bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of Adherence to Guidelines for Testing and Treatment of Pharyngitis Among Children in Palestine: A Retrospective Study
Authors: Najjar Shahenaz , Falana Hiba H , Sultan Haya O , Dreidi Mutaz , Ata Razan O , Manasrah Maryam A , Naseef Hani A. 
Published: November 2021

Abstract
Background

Acute Pharyngitis is a common upper respiratory tract infection, and is considered to be one of the leading causes for paediatric outpatient visits. Bacterial pharyngitis is less common and is mainly caused by Group A Beta haemolytic streptococcus (GABHS), also known as Streptococcus pyogenes. Accurate diagnosis guided by appropriate diagnostic tools is essential in managing paediatric pharyngitis as antibiotics are indicated only for documented bacterial cases. This researched aimed to assess the extent of physicians’ adherence to clinical guidelines regarding the testing and management of pharyngitis among children in Palestine.
Method

A retrospective, observational study that was conducted at the Palestine Medical Complex (PMC). Data were collected from the emergency department between June and December 2019. The Modified Centor score was used to assess the extent of physicians’ adherence to guidelines regarding pharyngitis testing and management among children 3 to 13 years old. It included assessing throat swab collection and antibiotics prescribing. SPSS was used for data analysis.
Results

A total of 290 cases were collected. 217 patients (74 .8 %) had a Modified Centor score of ≥ 2; 126 of them received antibiotics and swab was taken for only 8 of them. On the other hand, 73 cases (25.2 %) had a Modified Centor score of < 2; 34 of them received antibiotics. Azithromycin was the most commonly prescribed antibiotic (41.3%), followed by Amoxicillin-clavulanic acid (38.1%). The frequency of empirical antibiotics prescribing was significantly higher among children with Centor score >2, elder children and those presenting with fever.
Conclusion

Pharyngitis management should include appropriate swab collection and antibiotic selection. Prescribing antibiotics empirically early on for most patients with pharyngitis will hasten the development of bacterial resistance and will increase the cost of treatment without adding any benefit in terms of protecting patients from pharyngitis complications.
Left Ventricular Myocardial T1 Values and Extracellular Volume Fraction in Asymptomatic Subjects: Variations According to Left Ventricular Segments and Correlation with Cardiovascular Risk Factors
Authors: Kim Moon Young , Cho Soo Jin , Kim Hae Jin , Kim Sung Mok , Lee Sang-Chol , Paek MunYoung , Choe Yeon Hyeon 
Published: November 2021

Abstract
Purpose: To evaluate the normal range and variation in pre-contrast (preT1) and post-contrast (postT1) myocardial T1 values and extracellular volume fraction (ECV) according to left ventricular (LV) segments and to check for correlations between them and known cardiovascular risk factors.Methods: This study included 233 asymptomatic subjects (210 men and 23 women; aged 54.1±6.0 years) who underwent cardiac magnetic resonance imaging with preT1 and postT1 mapping on a 1.5-T scanner. T1 values and ECVs were compared among LV segments, age groups, and sex, and correlated with renal function. Based on the presence of hypertension (HTN) and diabetes mellitus (DM), the subjects were subdivided into the control (n=121), HTN (n=58), DM (n=25), and HTN and DM (HTN-DM) groups (n=29).Results: T1 values and ECV showed significant differences between the basal septal and lateral segments (p≤0.001) and between the mid-septal and mid-lateral segments (PreT1 p≤0.003, postT1 and ECV p<0.001). Among subgroups according to the HTN and DM status, the HTN-DM group showed a significantly higher ECV (0.260±0.023) than the control (0.240±0.021, p=0.011) and HTN (0.241±0.024, p=0.041) groups. Overall postT1 and ECV of the LV had significant correlation with the estimated glomerular filtration rate (r = 0.19, p=0.038 for postT1; r = -0.23, p=0.011 for ECV).Conclusion: Septal segments show higher preT1 and ECV but lower postT1 than lateral segments at the mid-ventricular and basal levels. ECV is significantly affected by cardiovascular risk factors such as HTN, DM, and decreased renal function, even in asymptomatic subjects.
IgA Vasculitis and COVID-19 in Children: A Systematic Review
Authors: Lecea Eva Maria Glenn , Abisad Daniela Aguilar , Paredes Ana , Hay Arielle 
Published: November 2021

Abstract
Background: Immunoglobulin A vasculitis is the most common form of vasculitis in children. The diagnosis is made clinically and patients will present with a rash, together with gastrointestinal, musculoskeletal, and renal system involvement. Progress in the classification of the systemic vasculitides has facilitated better understanding of the pathogenesis underlying these inflammatory conditions. Over the past year, several cases of IgA vasculitis have been reported in both children and adults in association with SARS-CoV2 infection, raising the question of whether there is any causal or even a synergistic association.Methods: This systematic review was performed following the guidelines of Meta-analysis of Observational Studies in Epidemiology. A literature search was conducted using MEDLINE, SciELO and Google Scholar using the search terms “COVID-19” or “SARS-CoV-2" in combination with “IgA vasculitis”, or “Henoch-Schonlein Purpura”. We considered articles to be eligible for inclusion if they reported a case report or series of cases of IgA vasculitis associated with proven COVID-19 infection. We excluded cases from further review if the case reported was a patient older than 18 years. WHO causality assessment categories were used to standardize case causality. Results: After reviewing the complete article and applying our exclusion criteria, 12 articles describing 12 cases of COVID-19 associated IgA vasculitis in children were included. In 83% of the cases the diagnosis of COVID-19 was made on presentation of IgA symptoms or on presentation to seek medical care. In 17% of cases the SARS Cov-2 test was positive before IgA vasculitis symptoms presentation. The mean age of the patients was 7.3 years of age (SD ±4.8). Male to female ratio was 3:1. Lower extremity purpura was present in all 12 patients. Gastrointestinal manifestations were present in 7 patients. Oligoarthritis was present in 7 patients. Three patients presented renal involvement with hematuria/proteinuria. Conclusions: During the pandemic, several autoimmune phenomena have been described to co-occur with or following COVID-19. The exact role of COVID-19 in the development of these IgA-related diseases is still being explored. Our review of case series and case reports with standardized causality assessment identified 12 cases of IgA vasculitis associated with COVID-19 infection in children.
Alterations in Cortisol and Interleukin-6 Secretion in Patients With COVID-19 Suggestive of Neuroendocrine-Immune Adaptations
Authors: Yavropoulou Maria P. , Filippa Maria G. , Mantzou Aimilia , Ntziora Fotinie , Mylona Maria , Tektonidou Maria G. , Vlachogiannis Nikolaos I. , Paraskevis Dimitrios , Kaltsas Gregory A. , Chrousos George P. , Sfikakis Petros P. 
Published: November 2021

Abstract
Purpose: The beneficial effect of glucocorticoids in coronavirus disease (COVID-19) is established, but whether adrenal cortisol secretion is impaired in COVID-19 is not fully elucidated. In this case-control study we investigated the diurnal free bioavailable salivary cortisol secretion in COVID-19 patients.Methods: Fifty-two consecutive COVID-19 patients -before dexamethasone treatment- recruited between April 15th -June15th-2021, (NCT04988269) at Laikon Athens University-Hospital, and 33 healthy age- and sex-matched controls were included. Diurnal salivary cortisol (8am, 12, 6, and 10pm), plasma adrenocorticotropin (ACTH) and aldosterone, and serum interleukin-6 (IL-6) and C-reactive protein (CRP) levels were assessed. Diurnal salivary dehydroepiandrosterone (DHEA) and IL-6 were also assessed in subgroups of patients.ResultsMedian CRP and IL-6 measurements were about 6-fold higher in patients than controls (both p<0.001) Morning salivary cortisol levels did not differ between the two groups, but patients exhibited higher median levels of evening and nocturnal salivary cortisol compared to controls [0.391(0.054, 0,663) vs. 0.081(0.054, 0.243)μg/dl, p<0.001 and 0.183(0.090, 0.834) vs. 0.054(0.054, 0.332)μg/dl, p<0.001, respectively], resulting in higher time-integrated area under the curve (AUC) (4.81±2.46 vs. 2.75±0.810, respectively, p<0.001). Circulating ACTH, DHEA, and aldosterone levels were similar in patients and controls. Serum IL-6, but not ACTH levels, WAS strongly correlated with nocturnal cortisol salivary levels (rho=0.555, p<0.001) in patients.ConclusionIncreased evening and nocturnal but not morning cortisol secretion occur in even clinically mild COVID-19. In the context of acute viral infection (Covid-19), IL-6 may partially replace ACTH as a stimulus of the glucocorticoid-secreting adrenal zona-fasciculata without influencing the secretion of DHEA and aldosterone.
Altered Effective Connectivity in Migraine Patients During Emotional Stimuli: a Multi-frequency Magnetoencephalography Study.
Authors: Ren Jing , Yao Qun , Tian Minjie , Li Feng , Chen Yueqiu , Chen Qiqi , Xiang Jing , Shi Jingping 
Published: November 2021

Abstract
Background: Migraine is a common and disabling primary headache associated with a wide range of psychiatric comorbidities. However, the mechanisms of emotion processing in migraine are not fully understood yet. The present study was designed to investigate the neural network during neutral, positive，and negative emotional stimuli in migraine suffers.Methods: We enrolled 24 migraine suffers and 24 age- and sex-matched controls in this study. Neuromagnetic brain activity was recorded by using a whole-head magnetoencephalography (MEG) system towards human faces expression pictures. MEG data were analyzed in the multi-frequency band of 1–100 Hz.Results: Migraine patients exhibited significantly enhanced effective connectivity from the prefrontal lobe to the temporal cortex during negative emotional stimuli in the gamma band(30-90Hz). Graph theory analysis revealed that patients had (1) an increased degree and clustering coefficient of connectivity in the delta band(1-4Hz) during positive emotional stimuli; (2) an increased degree of connectivity in the delta band(1-4Hz) during negative emotional stimuli.Conclusion: The results suggested individuals with migraine showed deviant effective connectivity when viewing human facial expressions in multi-frequency. The prefrontal-temporal pathway might be related to the altered negative emotion modulation in migraine. These findings may contribute to understanding the mechanism of the comorbidity of depression and anxiety in migraine and provide references for the comprehensive therapeutic plan.
Integration of Heavy Metal Pollution Indices and Health Risk Assessment of Groundwater in Semi-arid Coastal Aquifers, South Africa
Authors: Mthembu Philisiwe P , Elumalai Vetrimurugan , Li Peiyue , Uthandi Sivakumar , Anderson William P. 
Published: November 2021

Abstract
The metal contaminated groundwater results in serious health issues and hence this study attempts to address metal contamination and its sources by using integrated techniques including indexed and statistical methods and its related health hazards. Groundwater pH varied from 5.3 to 8.3 indicating acidic to alkaline in nature. Heavy metal evaluation index and degree of contamination reveal that all the groundwater samples fall under low pollution and are appropriate for human consumption. According to the pollution index majority of the samples fall in the insignificant pollution zone. Water quality index reveal that 19% and 2% of the groundwater samples belong to the poor and very poor water quality category and are spatially situated on the central, northern and southern parts of the study region. Correlation matrix and principal component analysis reveal that weathering of aquifer matrix and anthropogenic activities are accountable for the release of heavy metals into groundwater. Furthermore, R-mode and Q-mode cluster analysis revealed two clusters which are linked to mixed sources including weathering and anthropogenic activities. Based on the hazard quotient the order of heavy metal impact is: Co>Pb>Cd>Zn>As>Mn>Cu>Cr>Fe>Ni for both children and adult. The hazard index values varied from 0.06 to 8.16 for children and from 0.02 to 2.14 for adult. In this study, it is discovered that 43% and 26% of groundwater samples pose non-carcinogenic health risk in children and adult, respectively. This study highly recommends treatment of contaminated groundwater before consumption in order to protect and maintain the public health.
Is The Disinfection Procedure of The Intensive Care Unit Able To Reduce the Bacterial Resistance and Risk of Contamination?
Authors: Abreu Paloma Ohana Sousa , Guzman Julio Lenin Diaz , Mata Camila P da Silveira Martins da , Apolônio Ana Carolina Morais , Santos Uener Ribeiro dos , Silva Aline , Conceição Aline Oliveira da , Filho Heitor Portella Póvoas , Lemos Ana Paula Motta Lavigne , Madureira Arliane Silva , Fontana Renato , Andrioli João Luciano , Alves Maria Silvana , Rezende Rachel Passos , Romano Carla Cristina , Dias Joao Carlos Texeira , Uetanabaro Ana Paula Trovatti , Queiroz Guilherme Rosemberg Guimarães , Carvalho Luciana Debortoli 
Published: November 2021

Abstract
Background: Healthcare-associated infections (HAIs) represent one of the main causes for the morbidity and mortality in the intensive care unit (ICU). In this study, we aimed to verify the presence, type, and antimicrobial susceptibility of bacteria in ICU settings, before and after disinfection procedures, and analyze the risk of contamination related to these bacteria in each area of the ICU.Methods: The study was conducted in the ICU of a medium-sized hospital in Brazil from February 2019 to February 2020. Samples were obtained from the surfaces of beds, bathrooms, pantries, sinks, pharmacies, administrative areas, and floors, before and after the disinfection process, with 1% benzalkonium chloride and biguanide mixture (BCB). The samples were processed and inoculated in different culture media for the selective isolation of strains of clinical interest. In addition, phenotypic identification and antimicrobial susceptibility tests were performed using the VITEK® 2 system. We grouped different environmental, temporal, and microbial factors and characteristics to calculate the risk of contamination before disinfection (Rbd) and after disinfection (Rad), as well as the total risk (Rtt) and real risk observed (Foldrisk) in the ICU.Results: Gram-positive cocci and rods, gram-negative rods of the Enterobacteriaceae family, and non-fermenting gram-negative rods were recovered after disinfection and were found to be widely distributed. Higher bacterial diversity and frequency of resistance were observed, mainly the resistance of gram-positive bacteria to cephalosporin (p < 0.05) and lincosamides (p < 0.0001), and gram-negative bacteria to quinolones (p < 0.0001) and aminoglycosides (p < 0.05). The pantry, pharmacy, and beds showed major risks of contamination after disinfection (Rad), ranging from intermediate to very high-risk levels. Foldrisk for the pantry and beds presented a significant increase in two and three risk levels, respectively, after the disinfection process.Conclusions: Our results demonstrate the presence of bacterial pathogens with multidrug-resistant profiles after disinfection with a higher risk of contamination, indicating that challenges still exist in the deployed disinfection protocols in the ICU settings, which are associated with the increased critical risk of HAIs after the disinfection procedure.
Using Household Economic Survey Data to Assess Food Expenditure Patterns and Trends in a Country with Notable Health Inequities
Authors: Nghiem Nhung , Teng Andrea , Cleghorn Christine , McKerchar Christina , Wilson Nick 
Published: November 2021

Abstract
Background Dietary factors are one of the most important risk factors for health loss worldwide, however there is limited information on dietary trends in Aotearoa New Zealand (NZ) and whether inequities in dietary patterns are changing.Methods We extracted data from the Household Economic Survey (HES), which was designed to provide information on impacts of policy-making in NZ. Three HES waves in 2006/07, 2009/10 and 2012/13 (n=9030) were used to examine the trends in household expenditure for key food groups by income-level and ethnicity, including food group expenditure (absolute amounts and as a proportion of total food expenditure, inflation adjusted).Results Overall, total household food expenditure per capita (CPI-adjusted) increased by 0.38% annually over this period (albeit not statistically significant). In absolute terms, low-income households spent around three quarters of what high-income households spent on food per capita. High-income households experienced a greater increase in expenditure on nuts and seeds (increasing the gap) and a greater reduction in expenditure on processed meat (reducing the gap because expenditure remained higher than in low-income households). There was increased expenditure over time on fruit and vegetables (NZ$273 per capita per year), nuts and seeds, and healthy foods (NZ$507) in Māori (Indigenous) households with little variations in non-Māori households. As a result, the relative health-related gap in food expenditure between Māori and non-Māori households declined over time. But there was little change in processed meat expenditure for Māori households and expenditure on less healthy foods also increased over time. Conclusions HES data were useful for understanding trends in food expenditure patterns, in the absence of nutrition survey data. Potentially positive expenditure trends for Māori were identified, which could indicate a shift towards healthier diets. However, food expenditure inequities in processed meat and less healthy foods by ethnicity and income continue to be substantial. Public policies that aim to support healthy diets for all could involve changes to the food environment and government support for culturally appropriate Māori-led interventions.
Evaluating Diuretics in Normal Care (EVIDENCE): A feasibility report of a pilot cluster randomised trial of prescribing policy in primary care to compare the effectiveness of thiazide-type diuretics in hypertension
Authors: Flynn Angela , Rogers Amy , McConnachie Lewis , Barr Rebecca , Flynn Robert WV , Mackenzie Isla S , MacDonald Thomas M , Doney Alexander SF 
Published: November 2021

Abstract
BackgroundObtaining evidence on comparative effectiveness and safety of widely prescribed drugs in a timely and cost-effective way is a major challenge for healthcare systems. Here we describe the feasibility of the Evaluating Diuretics in Normal Care (EVIDENCE) study that compares a thiazide and thiazide-like diuretics for hypertension as an exemplar of a more general framework for efficient generation of such evidence. In 2011, the UK NICE hypertension guideline included a recommendation that thiazide-like diuretics (such as indapamide) be used in preference to thiazide diuretics (such as bendroflumethiazide) for hypertension. There is sparse evidence backing this recommendation, and bendroflumethiazide remains widely used in the UK. MethodsPatients prescribed indapamide or bendroflumethiazide regularly for hypertension were identified in participating General Practices. Allocation of a prescribing policy favouring one of these drugs was then randomly applied to the Practice and, where required to comply with the policy, repeat prescriptions switched by pharmacy staff. Patients were informed of the potential switch by letter and given the opportunity to opt-out. Practice adherence to the randomised policy was assessed by measuring the amount of policy drug prescribed as a proportion of total combined indapamide and bendroflumethiazide. Routinely collected hospitalization and death data in the NHS will be used to compare cardiovascular event rates between the two policies. ResultsThis pilot recruited 30 primary care practices in five Scottish National Health Service (NHS) Boards. Fifteen practices were randomised to indapamide (2682 patients), and 15 to bendroflumethiazide (3437 patients); a study population of 6119 patients. Prior to randomisation, bendroflumethiazide was prescribed to 78% of patients prescribed either of these drugs. Only 1.6% of patients opted out of the proposed medication switch. ConclusionThe pilot and subsequent recruitment confirms the methodology is scalable within NHS Scotland for a fully powered larger study, currently 102 GP practices (>12,700 patients) are participating in this study. It has the potential to efficiently produce externally valid comparative effectiveness data with minimal disruption to practice staff or patients. Streamlining this pragmatic trial approach, has demonstrated the feasibility of a random prescribing policy design framework that can be adapted to other therapeutic areas.
Identification on the potential mechanism of Radix pueraria on colon cancer based on network pharmacology
Authors: Li Yi , Zhang Chunli , Ma Xiaohan , Yang Liuqing , Ren Huijun 
Published: November 2021

Abstract
Radix Puerariae (RP), a dry root of the Pueraria lobata (Willd.) Ohwi, is used to treat a variety of diseases, including cancer. Several in vitro and in vivo studies have demonstrated the efficacy of RP in the treatment of colon cancer (CC). However, the biological mechanism of RP in the treatment of colon cancer remains unclear. In this study, the active component of RP and its potential molecular mechanism against CC were studied by network pharmacology and enrichment analysis. The methods adopted included screening of active ingredients of Chinese medicine, prediction of target genes of Chinese medicine and disease, construction of protein interaction network, and GO and KEGG Enrichment Analysis. Finally, the results of network pharmacology were further validated by molecular docking experiments and cell experiments. 8 active constituents and 14 potential protein targets were screened from RP, including EGFR, JAK2 and SRC. The biological mechanism of RP against CC was analyzed by studying the relationship between active components, targets, and enrichment pathway. This provides a basis for understanding the clinical application of RP in CC.