bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multidrug-resistant Mycobacterium tuberculosis: a report of cosmopolitan microbial migration and an analysis of best management practices
Authors: Joean Oana , Thiele Thea , Schütz Katharina , Schwerk Nicolaus , Sedlacek Ludwig , Kalsdorf Barbara , Baumann Ulrich , Stoll Matthias 
Published: September 2020

Abstract
Background
Tuberculosis (TB) control is a primary global health priority but the goal to eliminate TB is being threatened by the increase in incidence of multidrug-resistant tuberculosis (MDR-TB). With this series of seven MDR-TB cases in migrant patients with identical Mycobacterium tuberculosis strains we aim to illustrate the challenges encountered during therapy and follow-up: language barriers, access to care for migrant patients, depression due to isolation, adverse reactions to the treatment, management of pediatric TB, further contact tracing. We also discuss best practices for the management of complex MDR-TB cases in settings with low overall TB incidence focusing on modern diagnostic assays and an individualized and an interdisciplinary therapeutic approach.

Methods
We describe a case series of seven consecutively diagnosed MDR-TB patients, six of them treated at our tertiary care hospital between May 2018 and March 2020. Epidemiologic data was gained by semi-structured patient interviews and reconstruction of the migration route. The origin of the cluster was confirmed by genotyping of the TB-strains.

Results
Six related patients were diagnosed with pulmonary MDR-TB between May and August 2018. All had a positive Interferon-Gamma-Release Assay (IGRA), in five patients sputum microscopy was positive for acid-fast bacilli (AFB). The genetic and phenotypical drug susceptibility test did not match with MDR-TB strains from an East-African origin. The index patient was identified through genetical fingerprinting. By changing the therapy to a modern MDR-TB regime and using an interdisciplinary and culture-sensitive approach, all patients improved clinically and radiologically.

Conclusion
Human migration plays an important role for the global spread of MDR-TB in low incidence countries. Early case detection and adequate treatment are key to prevention of outbreaks. Especially language barriers and complex migration routes make genotyping of TB-strains a crucial tool to identify cases clusters, the potential index patient and transmission dynamics. We are fortunate enough to experience times in which new TB-antibiotics were made available and in which molecular assays revolutionized TB-diagnostics. We need to take advantage of that and develop personalized therapies for patients suffering from drug resistant TB.
First case report of Cryptococcus laurentii knee infection in a previously healthy patient
Authors: Huang Hetao , Pan Jianke , Yang Weiyi , Lin Jiongtong , Han Yanhong , Lan Kai , Zeng Lingfeng , Liang Guihong , Liu Jun 
Published: September 2020

Abstract
Background
The purpose of this case report was to report a case of Cryptococcus laurentii infection in the left knee of a previously healthy 29 year old male patient.

Case presentation
After an initial misdiagnosis and 7 months of failed treatment, the patient received nearly a month of treatment with voriconazole (200 mg IV q12 h) and knee irrigation with amphotericin B until the infection was controlled. The treatment continued with fluconazole for nearly 7 months and approximately 5 weeks of antibiotic treatment for a skin bacterial coinfection. In the end, the patient’s symptoms disappeared completely, the left knee recovered well, and there was no recurrence of infection.

Conclusion
The key points of successful treatment in this case were the thorough debridement, the adequate course of knee irrigation with antifungal drugs and more than 6 months of oral antifungal drugs that were able to eradicate the infection.
Trends and correlates of maternal, newborn and child health services utilization in primary healthcare facilities: an explorative ecological study using DHIMSII data from one district in the Volta region of Ghana
Authors: Alhassan Robert Kaba , Owusu-Agyei Seth , Ansah Evelyn Korkor , Gyapong Margaret , Ashinyo Anthony , Ashinyo Mary Eyram , Nketiah-Amponsah Edward , Akorli-Adzimah Edem , Ekpor Edith 
Published: September 2020

AbstractBackgroundSustainable Development Goal 3 aims at reducing global neonatal mortality to at least 12 per 1000 livebirths, under-five mortality to at least 25 per 1000 livebirths and maternal mortality ratio to less than 70 per 100,000 livebirths by 2030. Considering the achievement so far, many countries in sub-Saharan Africa, including Ghana are not likely to achieve these targets. Low utilization of maternal, newborn and child health (MNCH) services partly account for this predicament. This study explored the trend and correlates of MNCH services utilization in one administrative district in the Volta Region of Ghana.MethodsThis is an explorative ecological study employing trend analysis of 2015–2017 data from Ghana Health Service District Health Information Management System II. Univariate Poisson regression models were used to determine the factors associated with MNCH services utilization at 95% confidence level.ResultsCumulative record of 17,052 antenatal care (ANC) attendance and 2162 facility-based spontaneous vaginal deliveries (SVDs) was discovered. Compelling evidence of potential unskilled deliveries was observed in 23% of the 26 facilities reported in the DHIMSII data. High cumulative number of midwives in health facilities associated positively with high records of ANC visits (IRR = 1.30, [95% CI:1.29, 1.32];p = 0.0001), facility-based SVDs (IRR = 1.30 [95% CI:1.25, 1.35];p = 0.0001) and BCG immunizations (IRR = 1.32 [95% CI:1.29, 1.34];p = 0.0001). Likewise, high records of ANC visits correlated positively with high facility-based SVDs and child immunizations records (p < 0.0001).ConclusionTargeted health system and community level interventions alongside progressive frontline health staff motivation and retention strategies could further enhance enrollment and retention of mothers in pre-natal and postnatal care services throughout the continuum of care to guarantee better MNCH health outcomes. Investments in universal coverage for quality ANC services has the potential to enhance utilization of supervised deliveries and post-natal care services such as immunizations.
Rare heterotopic pregnancy after frozen embryo transfer: a case report and literature review
Authors: Wang Xianping , Ma Ding , Zhang Yangang , Chen Yanhua , Zhang Yuxia , Liu Zhongyu , Bi Xingyu , Wu Xueqing , Fan Junmei 
Published: September 2020

Abstract
Background
Heterotopic pregnancy occurred after frozen embryo transfer with two D3 embryos, and the case had a history of bilateral salpingectomy due to salpingocyesis. An ectopic heterotopic pregnancy was implanted in the left psoas major muscle, which has not been previously reported.

Case presentation
A 33-year-old woman presented with left back pain after curettage due to foetal arrest in the uterus without vaginal bleeding and spotting, and painkillers relieved the pain initially. When the painkillers ceased to work, the patient returned to the hospital. The β-human chorionic gonadotropin (β-hCG) level remained increased compared with the time of curettage, and a diagnosis of retroperitoneal abdominal pregnancy was suggested by ultrasonography and computerized tomography (CT) with the gestational sac implanted in the left psoas major muscle at the left hilum level. Laparotomy was performed to remove the ectopic pregnancy. During the operation, we carefully separated the adipose tissue between the space of the left kidney door and left psoas major muscle, peeled away the gestational sac that was approximately 50 mm × 40 mm with a 25-mm-long foetal bud, and gave a local injection of 10 mg of methotrexate in the psoas major muscle. Fifty days later, β-hCG decreased to normal levels.

Conclusion
It is necessary to pay more attention to the main complaints to exclude rare types of ectopic pregnancies of the pelvis and abdomen after embryo transfer.
ALDH-1-positive cells exhibited a radioresistant phenotype that was enhanced with hypoxia in cervical cancer
Authors: Yao Tingting , Weng Xueling , Yao Yao , Huang Chunxian , Li Jing , Peng Yongpai , Lin Rongchun , Lin Zhongqiu 
Published: September 2020

Abstract
Background
We have previously found there was a small subpopulation of cells with cancer stem cell-like phenotype ALDH-1 in cervical cancer. Radiotherapy has been applied in most of the cervical cancer. However,the mechanisms underlying radioresistance still remained elusive. Our study is to explore whether ALDH+ cell promotes radioresistance by hypoxia.

Methods
Cells were respectively cultured in hypoxia and normoxia environment and analyzed for marker stability, and cell cycle distribution. Results: Cell growth, apoptosis, cell cycle, sphere formation were affected by hypoxia. ALDH-1 and CHK2 were upregulated after hypoxia.

Conclusions
Here we show that ALDH-1 positive cells contribute to cervical carcinoma radioresistance through preferential activation of the DNA damage checkpoint response and an increase in DNA repair capacity. The fraction of these cells is enriched after radiation in cervical carcinoma.
Cost-consequence analysis of extended loading dose of anti-VEGF treatment in diabetic macular edema patients
Authors: Ruiz-Moreno J. M. , de Andrés-Nogales F. , Oyagüez I. 
Published: September 2020

Abstract
Background
The DRCR.net Protocol T clinical trial assessed the comparative efficacy and safety of anti-VEGF treatments including aflibercept, ranibizumab and bevacizumab in diabetic macular edema (DME). Post -hoc analyses showed that after a 12-week induction period, there was still DME resolution in an increasing number of patients through week 24.

Purpose
To assess clinical and cost consequences of extending the anti-VEGF loading dose from 3 to 6 monthly injections in patients with persistent DME in Spain.

Methods
From a hospital pharmacy perspective, a cost-consequence analysis model was developed to estimate the incremental cost needed to obtain an additional response at month 6. To estimate drug treatment costs, ex-factory prices (€, 2019) were considered for aflibercept, ranibizumab and bevacizumab. Response/nonresponse rates at 3/6 months were obtained from the Protocol T 24-week post hoc analysis (n = 546). Persistent DME was present in 50.8 and 31.6% of the 190 aflibercept-treated patients at month 3 and month 6, respectively. Of the 176 ranibizumab- and 180 bevacizumab-treated patients, 53.2 and 72.9%, respectively, had persistent DME at month 3, and 41.5 and 65.6%, respectively, had persistent DME at month 6. Sensitivity analysis considered the split of bevacizumab vials.

Results
Extending the loading dose in nonresponder patients would cost €214,862.57, €208,488.98 and €134,483.16 to obtain 37, 21 and 13 additional aflibercept, ranibizumab and bevacizumab responder patients, respectively. The total number of extended injections (months 3–6) used in patients with persistent DME at month 6 was 180, 219 and 354 for aflibercept, ranibizumab and bevacizumab, respectively.

Conclusions
To extend the anti-VEGF loading dose from 3 to 6 injections necessitates investing €5882.77 (8 injections), €10,091.03 (14 injections) and €10,198.59 (30 injections) per additional responder patient (3-month nonresponders and 6-month responders) to aflibercept, ranibizumab and bevacizumab, respectively. For the total of patients treated, on average €7927.02 (14 injections) per additional responder patient would be needed.
Spatial distribution and determinants of household iodized salt utilization in Ethiopia: a spatial and multilevel analysis of Ethiopian demographic and Health survey
Authors: Yeshaw Yigizie , Alem Adugnaw Zeleke , Tesema Getayeneh Antehunegn , Teshale Achamyeleh Birhanu , Liyew Alemneh Mekuriaw , Tesema Ayenew Kassie 
Published: September 2020

Abstract
Background
Iodine deficiency disorder is a significant public health problem, affecting both developed and developing nations worldwide. It is associated with poor body growth and irreversible mental retardation. However, little is known about the spatial distribution and determinants of household iodized salt utilization in Ethiopia. Therefore, this study aimed to explore the spatial distribution and determinants of iodized salt utilization at national level.

Methods
Ethiopian Demographic and Health Survey 2016 data was used to investigate the spatial distribution and determinants of household iodized salt utilization in Ethiopia. ArcGIS 10.6 and SaTScan™ version 9.6 software were used to explore the spatial distribution and detect significant clusters, respectively. The odds ratio with its 95% confidence interval (CI) was determined for potential determinants included in the multivariable multilevel logistic regression model.

Results
Household iodized salt utilization was spatially clustered in Ethiopia (Moran’s Index = 0.076, p-value = 0.01). The significant hotspot areas with high iodized salt utilization were located in Benishangul, Amhara, Gambella, Tigray and Northwest Oromia regions. Significant cold spot areas (areas with low iodized salt utilization) were found in Somali, and East Afar regions. Those households with higher education level ((Adjusted Odds Ratio [AOR] =1.49, 95% CI =1.14–1.93), high community level education (AOR = 1.51, 95% CI = 1.03–2.20), middle wealth index (AOR = 1.31, 95% CI = 1.04–1.65) and high community media exposure (AOR = 1.52, 95% CI = 1.07–2.17) had higher odds of iodized salt utilization.

Conclusions
Household iodized salt utilization had significant spatial variation across the country. Both household and community level variables were found to be associated with household iodized salt utilization in Ethiopia. Therefore, increasing the education level, wealth status and community media exposure is recommended to improve iodized salt utilization in a country. A targeted intervention is also needed for those regions with low household iodized salt utilization.
Nailing vs. plating in comminuted proximal ulna fractures – a biomechanical analysis
Authors: Hopf Johannes Christof , Nowak Tobias Eckhard , Mehler Dorothea , Arand Charlotte , Gruszka Dominik , Westphal Ruben , Rommens Pol Maria 
Published: September 2020

Abstract
Background
Comminuted proximal ulna fractures are severe injuries with a high degree of instability. These injuries require surgical treatment, usually angular stable plating or double plating is performed. Nailing of proximal ulna fracture is described but not performed regularly. The aim of this study was to compare a newly developed, locked proximal ulna nail with an angular stable plate in an unstable fracture of the proximal ulna. We hypothesize, that locked nailing of the proximal ulna will provide non-inferior stability compared to locked plating.

Methods
A defect fracture distal to the coronoid was simulated in 20 sawbones. After nailing or plate osteosynthesis the constructs were tested in a servo-pneumatic testing machine under physiological joint motion (0°-90°) and cyclic loading (30 N – 300 N). Intercyclic osteotomy gap motion and plastic deformation of the constructs were analyzed using micromotion video-analysis.

Results
The locked nail showed lower osteotomy gap motion (0.50 ± 0.15 mm) compared to the angular stable plate (1.57 ± 0.37 mm, p < 0.001). At the anterior cortex the plastic deformation of the constructs was significantly lower for the locked nail (0.09 ± 0.17 mm vs. 0.39 ± 0.27 mm, p = 0.003). No statistically significant differences were observed at the posterior cortex for both parameters.

Conclusions
Nail osteosynthesis in comminuted proximal ulna fractures shows lower osteotomy gap motion and lower amount of plastic deformation compared to locking plate osteosynthesis under laboratory conditions.
Initial conservative treatment of osteochondral fracture of the patella following first-time patellar dislocation
Authors: Song Si Young , Kim Tae-Soung , Seo Young-Jin 
Published: September 2020

Abstract
Background
There has been no gold standard of the initial treatment strategy for acute patellar dislocation (APD) with osteochondral fracture (OCF). Hence the study aim is firstly, to review and compare clinical outcomes of patients who underwent conservative treatment for APD with or without OCF. Secondly, to characterize the location and size of fracture fragment.

Methods
Sixty-nine consecutive patients who were retrospectively evaluated after first-time APD over a 2- year period were divided into two groups (group 1 (n = 24): APD with OCF and group 2 (n = 45): APD only). Magnetic resonance imaging (MRI) was used to assess patients with APD and OCF from the medial patella. All patients were treated with a supervised course of immobilization followed by progressive range of motion and strength exercise protocol. History of a recurrent dislocation, radiologic and functional scores were analyzed.

Results
Redislocation rate was 31.2% in group 1 and 26.6% in group 2, showing no significant difference between the two groups (p = 0.690). Intergroup differences in terms of final Kujala and IKDC scores were not significant (p = 0.117 and p = 0.283, respectively). Fracture sites of the patella in group 1 were classified as follows: patellar medial margin (12), inferomedial facet (7), and inferomedial facet involving central ridge (5). In the subgroup of patient with OCF of the inferomedial facet of the patella, the fragments were found in the lateral gutter and did not cause pain or mechanical symptoms. Thus, loose body removal was not performed. However, all five patients with large OCF involving the central ridge of the patella failed non-operative treatment with recurrent dislocations, ultimately requiring fragment refixation and medial retinacular imbrication.

Conclusions
First, APD patients with OCFs of medial margin or inferomedial facet showed similar redislocation rates and functional knee scores with those without OCFs after conservative treatment. Second, initial conservative treatment failed in some APD patients with large OCF, especially when OCFs were fractured from inferomedial facet involving central ridge. Surgery should be considered with this type.
Perception of cancer in patients diagnosed with the most common gastrointestinal cancers
Authors: Czerw Aleksandra , Religioni Urszula , Banaś Tomasz 
Published: September 2020

Abstract
Background
Gastrointestinal cancers, including colorectal cancer, stomach cancer and pancreatic cancer are among the most common cancers in Poland. Cancer patients usually assess their quality of life much worse than the general population, while negative emotions associated with the illness may affect the results of treatment.

Methods
The study involved 378 patients with colorectal cancer, stomach cancer and pancreatic cancer, treated as outpatients at the Oncology Center - Maria Skłodowska-Curie Institute in Warsaw in 2013–2018. Standardized tools were used in the study: the Beliefs about Pain Control Questionnaire (BPCQ), the Pain Coping Strategies Questionnaire (CSQ), Approval Illness Scale (AIS), Mental Adjustment to Cancer (MiniMAC). The main goal of the study was to assess pain control, pain management strategies, illness acceptance and adaptation to cancer in patients with the most common gastrointestinal cancers.

Results
Patients with gastrointestinal cancers ascribe the greatest role in controlling pain to internal factors (M = 16.84, SE = .34), and the highest score in this area was obtained by patients with colorectal cancer (M = 17.33, SE = .35). The most frequently chosen strategy is declaring coping (M = 20.95, SE = .57), although patients with pancreatic cancer obtained a high score also in the area of catastrophizing (M = 17.99, SE = 1.14). The average value of illness acceptance for patients with gastrointestinal cancers was M = 25.00 (SE = .50) and it was the lowest in the group of patients diagnosed with pancreatic cancer (M = 23.41, SE = 1.16), and the highest in a group of people with colorectal cancer (M = 27.76, SE = .51). Patients with gastrointestinal cancers obtained the highest values of the MiniMAC test in the area of the fighting spirit (M = 21.30, SE = .25), characteristic mainly for patients with colorectal cancer. Patients with pancreatic cancer were characterized by high anxiety and helplessness/hopelessness.

Conclusions
Patients with gastrointestinal cancers use different methods of pain control and pain coping strategies, with active behaviors being preferred by patients with colorectal cancer and destructive - by patients with pancreatic cancer. The majority of socio-economic variables, as well as the treatment method, affect the patients’ behaviors.
How to assess? Perceptions and preferences of undergraduate medical students concerning traditional assessment methods
Authors: Holzinger Anita , Lettner Stefan , Steiner-Hofbauer Verena , Capan Melser Meskuere 
Published: September 2020

AbstractBackgroundMedical students’ perception of traditional assessments have an important impact on their approaches to learning. Even though these assessment formats such as Multiple-Choice Question (MCQ), Short Answer Question (SAQ) or oral examinations, are frequently used in medical curricula, only little is known about student’s perceptions of these assessments. The objective of this study was to assess perceptions and preferences of undergraduate medical students concerning traditional assessment formats.MethodsThe study was conducted at the Medical University of Vienna. Attitudes of 2nd year undergraduate medical students towards traditional assessment formats, and their relation to students’ learning, and students’ attitude towards objectivity, was inquired using a self-developed questionnaire.Results459 students participated in this study. MCQs examinations were the most preferred assessment format and were chosen as the most objective format. Most students agreed that oral examinations are more appropriate for achieving long-term knowledge. Female students showed higher preference for oral examinations than male students. Students would prefer an assessment mix of 41.8% MCQs, 24.0% oral examinations, and 9.5% SAQs, if they were free to choose the assessment tools.ConclusionStudents prefer MCQ format over SAQs/oral examinations. Students’ subjective perception of the importance of gaining long-term knowledge through an assessment has no influence on their assessment preference.
Clinicians perceptions of a telemedicine system: a mixed method study of Makassar City, Indonesia
Authors: Indria Dea , Alajlani Mohannad , Fraser Hamish S F 
Published: September 2020

Abstract
Background
This case study in Makassar City, Indonesia aims to investigate the clinicians’ perceptions, including both satisfaction and barriers in using telemedicine in a large, established program which supported 3974 consultations in 2017.

Methods
A mixed methodology was used in this research utilizing a questionnaire with 12 questions, and semi-structured interviews. A purposeful sample of clinicians using the telemedicine system at the 39 primary care clinics in Makassar City were surveyed.
A total of 100 clinicians participated in this study. All of them completed the questionnaires (76.9% response rate) and 15 of them were interviewed.

Results
The result showed that 78% of the clinicians were satisfied with the telemedicine system. In free text responses 69% said that telemedicine allowed quicker diagnosis and treatment, 47% said poor internet connectivity was a significant obstacle in using the system, and 40% suggested improvement to the infrastructure including internet connection and electricity.

Conclusion
Overall, the clinicians were satisfied with the system, with the main benefit of rendering the diagnosis faster and easier for patients. However, poor internet connectivity was indicated as the main barrier. Most of the clinicians suggested improving the infrastructure especially the internet network.