bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Quantitative Evaluation of Empathy Using JSE-S Tool, Before and After a Medical Humanities Module, Amongst First-year Medical Students in Nepal
Authors: G.C. Krishna , Arjyal Amit , Douglas Amanda , Subedi Madhusudan , Gongal Rajesh 
Published: January 2021

Abstract
Background

Doctors’ empathy: the understanding of patients’ experiences, concerns and perspectives, is highly valued by patients yet often lacking in patient care. Medical humanities has been introduced within undergraduate curriculum to address this lack in empathy. There is a paucity of research on the impact of a course on medical humanities on the empathy of medical students, particularly in South Asia. Here we report on the impact of such an intervention in first-year medical students and aim to help outcome-based medical education and the evaluation and promotion of humanities within medical courses.
Methods

This study is a quantitative evaluation of student empathy before and after a Medical Humanities course. The study employs the Jefferson Scale of Empathy-Student version (JSE-S). Participants were first-year medical students at Patan Academy of Health Sciences, Nepal. All cohort students were invited to participate and written consent was obtained. Data were collected both prior-to and on-completion-of, a six-week Medical Humanities module. Pre- and post-module data were analyzed and the resulting empathy scores compared using the paired t-test or Wilcoxon Sign Rank test. Subgroup analysis was undertaken to determine the association of the score with gender and preferred future speciality.
Results

Sixty-two student responses were analyzed, 32 (52%) male. In the Pre-module scores females had a slightly higher mean score than males:108 and 103 respectively. Participants who preferred people-oriented specialities also scored higher than those preferring procedure and technology-oriented specialities: 107 and 103. There was a significant increase in mean score for the entire class from Pre-module to Post-module: 105 to 116, p-value of < 0.001. Mean scores rose from 103 to 116 in males, and from 108 to 116 in females. Participants preferring Procedure and Technology-Oriented specialities showed a significant increase in meanscores:103 to 117, and participants preferring People-Oriented specialities demonstrated a smaller increase:107 to 111.
Conclusion

This study provides evidence of the impact of a Medical Humanities course for increasing medical student empathy scores at an institution in Nepal. Teaching of Medical Humanities is an important contributor to the development of empathy in medical students and its widespread expansion in the whole of South Asia should be considered.
Clinical Features and Outcomes of Raoultella Terrigena Infections. A Single-center Experience from Karachi, Pakistan: A Retrospective Study
Authors: Ahmed Ishfaque , Nasir Nosheen , Jamil Bushra , Mahmood Syed Faisal 
Published: January 2021

Abstract
Objectives:Raoultella terrigena (formerly Klebsiella terrigena) is an environmental gram-negative rod. It may cause infections in humans, especially in the elderly and immunosuppressed patients. Moreover, this organism tends to be multi-drug resistant, limiting treatment options. Evidence on clinical presentation and outcomes of this infection is limited. We conducted this study to see its various clinical features, available treatment options, and associated clinical impacts of the R.terrigena infections. Methodology:We conducted a cross-sectional study on all adult patients with clinical specimens positive for Raoultella terrigena at a 700-bedded tertiary care hospital in Karachi, Pakistan, between January 2013 to December 2018. Results:There were 58 patients with R.terrigena in different cultures specimens identified. Amongst them n=12 (22.6%) were colonizers. The median age was 61.5 years (IQR=28), and most were male (60.9%). The most common infection site was the respiratory tract in 28.3%, followed by urinary tract infections, 26%, and central line-associated infections at 26.1%. Amongst infected cases, 37% were in septic shock, and of which 76.5% required vasopressors. 45.7% had respiratory failure requiring non-invasive ventilation in 47.6%, and mechanical ventilation in 52.4%. The previous history of multidrug-resistant organisms was present in 67.4% of patients and the history of prior antibiotics use within the last six months was present in 78.3%. 91.3% of isolates were resistant to piperacillin-tazobactam and meropenem, 65.2% were resistant to colistemethate. Eight patients lost to follow up. The majority of patients treated with combination therapy (n=31, 81.6%) and meropenem plus colistemethate was the most commonly used combination (n=11, 44%). The overall mortality rate was 44.7%. Conclusion: R.terrigena is a highly drug-resistant organism with a high mortality rate and causes hospital-acquired respiratory tract infections in most patients.
Arrival-Time Parametric Imaging in Contrast-Enhanced Ultrasound for Diagnosing Fibrosis in Primary Biliary Cholangitis
Authors: Yoshimine Naoyuki , Wakui Noritaka , Nagai Hidenari , Igarashi Yoshinori 
Published: January 2021

Abstract
Background: To investigate arrival-time parametric imaging (At-PI) in contrast-enhanced ultrasonography (CEUS) for diagnosing fibrosis in primary biliary cholangitis (PBC). Methods: Participants were 48 patients (male/female: 8/40; mean age, 60 ± 13 years) with PBC diagnosed by liver biopsy who underwent CEUS during 2009-2019. Of these, 27 (male/female: 4/23; mean age, 61 ± 13 years) who also underwent shear wave elastography (SWE) were further analyzed. SonazoidTM was intravenously injected and CEUS performed. Contrast dynamics of hepatic segment V and the right kidney were recorded. At-PI were generated from the recorded video clips. Contrast arrival time <5 s was displayed in red, and the ratio of red (ROR) area to the entire liver contrast-enhanced area was calculated. ROR and shear wave velocity (Vs) measured by SWE were compared by fibrosis stage (F0-F3), bile duct loss score, cholangitis activity, hepatitis activity (HA0-HA3), and disease stage (stage 1-4), as determined by liver biopsy.Results: ROR significantly differed between F0 and F2-F3 and between F1 and F2-3. Using ROR to diagnose ³F1 (³F2), area under the receiver operating characteristic curve (AUROC) was 0.77 (0.92) (cutoff, 36.7% [47.1%]; sensitivity, 0.75 [0.92]; specificity, 0.82 [0.81]). Vs significantly differed between F0 and F1, F0 and F2-3, and HA0 and HA1. For diagnosing ³F1 (³F2), Vs had AUROC of 0.84 (0.80) (cutoff, 1.23 m/s [1.40 m/s]; sensitivity, 0.75 [0.60]; specificity, 0.82 [0.86]).Conclusions: At-PI was useful for diagnosing fibrosis, especially F2 or worse, in PBC, suggesting that At-PI can correctly diagnose fibrosis regardless of hepatic inflammation.
Combination Inhibition Activity of Chlorhexidine and Antibiotics on Multidrug-Resistant Acinetobacter Baumannii in Vitro
Authors: Lin Fei , Yu Bin , Wang Qinghui , Yuan Mingyong , Ling Baodong 
Published: January 2021

Abstract
Background: Chlorhexidine is a widely used disinfectant in clinical settings and a broad-spectrum antimicrobial agent effective against aerobic and anaerobic bacteria. However, disinfectant resistant or non-susceptible bacteria, including antibiotic-resistant Acinetobacter baumannii, have been found. This study aimed to develop a new technique to prevent and control A. baumannii infection in the hospital setting. Methods: Chlorhexidine combined with minocycline, doxycycline, meropenem, imipenem, levofloxacin and ciprofloxacin were tested against the 30 multidrug-resistant and extremely drug-resistant A. baumannii clinical isolates. The checkerboard test was used to calculate the fractional inhibitory concentration index according to the minimum inhibitory concentration value for chlorhexidine combined with antibiotics. Results: The combination of chlorhexidine with minocycline, doxycycline, meropenem, or ciprofloxacin showed synergistic responses in all clinical isolates, and more than 50% of isolates showed FICI ≤ 0.5. However, chlorhexidine together with imipenem or levofloxacin showed indifferent responses in 10% and 3.33% clinical isolates, respectively. In all tests, combinations of chlorhexidine with each of the above six antibiotics showed synergistic and additive effects, and inhibited the clinical isolates.Conclusions: We concluded that, chlorhexidine combined with antibiotics could be used to control the risk of infection with A. baumannii.
Patterns of oxygen debt repayment in cardiogenic shock patients sustained with extracorporeal life support: a retrospective study
Authors: Ganushchak Yuri , Kurniawati Eva , Horst Iwan van der , Kuijk Sander van , Weerwind Patrick , Lorusso Roberto , Maessen Jos 
Published: January 2021

Abstract
Cardiogenic shock is the most frequent shock in cardiac intensive care, and cardiac dysfunction and sever hypoxia are often seen in critically ill patients. Inadequate organ and tissue perfusion and hypoxia result in anaerobic metabolism with hyperlactatemia and oxygen debt accumulation. However, the role of accumulated oxygen debt in course of cardiogenic shock and hypoxia is not clearly described. Here we first described the existence of several patterns of oxygen debt repayment in cardiogenic shock patients maintained by extracorporeal life support system. Oxygen debt was computed from the lactate concentration at five time points, covering the first 26 hours of ECLS. The patterns as the basic pathophysiological processes are independent from the cause of primary insult. The groups of patients classified to the specific patterns differed by survival rate from 51.5% to only 4.6%. It is very important that initial class does not predetermine the fate and can change in the course of treatment due to ‘between clusters migration’. We believe that our finding of patterns of oxygen debt repayment in cardiogenic shock patients may offer a new insights for a more rational, goal-directed treatment of such highly morbid conditions as hypoxia and cardiogenic shock.
Performance of A Metabolomic Biomarker Score Compared to Three Prognostic Scores in Chronic Heart Failure
Authors: McGranaghan Peter , Saxena Anshul , Düngen Hans-Dirk , Rubens Muni , Appunni Sandeep , Salami Joseph , Veledar Emir , Lacour Philipp , Blaschke Florian , Obradovic Danilo , Loncar Goran , Tahirovic Elvis , Edelmann Frank , Pieske Burkert , Trippel Tobias 
Published: January 2021

Abstract
The Cardiac Lipid Panel (CLP) is a novel panel of metabolomic biomarkers that has previously shown to improve the diagnostic and prognostic value for CHF patients. Several prognostic scores have been developed for cardiovascular disease (CVD) risk, but their use is limited to specific populations and precision is still inadequate. We compared a risk score using the CLP plus NT-proBNP to three commonly used risk scores: The Seattle Heart Failure Model (SHFM), Framingham Risk Score (FRS), and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score. We included 280 elderly CHF patients from the Cardiac Insufficiency Bisoprolol Study in Elderly (CIBIS-ELD) trial. Cox Regression and hierarchical cluster analysis was performed. Integrated area under the curves (IAUC) was used as criterium for comparison. The mean (SD) follow-up period was 81 (33) months, and 95 (34%) subjects met the primary endpoint. The IAUC for FRS was 0.53, SHFM 0.61, MAGGIC 0.68, and CLP 0.78. Subjects were partitioned into three risk clusters: low, moderate, high with the CLP score showing the best ability to group patients into their respective risk cluster. A risk score composed of a novel panel of metabolite biomarkers plus NT-proBNP outperformed other common prognostic scores in predicting 10-year cardiovascular death in elderly ambulatory CHF patients. This approach could improve the clinical risk assessment of CHF patients.
Correlation between the geographical origin of Helicobacter pylori homB-positive strains and their clinical outcomes: a systematic review and meta-analysis
Authors: Karbalaei Mohsen , Keikha Masoud 
Published: January 2021

Abstract
Background
In general, all virulence factors of Helicobacter pylori (H. pylori) are involved in its infections. However, recent studies have shown that the homB gene is one of the virulence genes that affects the severity of the clinical results of this bacterium.
Methods
The main purpose of this study was to investigate the relationship between the presence of homB gene in H. pylori and the progression of its infection to peptic ulcer and gastric cancer. In the present study, we conducted a systematic search to collect all articles related to the effect of homB-positive strains on clinical outcomes. Finally 12 eligible studies according to our criteria were included in this meta-analysis and the effect of homB gene on gastric ulcer and gastric cancer diseases was evaluated by summary odds ratio.
Results
Current results showed that the homB-positive strains significantly increase the risk of peptic ulcer (OR: 1.36; 1.07–1.72 with 95% CIs), especially in western countries (OR: 1.61; 1.20–2.14 with 95% CIs). Moreover, we observed a positive association between the homB gene and risk of gastric cancer (OR: 2.10; 1.35–3.29 with 95% CIs). In addition, based on subgroup analysis, it was found that the presence of this gene in H. pylori strains increases the risk of gastric cancer in the Asian population (OR: 3.71; 1.85–7.45 with 95% CIs).
Conclusions
Overall, in the present study we found that homB gene is responsible for the progressing of primary infection to severe complications, in particular peptic ulcer in western countries and gastric cancer in Asian countries.
No Harmful Effects of Steroids in Severe Exacerbations&nbsp;of COPD Associated With Influenza
Authors: Studer Severin , Albrich Werner , Baty Florent , Rassouli Frank , Waldeck Frederike , Brutsche Martin 
Published: January 2021

Abstract
Background: COPD has large impact on patient morbidity and mortality worldwide. Acute exacerbations (AECOPD) are mostly triggered by respiratory infections including influenza. While corticosteroids are strongly recommended in AECOPD, they are potentially harmful during influenza. We aimed to evaluate if steroid treatment for AECOPD due to influenza may worsen outcomes.Methods: A retrospective analysis of a Swiss nationwide hospitalisation database was conducted identifying all AECOPD hospitalisations between 2012 and 2017. In separate analyses, outcomes concerning length-of-stay (LOS), in-hospital mortality, rehospitalisation rate, admission to intensive care unit (ICU), empyema and aspergillosis were compared between AECOPD during and outside influenza season; AECOPD with and without laboratory confirmed influenza; and AECOPD plus pneumonia with and without laboratory confirmed influenza. Results: Patients hospitalised for AECOPD during influenza season showed shorter LOS and fewer ICU admissions but higher rehospitalisation rates compared to those hospitalised outside influenza season. Patients with confirmed influenza infection had lower in-hospital mortality and rehospitalisation rates but higher risk for ICU admission than those without confirmed influenza. In patients with AECOPD plus pneumonia, there was a higher risk of ICU admission for those with laboratory-confirmed influenza compared to those without.Conclusions: Using different indicators for influenza as the likely cause of AECOPD, we found no consistent evidence of worse outcomes of AECOPD due to influenza. Assuming that most of these patients received corticosteroids, as it is accepted standard of care throughout Switzerland, this study provides important information and supports the current practice of using corticosteroids for AECOPD independent of the influenza status.
Effect of&nbsp;Intrauterine Recombinant Human Granulocyte Colony-stimulating Factor&nbsp;(rhG-CSF) Infusion on Pregnancy Outcomes in Patients With Repeated Implantation Failure During Freeze-Thaw Embryo Transfer Cycles: A Retrospective Cohort Study
Authors: Lyu Meng , Ma Xiaoling , Hu Junping , Zhan Hongjuan , Liu Lin 
Published: January 2021

Abstract
Background: Repeated implantation failure (RIF) is one of the difficulties that hinder the further improvement of clinical pregnancy rate by assisted reproductive technology. RIF has become an urgent clinical problem and hot research topic in the field of assisted reproduction, which is also a challenge for clinicians.Objective: The aim of this study was to evaluate the effects of intrauterine recombinant human granulocyte colony-stimulating factor(rhG-CSF) to improve implantation, clinical pregnancy, early abortion, multiple pregnancy and live birth rate(LBR) rate in women with RIF. Methods: A retrospective clinical analysis involving 142 women with RIF was conducted in the reproductive Medicine Center, the First Hospital of Lanzhou University between 1 January 2015 and 30 June 2018. They were divided into two groups: rhG-CSF group and control group, according to whether or not intrauterine rhG-CSF. In rhG-CSF group (n=47) granulocyte colony-stimulating factor (300 micrograms in 1 mL) was infused into the uterus within five minutes by embryo transfer cathete during the proliferative period of menstrual cycle before freeze-thaw embryo transfer(FET), while the control group was not given intrauterine perfusion. The implantation, clinical pregnancy, early abortion and multiple pregnancy were compared between the two groups. Results:The mean age for whole study group was 35.3±4.2 years old. There were no significant differences between demographic characteristics in two groups(p>0.05). The successful implantation (28.44% vs 12.44%, p=0.012), and clinical pregnancy (48.95% vs 27.35%, p=0.011) rates were significantly higher in the rhG-CSF group than in the control group. Binary logistic regression indicated that rhG-CSF treatment remained significantly associated with successful clinical pregnancy(OR=2.979, 95% CI=1.262-7.003).Conclusion: Intrauterine infusion of rhG-CSF can increase embryo implantation rate, clinical pregnancy rate in patients with RIF. In addition, the age and rhG-CSF are the independent risk factors affecting pregnancy outcomes.
Skeletal Muscle Area Is an Independent Predictor for Mortality in Elderly Patients With ANCA Associated Vasculitis
Authors: Zheng Xixi , Xia Peng , Li Jiaying , Zhang Gu-Mu-Yang , Yan Qin , Li Xuemei , Sun Hao , Chen Limeng 
Published: January 2021

Abstract
Objectives This study aims to investigate the relationship between baseline skeletal muscle area and infections or death in elderly AAV patients with renal involvement.Results A total of 57 AAV patients with renal involvement older than 65 years from a single center in China were enrolled. The mean age was 72.4 ±5.6 years. The baseline BVAS score was 17.04 ±4.40, and eGFR was 18.64 (7.63, 33.79) ml/min×1.73m2. Skeletal muscle area was calculated on CT at the third lumbar vertebra level. The mean muscle area was 102.68 ±24.41 cm2. After a median follow-up of 555 days, 29 patients experienced 36 episodes of severe infections. The median time to infection was 30 (15, 63) days. Ten patients died of infection, and two of fatal bleeding. The median time to death was 59 (26, 77) days. The muscle area correlates with age and BMI. Univariate Logistic regression showed that age (OR 1.11, P=0.044), muscle area (OR 0.97, P=0.008) and hsCRP (OR 1.01, P=0.017) were predictors of severe infection. In the multivariate Cox regression, muscle area (HR 0.97, P=0.022) independently predicted one-year mortality. Conclusion Elderly AAV patients have a high rate of infection and death during the first year following induction. Muscle area measured at L3 vertebrae level on non-contrast-enhanced CT is an independent predictor of 1-year infection and mortality.
T-Lymphocyte Subtyping: A Potential Diagnostic and Prognostic Indicator of Cytomegalovirus Infection in Sepsis Patients
Authors: Bai Guangxu , Wang Hao , Cui Na , Cheng Wei , Han Wen , Chen Jianwei 
Published: January 2021

Abstract
Background: This study aimed to investigate the use of T-lymphocyte subtyping as a diagnostic and prognostic marker for cytomegalovirus (CMV) infection in sepsis patients.Methods: We assessed T-lymphocyte subtyping and other commonly used clinical parameters in sepsis patients upon admission to the intensive care unit (ICU), and evaluated their potential impact on diagnosis and outcomes of CMV infection.Results: Among 599 sepsis patients, 82 were diagnosed with CMV infection. The 28-day mortality was significantly higher in CMV-infected than non-CMV-infected patients (20.7% vs. 9.9%). Both CD28+CD8+ and CD8+ T-cell counts could be combined with natural killer cell count, Acute Physiology and Chronic Health Evaluation II score, and immunoglobulin G as independent risk factors for CMV infection. Among 82 CMV-infected sepsis patients, 51 were assessed to have CMV-DNA negative conversion, while the other 31 were persistently positive for CMV DNA. The CD8+ and CD28+CD8+ T-cell counts were both independent risk factors for CMV-DNA negative conversion, with the latter having the better predictive ability. Lower CD28+CD8+ T-cell count was associated with higher 28-day mortality in CMV-infected sepsis patients. The CMV-DNA negative conversion and 28-day mortality of CMV-infected sepsis patients could be predicted using cutoff values of 151 (74.5% sensitivity and 87.1% specificity) and 64.5 (52.9% sensitivity and 92.3% specificity) CD28+CD8+ T cells/ml at ICU admission, respectively. Conclusions: Sepsis patients with CMV infection had higher 28-day mortality than those without CMV infection. CD28+CD8+ T-cell count was significantly higher in patients with CMV-DNA negative conversion than in those with persistently positive CMV DNA, and lower cell count was significantly associated with higher 28-day mortality. Therefore, CD28+CD8+ T-cell count may be a potential marker for early diagnosis of CMV infection and outcome prediction.Trial registration: Peking Union Medical College Hospital, registered at chictr.org.cn (identifier ChiCTR-ROC-17010750)