ratio for describing the treatment effect may not be a good estimand due to the lack of an easily understandable interpretation. To overcome this challenge, restricted mean survival time (RMST) has been strongly recommended for survival analysis in clinical literature due to its independence of the PH assumption as well as a more clinically meaningful interpretation. The RMST also aligns well with the estimand associated with the analysis from the recommendation in ICH E-9 (R1), and the test/estimation coherency. Currently, the Kaplan Meier (KM) curve is commonly applied to RMST related analyses. Due to some drawbacks of the KM approach such as the limitation in extrapolating to time points beyond the follow-up time, and the large variance at time points with small numbers of events, the RMST may be hindered. Methods: The dynamic RMST curve using a mixture model is proposed in this paper to fully enhance the RMST method for survival analysis in clinical trials. It is constructed that the RMST difference or ratio is computed over a range of values to the restriction time τ which traces out an evolving treatment effect profile over time.Results: This new dynamic RMST curve overcomes the drawbacks from the KM approach. The good performance of this proposal is illustrated through three real examples. Conclusions: The RMST provides a clinically meaningful and easily interpretable measure for survival clinical trials. The proposed dynamic RMST approach provides a useful tool for assessing treatment effect over different time frames for survival clinical trials. This dynamic RMST curve also allows ones for checking whether the follow-up time for a study is long enough to demonstrate a treatment difference. The prediction feature of the dynamic RMST analysis may be used for determining an appropriate time point for an interim analysis, and the data monitoring committee (DMC) can use this evaluation tool for study recommendation.
Two rare cases of acute myeloid leukemia with t(8;16)(p11.2;p13.3) and 1q duplication: case presentation and literature review
Authors: Liu Meng , Ren Yuan , Wang Xianfu , Lu Xianglan , Li Ming , Kim Young Mi , Li Shibo , Zhang Lijun 
Published: August 2020

Abstract
Background: Acute myeloid leukemia (AML) is a complex hematological disease characterized by genetic and clinical heterogeneity. The identification and understanding of chromosomal abnormalities are important for the diagnosis and management of AML patients. Compared with recurrent chromosomal translocations in AML, t(8;16)(p11.2;p13.3) can be found in any age group but is very rare and typically associated with poor prognosis.Methods: Conventional cytogenetic studies were performed among 1,824 AML patients recorded in our oncology database over the last 20 years. Fluorescence in situ hybridization (FISH) was carried out to detect the translocation fusion. Array comparative genome hybridization (aCGH) was carried out to further characterize the duplication of chromosomes.Results: We identified three AML patients with t(8;16)(p11.2;p13.3) by chromosome analysis. Two of the three patients, who harbored an additional 1q duplication, were detected by FISH and aCGH. aCGH characterized a 46.7 Mb and 49.9 Mb gain in chromosome 1 at band q32.1q44 separately in these two patients. One patient achieved complete remission (CR) but relapsed three months later. The other patient never experienced CR and died two years after diagnosis.Conclusion: A 1q duplication was detected in two of three AML patients with t(8;16)(p11.2;p13.3), suggesting that 1q duplication can be a recurrent event in AML patients with t(8;16). In concert with the findings of previous studies on similar patients, our work suggests that 1q duplication may also be an unfavorable prognostic factor of the disease.
Nutritional support for lactating women with or without Azithromycin for infants compared to breast-feeding counselling alone, to improve six-month growth outcomes among infants of peri-urban slums of Karachi, Pakistan – a protocol of multi-arm assessor blinded randomised controlled trial (Mumta LW trial)
Authors: Muhammad Ameer , Shafiq Yasir , Nisar M Imran , Baloch Benazir , Yazdani Amna Tanweer , Yazdani Nida , Jehan Fyezah 
Published: August 2020

Abstract
Introduction Globally, 45% of under-five deaths are, directly or indirectly, attributable to malnutrition, most of these deaths are in low- and middle-income countries (LMICs). Children in the first 6 months of life are particularly vulnerable. An estimated 4.7 million infants under the age of 6 months are moderately wasted whereas 3.8 million are severely wasted. Despite the increased risk to a child in a mother with nutritional decompensation, there are discrepancies in guidance in this area. Methods and analysis This is a community-based, open label factorial randomized controlled trial, using parallel assignment with 1:1:1 allocation ratio, in low income squatter settlements of urban Karachi, Pakistan. In the controls (Arm 1), women are randomized to standard counseling only; in first intervention group (Arm 2), lactating women receive two sachets of balanced energy-protein (BEP) supplementation per day from delivery until the infant reaches six months of age. In second intervention group (Arm 3), lactating women receive same BEP as in intervention arm 1 and their babies receive single dose (20mg/kg orally) of azithromycin at 42 days. The primary outcome is relative length velocity from 0 to 6 months by limb of allocation. Primary analysis will be Intention-to-treat analysis Trial registration This trial was registered at ClinicalTrials.gov with the number NCT03564652 on June 21, 2018. The trial registration data are available through https://clinicaltrials.gov/ct2/show/NCT03564652.
Genetic profile of African swine fever virus responsible for the 2019 outbreak in northern Malawi
Authors: Hakizimana J.N. , Kamwendo G. , Chulu J.L.C. , Kamana O. , Nauwynck H.J. , Misinzo G. 
Published: August 2020

Abstract
Background: African swine fever (ASF) is an infectious transboundary animal disease which causes high mortality, approaching 100% in domestic pigs and it is currently considered as the most serious constraint to domestic pig industry and food security globally. Despite regular ASF outbreaks within Malawi, few studies have genetically characterized the causative ASF virus (ASFV). This study aimed at genetic characterization of ASFV responsible for the 2019 outbreak in northern Malawi. The disease confirmation was done by polymerase chain reaction (PCR) followed by molecular characterization of the causative ASFV by partial genome sequencing and phylogenetic reconstruction of the B646L (p72) gene, nucleotide alignment of the intergenic region (IGR) between I73R and I329L genes and translation of the central variable region (CVR) coded by B602L gene.Results: All thirteen samples collected during this study in Karonga district in September 2019 were ASFV-positive and after partial genome sequencing and phylogenetic reconstruction of the B646L (p72) gene, the viruses clustered into ASFV p72 genotype II. The viruses characterized in this study lacked a GAATATATAG fragment between the I173R and the I329L genes and were classified as IGR I variants. Furthermore, the tetrameric amino acid repeats within the CVR of the B602L gene of the 2019 Malawian ASFV reported in this study had the signature BNDBNDBNAA, 100% similar to ASFV responsible for the 2013 and 2017 ASF outbreaks in Zambia and Tanzania, respectively.Conclusions: The results of this study confirm an ASF outbreak in Karonga district in northern Malawi in September 2019. The virus was closely related to other p72 genotype II ASFV that caused outbreaks in neighboring eastern and southern African countries, emphasizing the possible regional transboundary transmission of this ASFV genotype. These findings call for a concerted regional and international effort to control the spread of ASF in order to improve nutritional and food security.
Lower serum sodium level predicts poor clinical outcomes in patients with insomnia
Authors: Bae Eunjin , Lee Tae Won , Jang Ha Nee , Cho Hyun Seop , Jung Sehyun , Lee Seunghye , Chang Se-Ho , Park Dong Jun 
Published: August 2020

Abstract
Background

The association of lower serum sodium levels with clinical outcomes in insomnia patients remains unclear. We explored whether lower serum sodium is associated with poor clinical outcomes in patients with insomnia.

Methods

We retrospectively enrolled patients with a diagnosis of insomnia from January 2011 to December 2012. We divided participants into three groups according to initial serum sodium level: tertile 1 (< 138 mmol/L), tertile 2 (138.0–140.9 mmol/L), and tertile 3 (≥ 141.0 mmol/L). To calculate the relative risk of death, hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained using Cox proportional hazard models.

Result

A total of 412 patients with insomnia were included, of whom 13.6% (n = 56) had hyponatremia. Patients with lower serum sodium concentrations were older and had lower hemoglobin, calcium, phosphorus, and albumin levels. At the median follow-up of 49.4 months, 44 patients had died and 62 experienced acute kidney injury (AKI). Kaplan-Meier analysis showed significantly higher mortality in patients in the lowest tertile for serum sodium. Lowest tertile of serum sodium, and AKI were associated with all-cause mortality. However, lowest tertile of serum sodium was not significantly associated with AKI.

Conclusions

The lowest tertile of serum sodium was associated with a higher mortality rate in insomnia patients. Our results suggest serum sodium level could be used one of the prognostic factor in insomniacs and physicians should be careful to take care of them when they present lower sodium level.
Smartband use during enhanced recovery after surgery facilitates inpatient recuperation following minimally invasive colorectal surgery
Authors: Yin Tzu-Chieh , Huang Ching-Wen , Tsai Hsiang-Lin , Su Wei-Chih , Ma Cheng-Jen , Chang Tsung-Kun , Wang Jaw Yuan 
Published: August 2020

Abstract
Background Enhanced recovery after surgery (ERAS) is valuable in perioperative care for its ability to improve short-term surgical outcomes and facilitate patient recuperation after major surgery. Early postoperative mobilization is a vital component of the integrated care pathway and is a factor strongly associated with successful outcomes. However, early mobilization still has various definitions and lacks specific strategies. Methods Patients who underwent minimally invasive surgery for colorectal cancer followed our perioperative ERAS program, including mobilization from the first postoperative day. After perioperative care skills were improved in our well-established program, compliance, inpatient surgical outcomes, and complications associated with adding smartband use were evaluated and compared with the outcomes for standard protocol. Quality of recovery was evaluated using patient-rated QoR-40 questionnaires the day before surgery, on postoperative day 1 and 3, and on the day of discharge. Results Smartband use after minimally invasive colorectal surgery failed to increase compliance with early mobilization or reduce the occurrence of postoperative complications significantly compared with standard ERAS protocol. However, when smartbands were utilized, quality of recovery was optimized and patients returned to their preoperative status earlier, at postoperative day 3. The duration of theoretical hospital stays and hospital stays of uncomplicated patients wearing smartbands was also reduced by 1.1 and 0.9 days, respectively ( P = 0.0091 and 0.049). Conclusions Smartbands enable enhanced communication between patients and surgical teams and strengthen self-management in patients undergoing minimally invasive colorectal resection surgery. Accelerated recovery to preoperative functional status can be facilitated by integrating smartbands into the process of early mobilization during ERAS.