bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of indomethacin (Non steroidal anti-infilammatory drug) on intestinal permeability and liver functions
Authors: Mahmoud Shaimaa H , Elshaer Asmaa M , El-Waseef Dalia A , Erfan Dina M , Nabih Enas S , El-Kharashi Omnyah A , AboZeid Mahdy S 
Published: October 2021

Abstract

Background
Many theories tried to connect liver and gut as they have close anatomical, metabolic, and immunologic connections so exposure to large numbers of foreign molecules coming from the gastrointestinal tract via the portal vein like the bacterial components and other products may lead to liver damage by disturbing intestinal barrier and permeability which can be induced by indomethacin, one of non-steroidal anti inflammatory drugs(NSAIDs).

Aim
To investigate whether liver injury is linked to disturbance in intestinal permeability or not.

Methodology
Indomethacin was used to induce dysbiosis in male Wistar rats which were divided into two groups: Naive and Indomethacin groups. The later was received indomethacin (3mg\kg\day) by oral gavage. Liver function tests, micrbiological and histological studies were performed.

Results
Indomethacin induced elevation in liver enzymes, bacteremia and histological changes as compared to vehicle group.

Conclusions
Indomethacin induced dysbiosis with disturbance in the intestinal permeability that yield to hepatic injury.
Serum Amyloid A Level in Women with Unexplained Infertility
Authors: Ibrahim Mostafa , Mohammad Hayam Fathy , el-Khazragy Nashwa Nagy , El wahab Zeinab Saad Abd 
Published: October 2021

Abstract

Background
By various molecular and cellular research efforts it was displayed that folliculogenesis, ovulation, and corpus luteum formation is considered as an inflammatory processes that hav raised the research interest to investigate that serum amyloid A as an inflammatory mediator to reveal its possible role in infertility.

Objective
This study aims to assess the association between SAA and unexplained infertility in women.

Methods
The current research study have been conducted at Ain Shams University Maternity Hospital during the period from September 2018 to April 2019. Women approached were recruited from outpatient clinic of Ain Shams University Maternity Hospital. The recruited 90 research study subjects have been divided into two research groups

Results
Serum amyloid A was statistically significantly higher among the unexplained research group versus control group (SAA had excellent discriminative value with an area under the ROC curve (AUC) of 0.992 (95% CI = 0.945 to 1.000, Pvalue &lt;0.0001). A best cutoff criterion is SAA of 28.7 mg/l (sensitivity = 98%, specificity = 96%, J-index = 0.93)) denoting that amyloid A as an acute phase inflammatory modulator is higher among the unexplained research group reflecting a form of chronic inflammatory process in those category of cases. Analytical research results of multivariable binary logistic regression analysis as regards the correlation between SAA and unexplained infertility after adjustment for age and BMI, it was revealed that serum amyloid A an independent predictor for unexplained infertility.

Conclusion
s: Serum amyloid A as a biomarker for could be implemented as a predictability tool for unexplained infertility since it is a reflector of an chronic inflammatory process that is ongoing that could affect the process of implantation and ovulation however the clear molecular and cellular processes linked to the pathophysiological process that reflects the fertility hindering process should be implemented in future research efforts taking in consideration to have multicentric fashion of research with larger sample sizes to verify the value of serum amyloid A as biomarker that reflects the fertility potential besides the routine infertility work up.
Perineural injection as an alternative treatment of resistant lateral elbow pain
Authors: El-Naggar Hanaa Ahmed Hany Abd Eldayem Ahmed , El-Naby Mona Mansour Mohammed Hasab , Assaf Naglaa Youssef Mohammed , El-Fattah Elbadawy Mohja Ahmed Abd 
Published: October 2021

Abstract

Background
Lateral elbow pain (LEP) or lateral epicondylitis (LE) is a common problem affecting both males and females. Multiple therapeutic modalities are used with different outcomes.

Objective
The current study aimed at description of the effectiveness of a newly introduced modality, Perineural Injection (PNI) therapy in comparison to the already used therapeutic ultrasound (TUS) as a conventional modality in the treatment of resistant LEP (LE).

Patients and methods
This is a longitudinal interventional study. Thirty patients of both sexes aged between 21 to 62 years old who had LE were randomly allocated into two groups (15 each). In PNI group, 5% buffered dextrose was injected subcutaneously around the lateral epicondyle once weekly for 8 weeks. In TUS group, continuous US was used 3 sessions per week for 4 weeks. Tenderness grading scale, visual analogue scale (VAS), Patient- Rated Tennis Elbow Evaluation Questionnaire (PRTEE) score, and ultrasonographic evaluation were used before and 12 weeks after treatment.

Results
In both groups, there was a high significant clinical improvement at 12th week after treatment. However, the improvement was better in the PNI group than the TUS group. By US evaluation at 12th week after treatment, there was a significant decrease in hypoechoic areas and disturbed fibrillar pattern in PNI group compared to before therapy (p &lt; 0.001 and = 0.025) respectively. But in TUS group, there was decrease in hypoechoic areas and tendon thickness compared to before treatment (p = 0.02 and 0.026) respectively.

Conclusion
Both PNI and TUS therapies for LE gave clinical improvement for pain, functional limitations and some ultrasonographic findings (as echogenity, fibrillar pattern and tendon thickness). However, PNI therapy gave better outcome as compared to TUS.
The Efficacy of Preoperative Duloxetine in Patients Undergoing Major Abdominal Cancer Surgery
Authors: Hetta Diab Fuad , Elgalaly Nourhan Alaa , Mohammad Montaser A. Fattah 
Published: October 2021

Objective:
We aimed to evaluate the analgesic efficacy as well as the postoperative quality of recovery of preoperative oral duloxetine a serotonin and norepinephrine reuptake inhibitor for patients undergoing major abdominal cancer surgery.

Materials and Methods:
Sixty-two patients, undergoing major abdominal cancer surgery were divided into 2 equal groups, received oral duloxetine 60 mg (2 h preoperative) or placebo. Postoperative 48 hours morphine consumption, visual analog scale pain score, and quality of recovery were measured.

Results:
The cumulative 48 hours morphine consumption was significantly reduced in the duloxetine group compared with the placebo group (mean±SD) (5.2±3.2 vs. 12.9±3.4 mg), mean difference (95% confidence interval) 7.6 mg (5.9–9.3) P<0.001. The time to first morphine request was delayed significantly in the duloxetine group, median (interquartile range), 25 (19 to 38) versus 8 (4 to 9) hours, P<0.001. The duloxetine group had lower pain scores than the placebo group at 8, 12, 16, and 24 hours postoperatively, however, nonsignificant changes were observed at 0, 2, 4, 36, and 48 hours postoperatively. Participants in the duloxetine group had a better postoperative quality of recovery than the placebo group. The median (interquartile range) of the global quality of recovery-40 scoring system for the duloxetine group was 185 (180 to 191) compared with 170 (163 to 175) in the placebo group (P<0.001).

Discussion:
A single preoperative dose of oral duloxetine, 60 mg for patients subjected to major abdominal cancer surgery reduced postoperative pain, decreased opioid consumption, and improved the quality of recovery.
Implementing an Evidence-Based Feeding Protocol
Authors: McKenna Laura L. , Bellini Sandra , Whalen Mary , Magri Eileen , Akerman Meredith 
Published: October 2021

Background:
Evidence-based feeding practices are often variable among neonatal providers due to lack of knowledge and neonatal intensive care unit (NICU) feeding culture norms.

Purpose:
To evaluate changes in NICU nurses' knowledge, perceptions, feeding practices and culture following education about, and implementation of, an evidence-based Infant-Driven Feeding (IDF) protocol.

Methods:
A pre-/postprospective comparative design was used to survey 120 registered nurses employed in a level 3 NICU about feeding practices, knowledge, and culture prior to IDF education and 1 to 2 months after IDF implementation.

Results:
The preeducation survey yielded 59 respondents; of these, 30 responded to the same survey after IDF implementation. Postimplementation responses were significant for fewer nurses making decisions to begin oral feedings (P = .035), greater use of gestational age to increase frequency of oral feeding attempts (P = .03), less reliance on weight loss to decrease oral feeding attempts (P = .018), an increase in use of combination interventions to prepare infants for oral feeding (P = .001), and greater willingness to allow a rest period or stop the feeding if an infant falls asleep after completing 70% of the feeding (P = .03).

Implications for Practice and Research:
Trends in several survey categories following the education program and implementation of IDF support the use of evidence-based practices (EBPs) such as IDF. Future research focused on nurses' perceptions of how education influences integration of specific EBPs into practice is needed. Evaluating EBP mentorship combined with education about EBPs can provide insights on how best to integrate EBPs into practice.
A Rare Case of Neonatal Disseminated Herpes Simplex Virus (HSV) With Concomitant Methicillin-Sensitive Staphylococcus aureus (MSSA) Bacteremia
Authors: Sykes Stephanie R. , Sharpe Elizabeth L. 
Published: October 2021

Background:
Neonatal herpes simplex virus (HSV) infections can be challenging to diagnose and often occur without maternal history of infection. Routine initial pharmacologic management when a neonate presents with signs of sepsis in the first weeks of life typically targets antibiotic therapies. This case illustrates the importance of the addition of antiviral coverage, especially when a neonate demonstrates temperature instability and neurologic changes.

Clinical Findings:
This case report describes the unique presentation of a 9-day old neonate with clinical findings significant for sepsis. This neonate was diagnosed with methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia with concomitant disseminated HSV-2 infection after presenting with temperature instability, lethargy, and signs of multisystem organ impairment.

Primary Diagnosis:
This neonate was diagnosed with disseminated HSV infection, which occurs in 25% of neonatal HSV disease.

Interventions:
Treatment was initiated with high-dose intravenous acyclovir at 20 mg/kg/dose every 8 hours along with broad-spectrum antibiotics. Management should include anticipating and monitoring for progressive multisystem organ failure in bacterial or viral infection.

Outcomes:
This patient did not survive despite maximal intervention from the neonatal intensive care unit team. Disseminated HSV neonatal infections are associated with high mortality rates when they are present alone, and mortality is higher with concurrent bacteremia.

Practice Recommendations:
Providers should have a high index of suspicion for HSV infection in neonates presenting in the first 1 to 3 weeks of life with signs of sepsis. Prophylactic treatment with high-dose acyclovir as an adjunct to broad-spectrum antibiotics while awaiting laboratory confirmation can be lifesaving.
A Neonate With Vertical Transmission of COVID-19 and Acute Respiratory Failure
Authors: Farmer Meredith L. 
Published: October 2021

Background:
This case describes a case of vertical transmission of COVID-19 from a mother to her neonate. The neonate subsequently developed acute respiratory failure consistent with adult symptoms of COVID-19.

Clinical Findings:
This preterm neonate was born at 33 4/7 weeks' gestational age to a COVID-19–positive mother and admitted to the neonatal intensive care unit (NICU) for prematurity and respiratory distress. The neonate developed acute respiratory failure with severe persistent pulmonary hypertension of newborn (PPHN) and required intubation and maximum respiratory and cardiovascular support. The neonate subsequently tested positive for COVID-19 at 24 hours of life.

Primary Diagnosis:
Acute respiratory failure related to COVID-19 infection.

Interventions:
The neonate was admitted to the NICU on CPAP. At 11 hours of life, the neonate began to exhibit signs of worsening respiratory distress requiring intubation, mechanical, and high frequency ventilation. An echocardiogram revealed severe PPHN. The neonate required dopamine to manage hypotension and was treated with steroids to decrease inflammation associated with airway edema noted during intubation. Pharmaceutically induced paralysis, analgesia, and sedation was used to manage persistent hypoxia.

Outcomes:
The neonate fully recovered from acute respiratory failure and was discharged home with the mother.

Practice Recommendations:
Newborns born to mothers who are positive for COVID-19 are at risk for vertical transmission of COVID-19 and should be monitored closely for acute respiratory failure. Respiratory medical management should include supportive care. Staff should also encourage parents to consider receiving the COVID-19 vaccine to protect their newborn from the possibility of developing acute respiratory failure.
Increasing Safe Sleep Practices in the Neonatal Intensive Care Unit
Authors: Paul Eveline Treiber 
Published: October 2021

Background:
The American Academy of Pediatrics (AAP) encourages healthcare providers to practice and model safe sleep practices (SSPs) in the neonatal intensive care unit (NICU) when it is developmentally and medically appropriate for the infant. Preintervention data were collected as a baseline prior to the quality improvement (QI) initiative and revealed that 87% of eligible infants were in unsafe sleep environments (n = 331/379). This data revealed the need for an improvement project to help increase the percentage of infants placed in safe sleep in this NICU.

Purpose:
The purpose of this QI initiative was to increase the percentage of eligible infants being placed in safe sleep environments by registered nurses in a NICU.

Methods:
The development of an evidence-based safe sleep bundle was implemented in a level IV NICU at an academic medical center in the Southeastern United States. Data were subsequently collected for 5 months via bi weekly crib audits.

Results:
Of the 744 infants audited in the QI period, 604 were observed in a safe sleep environment. From the pre- to postintervention period, SSPs increased by 68% (preintervention: 13%, postintervention: 81%, P value < .001). Adherence to the varying components of SSPs also reflected statistically significant improvements.

Implications for Practice:
SSPs should be endorsed and modeled in all NICUs. Introducing proper SSPs in the hospital setting may lead to better compliance at home by the infants' caregivers.
Association Between Sleep Disturbance and Low Back Pain
Authors: Yabe Yutaka , Hagiwara Yoshihiro , Sekiguchi Takuya , Sugawara Yumi , Tsuchiya Masahiro , Yoshida Shinichirou , Tsuji Ichiro 
Published: October 2021

Study Design.
A longitudinal study.

Objective.
The aim of this study was to clarify the association between sleep disturbance and low back pain (LBP) using 3-year longitudinal data after the Great East Japan Earthquake, with a focus on the duration or frequency of sleep disturbance and the effect of sleep disturbance on LBP.

Summary of Background Data.
Sleep disturbance and LBP are common health problems in the general population and natural disaster survivors. However, a longitudinal study in this field is rare, and the association between sleep disturbance and LBP has not been clarified.

Methods.
A 3-year longitudinal study was conducted among people living in disaster-stricken areas after the Great East Japan Earthquake (n = 2059). Sleep disturbance and LBP were assessed at 4, 5, 6, and 7 years after the disaster. Multiple logistic regression analysis was performed to assess the association between the duration or frequency of sleep disturbance and LBP, and the effect of preceding sleep disturbance on the onset of LBP. The χ2 test and crude and multiple logistic regression models were used in data analysis.

Results.
The duration and frequency of sleep disturbance were significantly associated with LBP, and the effect was stronger with longer duration and increased frequency of sleep disturbance. Furthermore, the duration and frequency of preceding sleep disturbance were significantly associated with the onset of LBP, and the effect was stronger with an increase in the duration and frequency of sleep disturbance.

Conclusion.
Sleep disturbance is associated with LBP in a dose-dependent manner. Attention should be paid to sleep disturbance for the treatment and prevention of LBP, especially with regard to the duration and frequency of sleep disturbance.

Level of Evidence: 3
Evaluation of Gait and Functional Stability in Preoperative Cervical Spondylotic Myelopathy Patients
Authors: Hassanzadeh Hamid , Bell Joshua , Dooley Evan , Puvanesarajah Varun , Kamalapathy Pramod , Labaran Lawal , Shimer Adam , Shen Francis , Russell Shawn 
Published: October 2021

Study Design.
Prospective cohort study.

Objective.
The aim of this study was to 1) determine postural stability and spatiotemporal gait parameters and 2) characterize dynamic stability and variances in angular momentum (AM) of preoperative cervical spondylotic myelopathy (CSM) patients compared with healthy controls.

Summary of Background Data.
CSM is the most common cause of spinal cord dysfunction in the world and can lead to significant functional deficits including proprioception and gait disturbances. Biomechanical feedback mechanisms compensating for these deficits, specifically AM regulation, have remained largely unexplored.

Methods.
Fifty-six subjects: 32 preoperative Nurick grade 2 or 3 CSM patients and 24 controls were included. Standing balance trials were performed on a single force plate, while walking trials were conducted at self-selected pace over a 15 m runway and a series of five force plates. All trials were recorded with three-dimensional motion analysis cameras and gait modeling software was utilized to calculate stability, spatiotemporal gait parameters, and joint kinematics.

Results.
Tilted ellipse area, a measure of center of pressure variance and postural stability, was significantly greater among CSM patients (847.54 ± 764.33 mm2
vs. 258.18 ± 103.35 mm2, P < 0.001). These patients had two times as much variance medial-lateral (72.12 ± 51.83 mm vs. 29.15 ± 14.95 mm, P = 0.001) and over three times as much anterior-posterior (42.25 ± 55.01 mm vs. 9.17 ± 4.83 mm, P = 0.001) compared with controls. Spatiotemporal parameters indicated that the CSM patients tending to have slower, shorter, and wider gait compared with controls, while spending greater amount of time in double support. Compensatory AM among CSM patients was significantly increased in all three anatomic planes, where whole-body AM was approximately double that of controls (0.057 ± 0.034 vs. 0.023 ± 0.006), P < 0.001).

Conclusion.
Preoperative CSM patients showed significant alterations in spatiotemporal gait parameters and postural stability compared with controls, consistent with prior literature. Likewise, angular momentum analysis demonstrates that these patients have globally increased body excursion to maintain dynamic balance.

Level of Evidence: 3
Intrauterine and Lactational Exposure to Paracetamol: Cardiometabolic Evaluation in Adult Female and Male Offspring
Authors: Novi Daniella R. B. S. , Vidigal Camila B. , Moura Kawane F. , da Silva Deborah G. , Serafim Ana Flavia L. , Klein Rodrigo M. , Moreira Estefânia G. , Gerardin Daniela C. C. , Ceravolo Graziela S. 
Published: October 2021

Abstract:
Paracetamol (PAR) is the most common over-the-counter drug recommended by physicians for treatment of pain and fever during gestation. This drug is not teratogenic, being considered safe for fetus; however, PAR crosses the blood–placental barrier. Considering that, the present study aimed to evaluate the vascular and metabolic safety of PAR exposure during intrauterine and neonatal development in adult male and female-exposed offspring. Wistar female rats were gavaged, with PAR (350 mg/kg/d), from gestational day 6–21 or from gestational day 6 until postnatal day 21. Control dams received water by gavage at the same periods. The male and female offspring were evaluated at adulthood (80 days of life). The thoracic aorta reactivity to acetylcholine, sodium nitroprusside, and phenylephrine was evaluated in male and female adult offspring. It was observed that aortic relaxation was similar between the PAR and control offspring. In addition, the contraction to phenylephrine was similar between the groups. Further, the insulin sensitivity, adipose tissue deposition and blood pressure were not different between PAR and control adult offspring. These results suggest that the protocol of PAR exposure used in the present study did not program vascular and metabolic alterations that would contribute to the development of cardiometabolic diseases in adult life, being safe for the exposed offspring.
Pain management in outpatient surgical abortion
Authors: Liu Serena M. , Shaw Kate A. 
Published: October 2021

Purpose of review
To review the current literature focusing on pain management and experiences during abortion care.

Recent findings
Analgesic options in abortion care address pain associated with the procedure, osmotic dilator insertion, and cervical preparation. The paracervical block (PCB) is effective for pain control in first and second trimester abortions. Lower volume PCBs demonstrate non inferiority with osmotic dilator placement compared with higher volume PCBs with lower potential for toxicity. Self-administered vaginal lidocaine gel is noninferior to PCB in first trimester abortions. Preoperative oral narcotics and sedation do not reduce pain in first trimester abortions; however, the latter may reduce anxiety. For second trimester abortions, narcotics or gabapentin do not improve postoperative pain, yet up to half of patients will use narcotics if offered. Nonpharmacological methods have shown success in pain management. Music and doula support do not improve pain; however, patients would recommend these modalities, indicating some benefit that went unmeasured. Auricular acupuncture and transcutaneous electrical nerve stimulation (TENS) reduce pain and anxiety during first trimester abortions.

Summary
Several modalities reduce pain during abortion care; however, pain alone does not reflect patient satisfaction. Development of multidimensional measures for pain control assessment has the potential to capture the patient's overall experience.