bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epicardial fat attenuation, not volume, predicts obstructive coronary artery disease and high risk plaque features in patients with atypical chest pain
Authors: Pandey Niraj Nirmal , Sharma Sanjiv , Jagia Priya , Kumar Sanjeev 
Published: July 2020

Objective:
This study sought to investigate the association between volume and attenuation of epicardial fat and presence of obstructive coronary artery disease (CAD) and high-risk plaque features (HRPF) on CT angiography (CTA) in patients with atypical chest pain and whether the association, if any, is independent of conventional cardiovascular risk factors and coronary artery calcium score (CACS).

Methods:
Patients referred for coronary CTA with atypical chest pain and clinical suspicion of CAD were included in the study. Quantification of CACS, epicardial fat volume (EFV) and epicardial fat attenuation (EFat) was performed on non-contrast images. CTA was evaluated for presence of obstructive CAD and presence of HRPF.

Results:
255 patients (median age [interquartile range; IQR]: 51[41-60] years, 51.8% males) were included. On CTA, CAD, obstructive CAD (≥50% stenosis) and CTA-derived HRPFs was present in 133 (52.2%), 37 (14.5%) and 82 (32.2%) patients respectively. A significantly lower EFat was seen in patients with obstructive CAD than in those without (−86HU [IQR:−88 to −82 HU] vs −84 [IQR:−87 HU to −82 HU]; p = 0.0486) and in patients with HRPF compared to those without (−86 HU [IQR:−88 to −83 HU] vs −83 HU [−86 HU to −81.750 HU]; p &lt; 0.0001). EFat showed significant association with obstructive CAD (unadjusted Odd’s ratio (OR) [95% CI]: 0.90 [0.81–0.99];p = 0.0248) and HRPF (unadjusted OR [95% CI]: 0.83 [0.76–0.90];p &lt; 0.0001) in univariate analysis, which remained significant in multivariate analysis. However, EFV did not show any significant association with neither obstructive CAD nor HRPF in multivariate analysis. Adding EFat to conventional coronary risk factors and CACS in the pre-test probability models increased the area-under curve (AUC) for prediction of both obstructive CAD (AUC[95% CI]: 0.76 [0.70–0.81] vs 0.71 [0.65–0.77)) and HRPF (AUC [95% CI]: 0.92 [0.88–0.95] vs 0.89 [0.85–0.93]), although not reaching statistical significance.

Conclusion:
EFat, but not EFV, is an independent predictor of obstructive CAD and HRPF. Addition of EFat to traditional cardiovascular risk factors and CACS improves estimation for pretest probability of obstructive CAD and HRPF.

Advances in knowledge:
EFat is an important attribute of epicardial fat as it reflects the “quality” of fat, taking into account the effects of brown-white fat transformation and fibrosis, as opposed to mere evaluation of “quantity” of fat by EFV. Our study shows that EFat is a better predictor of obstructive CAD and HRPF than EFV and can thus explain the inconsistent association of increased EFV alone with CAD.
The implementation of an empty bladder filling protocol for localised prostate volumetric modulated arctherapy (VMAT): early results of a single institution service evaluation
Authors: Chetiyawardana Gayan , Hoskin Peter J. , Tsang Yat Man 
Published: July 2020

Objective:
To examine the impact of an empty bladder filling protocol on patients receiving radical RT for localised prostate cancer on post RT toxicity and biochemical progression free survival (bPFS).

Methods and materials:
Records of patients receiving radical external beam RT (EBRT) for localised prostate cancer with a full or empty bladder were reviewed. These included the bladder size on planning CT, daily online image guided RT (IGRT) setup data, treatment time and post treatment follow up data.These included bPFS, gastrointestinal(GI) and genitourinary(GU) toxicity scoring post RT using the CTCAE v4.0 scoring system. All patients included in the study were planned and treated under the same departmental clinical protocol with VMAT and daily online IGRT corrections.

Results:
90 patients were treated with 60 Gy in 20 fractions with a median follow up of 48 months. At 4 years bPFS in the empty bladder group was 100 and 98% in the full bladder group (p = 0.27). There were no statistically significant differences in cumulative ≥Grade 2GU (p = 0.10) and GI (p = 0.27) toxicity rates between the two bladder filling protocols. No statistically significant differences in the IGRT setup between the two groups of patients. Although the median treatment times per fraction were not statistically different between the two groups (p = 0.47), patients in the full bladder filling group were required to spend a longer time in the RT department per treatment session for bladder filling.

Conclusion:
An empty bladder filling protocol has non-inferior bPFS, GI and GU toxicities at 4 years in patients with localised prostate cancer using advanced RT techniques in comparison to a full bladder filling protocol. A longer follow up with a larger sample size is required to validate this approach.

Advances in knowledge:
This study suggests that an empty bladder filling protocol can be used in external beam EBRT for localised prostate cancer with non-inferior treatment outcomes.
Comparison of dental and skeletal indices between patients under haemodialysis and peritoneal dialysis with healthy individuals in digital panoramic radiography
Authors: Abdinian Mehrdad , Salehi Mohammad Mahdi , Mortazavi Mojgan , Salehi Hassan , Kazemi Naeini Maryam 
Published: July 2020

Objective: The aim was to compare dental and skeletal indices in panoramic radiography between patients undergoing haemodialysis, peritoneal dialysis and age- and sex-matched control group. Methods: In this comparative cross-sectional study, quantitative Indices including Antegonial Index (AI), Mental Index (MI), Panoramic Mandibular Index (PMI) and qualitative indices including Mandibular Cortical Index (MCI) and Trabecular Pattern (TP) were evaluated in panoramic images of 32 haemodialysis patients, 14 patients under peritoneal dialysis and 52 healthy individuals. The images were also investigated for pulp canal calcification, pulp stones, soft tissue calcification, changes in or loss of lamina dura, radiolucencies associated with brown tumour and ridge resorption. The indices were compared between the three groups and were investigated for association with the patients’ blood test parameters and their diseases causing chronic renal failure (CRF). Intraobserver agreement for the 2-week interval of assessment was calculated for the indices. Results MI (p = 0.574) and PMI (p = 0.100) were not significantly different, but AI (p = 0.01), MCI (p < 0.001) and TP (p = 0.002) were significantly different between the two case groups and the control group. The prevalence of pulp calcification (p = 0.03) and ridge resorption (p = 0.005) was higher in the haemodialysis group. Soft tissue calcification (p = 0.85) and lamina dura changes (p = 0.9) showed no significant difference. Brown tumours were observed in only one case in the haemodialysis group. Conclusions: AI, MCI and TP showed a reduction in mineral density of the cortical and trabecular bone in CRF patients and more severely in patients under haemodialysis than those under peritoneal dialysis.
Positioning accuracy assessment of minimally invasive percutaneous injection techniques for the treatment of temporomandibular disorders
Authors: Custódio Antônio Luís Neto , Cameron Andrew , Bakr Mahmoud , Little Chris , Chrcanovic Bruno Ramos , Reher Peter 
Published: July 2020

Objective: The aim of the present study was to evaluate the accuracy of an extraoral CBCT-planned 3D-printed surgical guide aimed to percutaneous injection of substances into the temporomandibular joint (TMJ) and the lateral pterygoid muscle (LPM). Methods: Nine human cadaver heads were used. Pre-planning CBCT and facial scans were obtained and three percutaneous injection sites were planned: one for the lower compartment of the TMJ and two for the LPM. A digital surgical guide was then designed with small titanium sleeves and printed by a 3D printer. After the injections, new CBCT scans with the needles in place were obtained in order to assess the accuracy of the procedure in relation to the virtual planning. Results: The mean values for angle deviation were very low (range 1.13o-4.08o), the same happening for the mean difference in the length reached (range 1.82–2.64 mm), as well as for the mean difference in the needle tip dislocation (range 0.94–2.03 mm). Conclusion: The guide seems to be a reliable tool for accurate percutaneous injection of drugs into the inferior compartment of the TMJ and the LPM. Further studies are necessary to test the efficacy and validate the method in an in vivo study.
FUNÇÕES E APLICAÇÕES DAS ATIVIDADES DO PLANEJAMENTO E CONTROLE DA PRODUÇÃO EM UMA INDÚSTRIA DE INSUMOS PARA EMPRESAS DO SETOR TÊXTIL DO CEARÁ
Authors: Costa Isaque Santiago Amaro , Gurgel Jorge Dos Santos , Souza Andréa Moura da Costa 
Published: July 2020

O objetivo deste estudo é analisar como as atividades do Planejamento e Controle da Produção (PCP) são realizadas na prática em uma empresa de insumos que atua no setor têxtil, observando a aplicação dos Sistemas de Coordenação de Ordens (SCOs), como o MRP e o Kanban são desenvolvidas em uma indústria de produção de insumos localizada na Região Metropolitana de Fortaleza, Maracanaú. Por meio de um estudo de caso, foi possível observar o funcionamento e associar a aplicação do sistema demonstrado na literatura com o praticado pela empresa. Observou-se como resultados na empresa a sensibilização e a aplicação inicial e limitada do Kanban; entretanto, posteriormente, o Kanban visou, de forma plena, aos melhoramentos na qualidade do produto, na redução dos níveis de estoque, no acompanhamento e no controle da produção e cumprimentos de prazos de entrega dos pedidos.
RELACIONAMENTO ENTRE BUROCRACIA E PÓS-BUROCRACIA EM UM CONTEXTO DE DOMINAÇÃO, CONTROLE E PODER: UM ENSAIO TEÓRICO
Authors: Jeremias Junior Jair , Pessi Anelise , Andrade Arthur Gehrke Martins de 
Published: July 2020

O presente ensaio teórico tem como objetivo relacionar a burocracia à pós-burocracia, utilizando-se dos conceitos de dominação, controle e poder. O referencial teórico aborda conceitos citados, focando na burocracia em Kalberg (2010) e Weber (2012) e sua pretendente a sucessora a teoria pós-burocrática, tomando o serviço público como contexto. Por fim, realizou-se uma discussão do referencial, encontrando na pós-burocracia a existência de controle coercitivo, exercido pelos pares que apresenta ainda maior rigidez que nos ambientes burocráticos. O argumento central mediante discussão é de que não ocorreu ruptura entre burocracia e pós-burocracia no serviço público, estando ele com características híbridas inerentes à burocracia e às diversas iniciativas pós-burocráticas. Como sugestão para estudos futuros, sugere-se a exploração empírica desse contexto por tratar-se de ambiente com característica adequada para tal, bem como relacionar com estudos que abranjam as teorias de carreira trazendo um olhar por meio dos praticantes.
A INSERÇÃO DA EDUCAÇÃO AMBIENTAL E DA GESTÃO AMBIENTAL NO CURSO DE ADMINISTRAÇÃO
Authors: Fernandes Vivian Duarte Couto , Abdala Etienne Cardoso , Cezarino Luciana Oranges 
Published: July 2020

Este caso de ensino trata da possibilidade de inserção dos temas educação ambiental e gestão ambiental em uma faculdade de Administração no interior de Minas Gerais. Roberta, professora efetiva da instituição, começou a pesquisar acerca da sustentabilidade desde a sua passagem pelo doutorado. Desde então, dedicou parte significativa de seu tempo para pesquisar o desenvolvimento sustentável nas organizações. Ao chegar à universidade, uniu-se a um grupo de professores os quais desenvolviam pesquisas nessa área. Por meio de um diagnóstico feito na unidade sobre o ensino de administração e sua relação com as temáticas ambientais, identificaram uma lacuna expressiva entre a realidade e a prática. Assim, o grupo de pesquisadores reavaliou o ensino, a pesquisa e a extensão de modo que a educação ambiental e o estudo da gestão ambiental nas organizações fossem inseridos no curso de Administração.
DETERMINANTES DE PREÇOS NO MERCADO IMOBILIÁRIO À LUZ DO MODELO HEDÔNICO
Authors: Paz Regileuza Rodriques Campelo Bezerra , Nobre Liana Holanda Nepomuceno , Nobre Fábio Chaves 
Published: July 2020

O mercado de imóveis é um segmento que contribui para o crescimento e desenvolvimento de uma região, pois é um dos setores com maior capacidade de impulsionar a economia, dada sua capacidade de gerar empregos e renda. O presente trabalho teve como objetivo geral analisar a formação de preços do mercado imobiliário de Mossoró-RN e, visando alcançá-lo, traçaram-se os seguintes objetivos específicos: descrever as variá veis determinantes na formação do preço dos imóveis e compreender o impacto de cada variável sobre o preço dos imóveis. A amostra compôs-se de 478 imóveis da cidade de Mossoró-RN, utilizando-se dados baseados nos registros disponibilizados por seis sítios de imobiliárias da cidade. Para análise dos dados, utilizou-se, inicialmente, a estatística descritiva das variáveis e, em seguida, a regressão linear múltipla. Os resultados sugeriram que o valor do imóvel sofre influência diretamente da classificação do bairro, da área do imóvel (m²), do número de salas, do número de garagens, do número de dormitórios, do número de suítes, do número de cozinhas e do número de banheiros. As variáveis independentes anteriores também explicaram 66,1% da variação do preço do imóvel no município de Mossoró-RN.
Emerging Anti-Microbial Resistance in Febrile Neutropenia: Is it high time to evaluate quality control measures?
Authors: Mahar Uzma , Anwar Nida , Fatima Naveena , Hassan Jawad , Shamsi Tahir 
Published: July 2020

Objective: We performed a prospective analysis at our center to find out the most common organisms causing bacterial infections to establish pattern of antibiotic resistance, in order to combat febrile neutropenia effectively in the terms of outcome as well as cost.
Methods: A hospital based observational study was conducted at National Institute of Blood Diseases and bone marrow transplantation from January 2017 to December 2017. Patients presented with absolute neutrophil count (ANC) of less than 500/ml were enrolled. Data were analyzed by SPSS version 21.0. P-value of <0.05 was considered statistically significant.
Results: In this study, a total of 242 patients from various hematological disorders were enrolled and 403 bacterial isolates were obtained. The most frequent isolated gram-negative organisms were Escherichia coli, followed by Klebsiella pneumoniae and the most prevalent gram-positive organisms were staphylococcus aureus and Enterococcus species. The antimicrobial susceptibility testing revealed that most of the Staphylococcus aureus isolates were highly resistant to methicillin (p = 0.002), whereas Enterococcus species were resistant to vancomycin (p = 0.000).
Conclusion: The choice of empirical antibiotic regimen should be based on local spectrum of bacteria and their regional susceptibility pattern to improve the survival and minimize hospital stay of patients.
doi: https://doi.org/10.12669/pjms.36.6.2138
How to cite this:Mahar U, Anwar N, Fatima N, Hassan J, Shamsi T. Emerging Anti-Microbial Resistance in Febrile Neutropenia: Is it high time to evaluate quality control measures? Pak J Med Sci. 2020;36(6):1246-1251. doi: https://doi.org/10.12669/pjms.36.6.2138
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.
Frequency of silent carotid artery stenosis in diabetics and its associated factors: An analysis in tertiary care hospital
Authors: Ali Faiza Sadaqat , Bader Nimrah , Zuberi Bader Faiyaz , Banu Sabiha 
Published: July 2020

Objective: To estimate frequency of silent carotid artery stenosis and its associated factors in diabetic patients attending a tertiary care hospital.
Methods: This cross-sectional study was conducted in tertiary care Civil Hospital, Karachi from March 2019 to September 2019,. A total of 166 patients with Diabetes Mellitus were included in this study. Brief history was taken for the duration of DM, treatment, and smoking habits. Carotid artery stenosis (CAS) wafrs measured by Doppler ultrasound of right and left common, internal, and external carotid arteries.
Results: Frequency of silent carotid artery stenosis (CAS) in diabetic patients was observed in 28.92% (48/166) cases. The mean age ±SD of the patients was 54.8 ±7.96 years. 27 (22.29%) patients were smoker and all were male. Out of 166 diabetic patients, 59 (35.54%) were treated with insulin and 107 (64.46%) were treated with oral hypoglycemic.
Conclusion: Substantial number of diabetic patients with increasing age, increased duration of diabetes and smoking habits have significant silent Silent Carotid Artery Stenosis (CAS).
doi: https://doi.org/10.12669/pjms.36.6.2306
How to cite this:Ali FS, Bader N, Zuberi BF, Banu S. Frequency of silent carotid artery stenosis in diabetics and its associated factors: An analysis in tertiary care hospital. Pak J Med Sci. 2020;36(6):1270-1274. doi: https://doi.org/10.12669/pjms.36.6.2306
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.
Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan
Authors: Ali Noman , Khan Nadeem Ullah , Waheed Shahid , Mustahsan Syed 
Published: July 2020

Objective: Our study aimed at identifying the characteristics and etiology of various causes of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care hospital.
Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever.
Results: A total of one hundred and fifty five patients were included. Out of these 97 (62.6%) were males and 58 (37.4%) were females. Most patients (25.2%, n= 39) were diagnosed as malaria followed closely by dengue fever (n=33, 21.3%) and then enteric fever (n= 10, 6.5%). while 41.9% (n=65) were diagnosed as suspected viral fever based on clinical judgment and inconclusive laboratory results.
Conclusion: Malaria was found to be the most common confirmed cause of acute undifferentiated fever followed by dengue and enteric fever. The provision of accurate epidemiological data will enable resources to be directed towards key areas and will be of practical importance to clinicians.
doi: https://doi.org/10.12669/pjms.36.6.2334
How to cite this:Ali N, Khan NU, Waheed S, Mustahsan S. Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan. Pak J Med Sci. 2020;36(6):1285-1290. doi: https://doi.org/10.12669/pjms.36.6.2334
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.
Policy makers, regulators and researchers’ perspectives on genomics research and the capacity of the National Health Research Act of 2013 to regulate genomics research in Zambia
Authors: Mweemba Oliver , Musuku John , Matenga Tulani Francis L. , Parker Michael , Rutakumwa Rwamahe , Seeley Janet , Simanga Twambo , Tindana Paulina , de Vries Jantina 
Published: July 2020

Background: Health research in sub-Saharan Africa takes place against a lengthy history of exploitation and unfair collaboration. This has involved the export of samples and data from the continent for the benefit of institutions and researchers elsewhere. In this paper, we report the perspectives of people involved in conducting genomics research in Zambia and the capacity of the Health Research Act (HRA) of 2013 in regulating genomics research. Methods: We approached 14 purposively selected stakeholders involved in the development or implementation of the HRA in Zambia for in-depth interviews. These were members of research ethics committees, genomics researchers, Ministry of Health policy makers and institutional lawyers. Results: Participants reported that there are benefits in genomics research for Zambia such as diagnosing and treatment of diseases. Participants also expressed concerns, most of which were ethical in nature. Prominent concerns were on consent. Participants’ main concern was the possible misuse of samples in the future. These concerns resonated with the HRA, which prohibits the use of broad consent for the collection of samples and data for future unspecified research. The implications of this is that Zambians may not participate in any kind of health research for which the storage, sharing and re-use of data or samples is envisaged. The restrictive nature of HRA means that genomics research may be excluded from future health research collaborations, thus isolating the country from potentially beneficial health research. Some policy makers also worried the samples and data that comes from such research may be difficult to access by local scientists. Conclusion: In this article, we describe the views of Zambian policymakers on genomics research and the capacity of HRA in regulating genomics research. Our findings are relevant for the Zambian audience, and other African countries that are aiming to regulate health research, especially genomics research.