bluuebunny/crossref_metadata_2025_split huggingface dataset:
Duration of obesity exposure between ages 10 and 40 years and its relationship with cardiometabolic disease risk factors: A cohort study
Authors: Norris Tom , Cole Tim J. , Bann David , Hamer Mark , Hardy Rebecca , Li Leah , Ong Ken K. , Ploubidis George B. , Viner Russell , Johnson William 
Published: December 2020

Background
Individuals with obesity do not represent a homogeneous group in terms of cardiometabolic risk. Using 3 nationally representative British birth cohorts, we investigated whether the duration of obesity was related to heterogeneity in cardiometabolic risk.

Methods and findings
We used harmonised body mass index (BMI) and cardiometabolic disease risk factor data from 20,746 participants (49.1% male and 97.2% white British) enrolled in 3 British birth cohort studies: the 1946 National Survey of Health and Development (NSHD), the 1958 National Child Development Study (NCDS), and the 1970 British Cohort Study (BCS70). Within each cohort, individual life course BMI trajectories were created between 10 and 40 years of age, and from these, age of obesity onset, duration spent obese (range 0 to 30 years), and cumulative obesity severity were derived. Obesity duration was examined in relation to a number of cardiometabolic disease risk factors collected in mid-adulthood: systolic (SBP) and diastolic blood pressure (DBP), high-density-lipoprotein cholesterol (HDL-C), and glycated haemoglobin (HbA1c).
A greater obesity duration was associated with worse values for all cardiometabolic disease risk factors. The strongest association with obesity duration was for HbA1c: HbA1c levels in those with obesity for <5 years were relatively higher by 5% (95% CI: 4, 6), compared with never obese, increasing to 20% (95% CI: 17, 23) higher in those with obesity for 20 to 30 years. When adjustment was made for obesity severity, the association with obesity duration was largely attenuated for SBP, DBP, and HDL-C. For HbA1c, however, the association with obesity duration persisted, independent of obesity severity. Due to pooling of 3 cohorts and thus the availability of only a limited number harmonised variables across cohorts, our models included adjustment for only a small number of potential confounding variables, meaning there is a possibility of residual confounding.

Conclusions
Given that the obesity epidemic is characterised by a much earlier onset of obesity and consequently a greater lifetime exposure, our findings suggest that health policy recommendations aimed at preventing early obesity onset, and therefore reducing lifetime exposure, may help reduce the risk of diabetes, independently of obesity severity. However, to test the robustness of our observed associations, triangulation of evidence from different epidemiological approaches (e.g., mendelian randomization and negative control studies) should be obtained.
Perceived stigma among patient with pulmonary tuberculosis at public health facilities in southwest Ethiopia: A cross-sectional study
Authors: Mohammedhussein Mustefa , Hajure Mohammedamin , Shifa Jemal Ebrahim , Hassen Tahir Ahmed 
Published: December 2020

Objectives
Although tuberculosis (TB) related stigma has a significant impact on the diagnosis, patient adherence with treatment, and recovery from the disease, there is limited evidence from Ethiopia regarding perceived stigma among patient with pulmonary tuberculosis (PTB).The purpose of this study was to assess perceived stigma and associated factors among patient with PTB on treatment in southwest Ethiopia.

Methods
Institution-based cross-sectional study was conducted from April to May 2019 among 410 patient with PTB. Data were collected by using the perceived tuberculosis stigma scale. Epi data v3.1 and SPSSv23 were used for data entry and analysis. Multivariable logistic regression models were fitted to identify factors associated with perceived stigma. Results are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

Result
Prevalence of perceived stigma among patient with Pulmonary tuberculosis was 57.1% (95% CI: 52.2, 61.7). Poor social support (AOR = 2.41; 95% CI: 1.06, 5.48), above a month duration of illness (AOR = 2.48; 95% CI: 1.33, 4.64), high perceived stress (AOR = 1.95; 95% CI:1.09, 3.49), current khat use (AOR = 1.88; 95% CI:1.05, 3.37), and presence of depression (AOR = 8.18; 95% CI:4.40, 15.22) were significantly associated with perceived stigma. Patient with HIV co-infection were 5.67 times (AOR = 5.67; 95% CI: 2.32, 13.87) more likely to have Perceived stigma than their counterparts.

Conclusion
TB related stigma was reported by more than half of the study participant. Stigma reduction measures are needed to lower TB related stigma perceived by the patient, the level of distress associated with it, and to promote the psychological wellbeing of patient with TB.
The side effect profile of Clozapine in real world data of three large mental health hospitals
Authors: Iqbal Ehtesham , Govind Risha , Romero Alvin , Dzahini Olubanke , Broadbent Matthew , Stewart Robert , Smith Tanya , Kim Chi-Hun , Werbeloff Nomi , MacCabe James H. , Dobson Richard J. B. , Ibrahim Zina M. 
Published: December 2020

Objective
Mining the data contained within Electronic Health Records (EHRs) can potentially generate a greater understanding of medication effects in the real world, complementing what we know from Randomised control trials (RCTs). We Propose a text mining approach to detect adverse events and medication episodes from the clinical text to enhance our understanding of adverse effects related to Clozapine, the most effective antipsychotic drug for the management of treatment-resistant schizophrenia, but underutilised due to concerns over its side effects.

Material and methods
We used data from de-identified EHRs of three mental health trusts in the UK (>50 million documents, over 500,000 patients, 2835 of which were prescribed Clozapine). We explored the prevalence of 33 adverse effects by age, gender, ethnicity, smoking status and admission type three months before and after the patients started Clozapine treatment. Where possible, we compared the prevalence of adverse effects with those reported in the Side Effects Resource (SIDER).

Results
Sedation, fatigue, agitation, dizziness, hypersalivation, weight gain, tachycardia, headache, constipation and confusion were amongst the highest recorded Clozapine adverse effect in the three months following the start of treatment. Higher percentages of all adverse effects were found in the first month of Clozapine therapy. Using a significance level of (p< 0.05) our chi-square tests show a significant association between most of the ADRs and smoking status and hospital admission, and some in gender, ethnicity and age groups in all trusts hospitals. Later we combined the data from the three trusts hospitals to estimate the average effect of ADRs in each monthly interval. In gender and ethnicity, the results show significant association in 7 out of 33 ADRs, smoking status shows significant association in 21 out of 33 ADRs and hospital admission shows the significant association in 30 out of 33 ADRs.

Conclusion
A better understanding of how drugs work in the real world can complement clinical trials.
Performing Endoscopic Retrograde Cholagiopancreatpgraphy and Endoscopic Ultrasound for Management of Malignant Bile Duct Obstruction in a Patient With a Situs Inversus Totalis
Authors: Coronel Martin , Lanke Gandhi , Cambell Donald , Coronel Emmanuel , Tzeng Ching-Wei D. , Foo Wai , Lee Jeffrey H. 
Published: December 2020

ABSTRACT
Situs inversus totalis (SIT) is a rare anomaly characterized by the transposition of organs. We present a case of a 67-year-old White woman with a history of SIT, who presented with fatigue, jaundice, and abnormal liver enzymes. Endoscopic ultrasound demonstrated a solid lesion at the distal common bile duct (CBD). Subsequent endoscopic retrograde cholangiopancreatography displayed severe stenosis in the CBD. A plastic stent was placed into the CBD, resulting in successful biliary decompression. Biliary brushings and biopsy showed atypical cells, suspicious for carcinoma. Ensuing pancreaticoduodenectomy confirmed cholangiocarcinoma. Although challenging, endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in SIT can be successfully performed in preoperative evaluation for possible pancreaticobiliary cancers.
H-type Tracheoesophageal Fistula: A Rare Cause of Cough and Dysphagia in Adults
Authors: Bank Jeffrey , Voaklander Rebecca , Sossenheimer Michael 
Published: December 2020

ABSTRACT
Tracheoesophageal fistula without associated esophageal atresia (H-type) is a rare congenital anomaly, accounting for about 4% of esophageal malformations. However, it can occasionally be seen in adults with chronic cough and respiratory infections. We present a 38-year-old woman with a new diagnosis of H-type tracheoesophageal fistula.
Influence of deficiency or insufficiency of vitamin D on the circadian rhythm of serum calcium level
Authors: Kovaleva Elena V. , Ajnetdinova Alina R. , Eremkina Anna K. , Mokrysheva Natalia G. 
Published: December 2020

Background: mild hypocalcemia is a common laboratory finding that is not accompanied by the clinical symptoms. The most common causes of hypocalcemia are inadequate calcium intake and vitamin D deficiency. Given the high prevalence of vitamin D deficiency (insufficiency), it seems relevant to determine the daily variability of serum calcium levels before and after its supplementation.Aims: to assess the effect of 25(OH) vitamin D level on the daily profile of serum calcium and 24-hour urinary calcium levels. MATERIALS AND METHODS: the interventional, prospective, comparative study of 10 healthy volunteers (women/men - 9/1) was performed. We have analyzed the daily profiles of serum calcium and 24-hour urinary calcium levels. Summary duration of this study was 8 months and consisted two hospitalizations. Statistical analysis was done on August 2020. The descriptive statistics are represented by medians and the first and third quartiles in Me (Q1; Q3), average, maximum, and minimum values M (min; max) and by absolute and relative frequencies.Results: Me serum calcium levels (Catotaland Cacorr.) and 24-hour urinary calcium levels did not differ before and after vitamin D supplementation. However, the number of reference calcium values increased as 25 (OH) vitamin D level was reached more than 30 ng/ml from 90.8% to 100% for Catotal and from 94.2% to 97.5% for Cacorr. Episodes of hypocalcemia were registered in patients with low vitamin D levels: in 3.33% of cases according to Catotal and 5.8% for Cacorr. The frequency of hypocalcemia decreased for Catotal (to 0%) and for Cacorr. (to 2.5%) after treatment with cholecalciferol. Analysis of Catotal and Cacorr. deviations during the day showed a less variability of the calcium profile after treatment, This study also revealed circadian character of daily serum calcium profile with the presence of maximum (09:40-17:40) and minimum (23:40-07:40) values during the day.Conclusions: Our study demonstrated the improvement of daily serum calcium profile after vitamin D supplementation. We confirmed the increased number of reference calcium values, decreased variability of serum calcium levels during the day and decreased frequency of hypocalcemia.
Difficulties in diagnosis of adenomas with mixed prolactin and growth hormone secretion: case presentation
Authors: Dzeranova Larisa K. , Aboishava Lizaveta A. , Fedorova Natalya S. , Vorotnikova Svetlana Y. , Pigarova Ekaterina A. , Lapshina Anastasiya M. 
Published: December 2020

Hyperpolactinemia is a persistent excess of prolactin in the blood serum. The symptom complex of hyperprolactinemia primarily consists of disturbances in function of the reproductive system. The secretion of prolactin is under complex neuroendocrine control, which involves factors of different nature: neurotransmitters, hormones of the peripheral endocrine glands. In most cases, prolactin is secreted by pituitary cells - lactotrophs, but in some cases, hypersecretion of prolactin is combined with an excess production of growth hormone, which is typical for tumors originating from the line of progenitor cells of lactotrophs and somatotrophs of the pituitary gland, mammosomatotrophs. In this case, the symptom complex of hyperprolactinemia is accompanied by clinical manifestations of acromegaly. In patients with acromegaly, the cause of hyperprolactinemia may be pituitary stalk compression or mixed secretion of prolactin and growth hormone. Differentiation of lactotropic and somatotropic pituitary cells is determined by transcription factor Pit-1. These cell lineages are closely connected, and this may be one of the reasons for formation of tumors with mixed secretion. Reports of late presentation of acromegaly in patients previously diagnosed with prolactinomas have also been described in literature.Clinical manifestations of hyperprolactinemia can cause the patient to seek doctor’s attention before acromegalic changes in appearance develop. Careful attention is needed both to the primary diagnosis and to the clinical course of the disease in patients with hyperprolactinemia and pituitary adenoma: full assessment of hormonal status with mandatory evaluation of IGF-1 is crucial at initial examination, during further observation it may be advised to consider periodic evaluation of IGF-1 in addition to assessment of prolactin and the size of adenoma. Pituitary adenomas with mixed secretion may have a poorer prognosis.
Why Don't We All Just Do the Same? Understanding Variation in PBL Implementation from the Perspective of Translation Theory
Authors: Scholkmann Antonia 
Published: December 2020

Variations in PBL implementation need to be seen as the norm rather than the exception, since local PBL practice will always diverge from the “original model”. In order to understand this phenomenon, this conceptional paper first systematizes variations in PBL implementation at the inter-institutional, intra-institutional, and individual level. Then, variation in PBL implementation is discussed through the lens of translation theory as part of the research tradition of Scandinavian Intuitionalism. Resulting insights are applied to develop guiding questions designed to help leaders and PBL researchers to reflect on PBL implementation processes. Uncharted territories in PBL implementation research are identified, and it is argued that researching PBL implementation can serve as a blueprint to understand educational change dynamics in institutions of higher education.
ESTUDO COMPARATIVO DO CONTROLE DA QUALIDADE DE COMPRIMIDOS DE NIMESULIDA COMPLEXADA E NÃO COMPLEXADA COM Β-CICLODEXTRINA
Authors: Jesus Mariana de Oliveira , Moraes Vitória Alves de , Lima Bruno dos Santos , Menezes Paula dos Passos 
Published: December 2020

O controle da qualidade de sólidos por meio de ensaios físico-químicos apresenta grande importância na garantia da qualidade de medicamentos. Diante disto, este estudo teve como objetivo comparar a qualidade de comprimidos de nimesulida com β-ciclodextrina (Maxsulid®) e sem β-ciclodextrina (Nisulid®) como forma de investigar se os testes vigentes se aplicam às formas farmacêuticas que contenham complexos de inclusão com ciclodextrinas em sua composição. Para tal, foram realizados ensaios físico-químicos descritos na Farmacopeia Brasileira 6ª edição para comprimidos de nimesulida. Frente ao exposto, ambos os medicamentos obtiveram resultados satisfatórios na maioria dos testes de caracterização físico-química. Os testes de doseamento e dissolução foram realizados por meio de determinações quantitativas utilizando a Cromatografia Líquida de Alta Eficiência. Os resultados do doseamento mostraram que a metodologia aplicada não está adequada para extrair o fármaco do complexo de inclusão e assim doseá-lo de maneira eficiente. No teste de dissolução, os dois medicamentos foram aprovados de acordo com os critérios estabelecidos na Farmacopeia Brasileira. Porém, Maxsulid® foi o único a obter sua totalidade dissolvida em 120 minutos. Dessa forma, fica clara a importância da implementação de protocolos analíticos adequados às novas tecnologias aplicadas na produção de medicamentos.
PROBLEMAS RELACIONADOS AOS MEDICAMENTOS EM PACIENTES ATENDIDOS NO PRONTO SOCORRO DE UM HOSPITAL UNIVERSITÁRIO
Authors: Da Cruz Paulimira Fernanda , Paiva Amanda de Cássia , Júnior Miguel Simião Pereira , Muniz Jaqueline Jóice 
Published: December 2020

Problemas relacionados aos medicamentos (PRM) são causados por falhas que afetam a efetividade e segurança dos medicamentos e representam um importante desafio para os sistemas de saúde. Este estudo teve por objetivo identificar e avaliar casos de PRM no Pronto Socorro (PS) do Hospital das Clínicas Samuel Libânio (HCSL). Trata-se de um estudo descritivo e transversal, realizado por meio de entrevistas a pacientes que procuraram atendimento no PS do HCSL. A identificação e classificação dos PRM foram baseadas no Segundo Consenso de Granada. Dos 100 pacientes entrevistados, houve alta prevalência de PRM no grupo de pacientes acima de 60 anos (46%), porém não houve diferença significativa entre sexo feminino (24%) e masculino (22%). Grande parte dos entrevistados teve pouca adesão ao tratamento (68%) e nível de escolaridade baixo, sem ensino fundamental (62%). Entre os avaliados, todos apresentaram algum tipo de PRM, sendo os mais encontrados: inefetividade quantitativa (78%) e problema de saúde não tratado (16%). Os casos de PRM atendidos no PS do HCSL são comuns em pacientes com doenças crônicas, com idade acima de 60 anos, devido a não adesão ao tratamento. Esses resultados demonstram a importância da implantação do seguimento farmacoterapêutico pautado na educação e atenção primária à saúde.
Lymphocyte cell population as a potential hematological index for early diagnosis of COVID-19
Authors: Zhu Yihua , Cao XingJian , Lu Yonghui , Xu Dongsheng , Lu Renfei , Li Xinling 
Published: December 2020

The pandemic diseases caused by SARS-CoV-2 are now threatening human health and survival. Early diagnosis and isolation of mild or asymptomatic COVID-19 patients is important to control the spread of SARS-CoV-2. In this study, we investigate the potential clinical utility of lymphocyte CPD for early diagnosis of COVID-19. To investigate the potential of lymphocyte cell population data (lymphocyte CPD) for use in early diagnosis of coronavirus disease 2019 (COVID-19). Lymphocyte CPD of healthy control (n = 51), common cold patients (n = 49) and mild COVID-19 patients (n = 126) were generated using hematology analyzer. The parameters were subjected to sensitivity and specificity analysis to determine their suitability as biomarkers for early diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Normality analysis showed that lymphocyte CPD followed a normal distribution. There were no significant differences in white blood cells (WBC) and lymphocyte (LY#) counts as well as the neutrophil-to-lymphocyte ratio (NLR) among the groups (p > 0.05). Lymphocyte volume standard deviation (LV-SD), lymphocyte conductivity standard deviation (LC-SD) and lymphocyte light scatter standard deviation (LS-SD) were significantly higher in the COVID-19 group than in common cold and control groups (p < 0.05). The corresponding mean lymphocyte light scattering (MLS) was significantly reduced in the COVID-19 group, relative to the common cold group, but was significantly increased, when compared with the control group (p < 0.05). Moreover, there was no significant difference in mean lymphocyte volume (MLV) between the COVID-19 group and the common cold or control group (p > 0.05), but it was significantly higher in the common cold group than in the control group (p < 0.05). At a cutoff value â‰¥ 16.38, LS-SD was more sensitive and specific than other lymphocyte CPD parameters. At a cutoff value â‰¥ 11.89, LC-SD achieved 84.4 % sensitivity, 87.5 % specificity, and an area under the curve (AUC) of 0.888. However, at a cutoff value â‰¥ 15.95, LS-SD reached 81.3 % sensitivity, 75 % specificity and an AUC of 0.876. These results suggest that lymphocyte CPD parameters have great diagnostic potential for SARS-CoV-2 infection and can be used for early diagnosis of the disease.
Multi-omics analysis profile oral tumor module clusters to reveal the potential pathogenic mechanism
Authors: Liu Jun , Zhao Chaoyue , Yang Song , Dong Chen 
Published: December 2020

Oral tumors are malignant cancers caused by abnormal proliferation or pathological changes of soft or hard tissues in the oral cavity. Serious cases may pose a threat to life. However, its precancerous lesions remain unclear. This study is based on a comprehensive strategy to explore a multi-factor-driven oral cancer barrier module, which is an attempt to describe the pathogenesis of the disease and potential regulatory drugs from a global perspective. Functional disease modules were identified by constructing a protein-specific interaction network in patients' oral tissues. Then, comprehensive pathogenesis was explored through combination with analysis of functional and signaling pathway enrichment, prediction of key regulatory factors. It was found that these specifically expressed proteins and their interactions often play a pivotal part in oral tumors. This is reflected in the results of functional and pathway enrichment of modulating genes, which show that they are mainly involved in various immune responses, inflammatory reactions, oral plaque, and oral ulcer-related regulatory processes. This may represent the potential pathogenesis of oral tumors. On the predictive analysis of regulators, a series of ncRNAs (including miR-590, CRNDE and miR-340) and transcription factors (including E2F1, MYC and TP53) were identified that have potential important regulatory effects on oral tumors. These key regulators may manipulate a crucial part of the module sub-network and then work together to mediate the occurrence of oral tumors. On the comprehensive Multi-omics module analysis, the specific proteins and their interactions in patients' oral tissues were identified, while the prominent pivotal regulators were involved in the different pathogenic functions of oral tumors.