bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between types of helmet and outcomes in motorcyclists after traffic accidents
Authors: Hsu Shiun-Yuan , Tsai Ching-Hua , Huang Chun-Ying , Hsieh Ting-Min , Chou Sheng-En , Su Wei-Ti , Hsieh Ching-Hua 
Published: November 2021

Background:
The use of helmets has been promoted worldwide to protect motorcyclists from head-and-neck injuries and to reduce motorcycle accident-related mortality. However, the results of previous studies regarding the effectiveness of different types of helmets are controversial. This study aims to investigate the effectiveness of three types of helmets: half-helmets, open-face helmets, and full-face helmets, in protecting motorcyclists during traffic accidents.

Materials and Methods:
A total of 6991 motorcyclists, who were hospitalized between January 1, 2015, and December 31, 2019, were enrolled in this study. They were divided into two groups: those who did not wear helmets (n = 506) and those who wore helmets (n = 6,485). The latter group was subdivided according to the type of helmet used: half-helmet (n = 3,027), open-face helmet (n = 2,528), and full-face helmet (n = 930). The primary outcome was inhospital mortality. The length of hospital stay and associated head-and-neck injuries were secondary outcomes.

Results:
Half-helmets offered significantly less protection than full-face helmets, considering that patients using half-helmets had a significantly higher rate of the Abbreviated Injury Scale ≥ 2 injuries to the head region and significantly higher odds of sustaining subdural hematoma, subarachnoid hemorrhage (SAH), and intracerebral hematoma than patients using full-face helmets. However, higher odds of sustaining SAH were noted in patients using open-face helmets. There were no significant differences in the Glasgow Coma Scale score after injury or in the mortality rate in patients using either half-helmets or open-face helmets compared to those using full-face helmets.

Conclusion:
This study revealed that half-helmets, but not open-face helmets, offered significantly less protection from head injuries than full-face helmets. However, the mortality rate and length of hospital stay after the injury did not differ among patients using the three types of helmets.
Is immediate adjuvant radiotherapy necessary for men with positive surgical margin after robotic-assisted radical prostatectomy?
Authors: Chen Yu-Ting , Liu Chung-Yi , Su Shih-Huan , Yu Kai-Jie , Chang Ying-Hsu , Lin Po-Hung , Shao I-Hung , Kan Hung-Cheng , Chu Yuan-Cheng , Huang Liang-Kang , Chuang Cheng-Keng , Pang See-Tong 
Published: November 2021

Background:
The role of immediate adjuvant radiotherapy (ART) in the management of positive surgical margin (PSM) following radical prostatectomy (RP) for low-grade prostate cancer (PCa) remains unclear. We aim to investigate our experience on survival outcome between immediate ART versus active surveillance in PSM groups after robotic-assisted RP (RaRP).

Materials and Methods:
The PSM cohort was divided into an adjuvant therapy group, consisting of immediate radiotherapy (RT) with or without androgen deprivation therapy (ADT) within six months after surgery, and observation group, consisting of close follow-up at the out-patient clinic. Salvage therapy was conducted using RT with/without ADT if biochemical recurrence (BCR) occurred (PSA level >0.2 ng/mL) during follow-up. 461 patients with PCa who underwent RaRP between December 2006 and June 2014 were included. Data of patients with PSM (n = 79) were extracted and followed up to June 2020. We aimed to compare the outcomes of immediate ART against observation or salvage RT in patients with PSM. Hence, we focused on those who had a PSA level <0.2 ng/mL after RaRP. Those with a PSA level >0.2 ng/mL were excluded.

Results:
No significant differences in age or preoperative PSA levels were observed after stratification to immediate ART and observation groups. Three patients (5.6%) received immediate ART with/without ADT. Another 51 patients received active surveillance, of which 18 (35.3%) received salvage ART with/without ADT due to BCR (PSA ≥0.2 ng/mL). There was no significant difference between immediate ART and observation groups in 5-year BCR-free survival (P = 0.072), local recurrence-free survival (P = 0.490), distant metastasis-free survival (P = 0.225), and overall survival (P = 0.517).

Conclusion:
Of the RaRP patients with PSM in the Asian population, we discovered that immediate ART following RaRP may not offer a significant advantage to active surveillance. Routine monitor of PSA levels had shown equally successful disease control. Salvage ART could be used on detection of BCR.
Patient Perspective on Telehealth During the COVID-19 Pandemic at the Cardiology Outpatient Clinic
Authors: Habibovic Mirela , Kraaij Channa M. , Pauws Steffen , Widdershoven Jos W. M. G. 
Published: November 2021

Background:
Within the field of cardiology, telehealth has been advocated by many as important benefits have been demonstrated regarding disease management and survival. Both patient- and physician-related barriers have hampered the uptake of telehealth in the clinical practice. The COVID-19 pandemic has pushed the upscaling of telehealth modalities.

Objective:
The current study will examine patients' preferences, needs, and recommendations regarding the use of telehealth at the cardiology outpatient clinic during the pandemic.

Methods:
Semi-structured focus groups were organized covering two themes: (1) patients' experiences with telehealth and (2) patients' needs and recommendations regarding the use of telehealth. Focus groups were held online using Microsoft Teams, and audio recordings were made. After transcribing the recordings, thematic analysis was applied to code the answers that were given.

Results:
A total of n = 19 patients were recruited; the mean age was 62.4 (7.7) and 10 (52.6%) were female. The majority of the patients (15/19) indicated to be positive regarding telehealth use mainly due to its time-saving character. Four patients were negative toward telehealth as they did not receive appropriate care in their perception due to telehealth use. Patients recommend using blended care where teleconsultation, and face-to-face appointments are provided in accordance with patients' preferences.

Conclusions:
This is the first study to examine, in-depth, cardiac patients' experiences, needs, and recommendations regarding telehealth use in the clinical practice. Learning from current experiences with the COVID-19 pandemic where upscaling of telehealth emerged will give us a foundation to further increase the uptake of telehealth in the clinical practice.
Using a Quality Improvement Project to Enhance the Standard Vaccination Rate for Long-Term Patients in Mental Health Services in Qatar
Authors: Elbakary Nervana , Riaz Sadaf , Mahran Islam , Assar Ahmed Hani , Abdallah Oraib , Abukuhail Rania , AlKhuzaei Noriya , Eltorki Yassin 
Published: November 2021

Background:
Countries launch vaccination programs to ensure vaccination coverage as part of the global health security. Special populations including patients with severe mental illness are under average vaccination rate. We aimed to improve the percentage of long-term patients in Qatar's mental health services who received their routine vaccination by the end of 2020 from a baseline rate of 10% to 90% from all vaccination types needed.

Methods:
This was an interrupted time series quality improvement project using two structured Plan-Do-Study-Act cycles to test the success of the outcome and process measures to reach the desired aim. Run charts were utilized to display the monthly vaccination rates as an outcome measure and the rate of vaccination refusals by the patients as a process measure. A multidisciplinary team was assembled. Root cause analysis was performed. Prioritizations for certain types of vaccines to be given were done.

Results:
We identified 50 eligible patients. Throughout 12 months, we reached a final vaccination rate of 92%. Number need to treat was used to express the effect size and was calculated as 1.2. Refusals to vaccinations by patients dropped from 41% at the start of the project to only 4% by the end.

Conclusion:
High vaccination rates over a 12-month period can serve as an indication for the success of the intervention. Sustainability of the results can be achieved by multiple strategies. These results may be useful to hospitals considering vaccine implementation or those currently struggling with implementation barriers.
Unpredictable Chronic Mild Stress-Induced Depressive-Like Behaviors in Spontaneously Hypertensive Rats
Authors: Zhang Lijun , Liu Meiyan 
Published: November 2021

Objective:
The objective is to explore whether hypertension influences unpredictable chronic mild stress (UCMS)-induced depressive-like behaviors and the potential therapeutic effect of Guan-Xin-Shu-Tong capsules (GXST) in controlling hypertension and depressive-like behaviors.

Materials and Methods:
Fifteen spontaneously hypertensive rats (SHR) and 15 wistar rats were divided into three groups respectively (n = 5, in each group), including control, UCMS, and UCMS + GXST groups. The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline and at the end of the experiment. Rats were subjected to seven kinds of UCMS over 4 weeks. GXST treatments were administrated (2.8 g/kg) by intragastric gavage once a day over 4 consecutive weeks during UCMS treatment. Sucrose-preference and open-field tests were used to detect depressive-like behaviors.

Results:
SHR exposed to 4-week UCMS treatment had lower HR when compared with control and UCMS + GXST groups (P < 0.05); Wister rats receiving UCMS or UCMS + GXST had lower SBP (P < 0.05), lower DBP (P < 0.05) and lower MAP (P < 0.05) than controls. Compared with the controls, UCMS reduced the sucrose preference of Wistar rats, UCMS and UCMS + GXST decreased both grid-crossings and the number of upright postures measured in Wistar rats (P < 0.05). SHR showed lower sucrose consumption, less sucrose preference, and fewer grid-crossings after UCMS than control SHR. However, the lower incidence of upright postures in SHR was prevented by GXST treatment (P < 0.05). Linear correlation showed that grid-crossings or upright postures were negatively related to the values of SBP, DBP, or MAP, presenting the positive relationship between depressive-like behaviors and SBP, DBP, or MAP reduction in Wistar rats; there was a negative correlation between grid-crossings and DBP responses, and MAP responses in SHR, and a positive correlation between depressive-like behaviors and DBP and MAP response elevation in SHR.

Conclusions:
UCMS-induced depressive-like behaviors in Wistar and SHR, accompanied by a blood pressure decrease in Wistar rats but not in SHR. While GXST exhibited effective relief of depressive-like behaviors in SHR without influencing their blood pressure.
Impact of COVID-19 pandemic on cataract surgical volume: A North Indian experience
Authors: Gupta Parul C , Aggarwal Shruti , Jain Punya , Jugran Deepak , Sharma Meenakshi , Pandav Surinder S , Ram Jagat 
Published: November 2021

Purpose:
To analyze the impact of the pandemic on trends in cataract surgical volume in 2020 in a high-volume tertiary care academic center in North India.

Methods:
The monthly cataract surgical volume for a large, high-volume, tertiary care academic center in North India was obtained from January 2018 through December 2020. Based on historical trends, we used time-series forecasting, probability sensitivity analysis, and linear regression models to estimate what the expected monthly cataract volume should have been from March 2020 onward.

Results:
In 2020, we expected to perform 7500 cases (assuming historical trends) but performed only 2500 cases (33% of the expected volume). The remaining 5000 cases (67% cases) constituted the “fixed” backlog. Assuming the ramp-up in cataract surgical volume starts in January 2021, results of the Monte Carlo simulation revealed that for our system, it would take on average 5 months (May 2021) under the optimistic scenario and 10 months (October 2021) under the ambivalent scenario to reach pre-pandemic expected surgical volume. There would be a collective backlog of 5500 cases under the optimistic scenario (8.8 months’ worth of cases) and a collective backlog of 6900 cases under the ambivalent scenario (11 months’ worth of cases).

Conclusion:
An intuitive approach and out-of-the-box solutions are required by the government and private institutes’ collaborative efforts to help mitigate the disruptions caused by the pandemic and lessen the backlog without causing provider burnout.
Changing trend in the morphology of cataracts at a tertiary eye care centre in South India due to COVID-19-pandemic related national lockdown
Authors: Bhalerao Sushank A , Majji Saisree , Mohamed Ashik , Vuyyuru Sowjanya , Gogri Pratik Y , Garg Prashant 
Published: November 2021

Purpose:
To study the changing trends in the morphology of cataracts at a tertiary eye care center in South India due to COVID-19 pandemic-related national lockdown.

Methods:
A retrospective study conducted at a tertiary eye care center in Andhra Pradesh state of South India, which included 1724 patients (1753 eyes) who underwent cataract surgery at our center during April 2019–July 2019 (1298 eyes of 1271 patients) and April 2020–July 2020 (455 eyes of 453 patients). Factors studied included preoperative lens status, associated phacodonesis or subluxation, pupil size, other eye lens status, associated retinal problems, glaucoma, and complications during surgery. Postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal clarity, intraocular pressure (IOP), and disc status at postoperative day 1, 1 week, and 1-month visits were compared.

Results:
A significantly lower proportion of nuclear sclerosis (decreased from 83.2% in last year before lockdown to 55.2% during lockdown) and significantly higher proportions of mature, brown, or black cataract and phacomorphic, phacolytic, or Morgagnian cataract (increased from 15.5% in last year before lockdown to 43.8% during lockdown) were observed. The proportion of small-incision cataract surgery decreased significantly (from 63.2% to 57.4%), whereas the proportion of phacoemulsification increased significantly (from 35.9% to 41.5%) during lockdown as compared to last year. A significantly higher proportion of eyes with small pupils and association with retinal pathology were also observed during the lockdown.

Conclusion:
During the national lockdown, there was a shift from nuclear sclerosis grade toward mature, brown, black grade of cataracts. In addition, the proportion of small-incision cataract surgery decreased significantly whereas the proportion of phacoemulsification increased significantly during the lockdown. More number of cataracts with small pupils and associated retinal pathology were observed during the lockdown.
A multicentric cross-sectional study measuring the equity of cataract surgical services in three high-volume eyecare organizations in North India: Equitable cataract surgical rate as a new indicator
Authors: Sabherwal Shalinder , Kuyyadiyil Subeesh , Tomar Vijay P S , Sood Ishaana , Singh Kunal V , Jain Elesh K , Majumdar Atanu , Bassett Ken 
Published: November 2021

Purpose:
Cataract remains the leading cause of blindness and visual impairment in most low-and middle-income countries, with the greatest burden borne by women. To achieve Global Action Plan targets, cataract programs must target people, especially women, with maximum need. This study examines whether cataract surgical programs in three major north Indian eyecare institutions are equitable and describes a refined indicator for reporting equity.

Methods:
Retrospective one-year cross-sectional study of cataract surgery utilization using routine administrative data from three north Indian eyecare institutions. Patient data were categorized by paying category, sex, and preoperative visual acuity. Comparisons were made between payment categories and sexes.

Results:
Out of the total number of patients operated, 86,230 were in the non-paying category and 56,738 in the paying category. Overall, 8.2% were blind, 21.1% were severely visual impaired (SVI) or worse, and 86.1% were moderate visual impaired (MVI) or worse. Non-paying patients had a significantly higher proportion of poorer visual categories compared to paying patients [(blind, 9.7% vs. 5.8%; SVI or worse, 24.6% vs. 15.8%; and MVI or worse, 89.1% vs. 81.6%, respectively, (P < 0.001)]. Women had significantly higher proportion of poorer visual categories than men [(blind, 8.9% vs. 7.4%, SVI or worse, 21.9% vs. 20.3% and MVI or worse 87.6 vs. 84.7%) (P < 0.001)].

Conclusion:
The institutions primarily provided surgery to patients with maximum need: too poor to pay, low visual acuity, and women. Similar data from all service providers of a region can help estimate the proposed “equitable cataract surgical rate”: the proportion of patients operated with maximum need among those operated in a year. This can be used for targeting people in need.
Sight-threatening intraocular infection in patients with COVID-19 in India
Authors: Nayak Sameera , Das Taraprasad , Parameswarappa Deepika , Sharma Savitri , Jakati Saumya , Jalali Subhadra , Narayanan Raja , Basu Soumyava , Tyagi Mudit , Dave Vivek Pravin , Pappuru Rajeev Reddy , Pathengay Avinash , Kaza Hrishikesh , Rani Padmaja Kumari , Behera Shashwat , Sahoo Niroj Kumar , Kapoor Aditya , Agrawal Hitesh , Agarwal Komal , Takkar Brijesh , Raval Vishal Ramesh 
Published: November 2021

Purpose:
Intraocular infection in patients with COVID-19 could be different in the presence of treatment with systemic corticosteroid and immunosuppressive agents. We describe the epidemiology and microbiological profile of intraocular infection in COVID-19 patients after their release from the hospital.

Methods:
We analyzed the clinical and microbiological data of laboratory-confirmed COVID-19 patients from April 2020 to January 2021 presenting with features of endogenous endophthalmitis within 12 weeks of their discharge from the hospital in two neighboring states in South India. The data included demography, systemic comorbidities, COVID-19 treatment details, time interval to visual symptoms, the microbiology of systemic and ocular findings, ophthalmic management, and outcomes.

Results:
The mean age of 24 patients (33 eyes) was 53.6 ± 13.5 (range: 5–72) years; 17 (70.83%) patients were male. Twenty-two (91.6%) patients had systemic comorbidities, and the median period of hospitalization for COVID-19 treatment was 14.5 ± 0.7 (range: 7–63) days. Infection was bilateral in nine patients. COVID-19 treatment included broad-spectrum systemic antibiotics (all), antiviral drugs (22, 91.66% of patients), systemic corticosteroid (21, 87.5% of patients), supplemental oxygen (18, 75% of patients), low molecular weight heparin (17, 70.8% of patients), admission in intensive care units (16, 66.6% of patients), and interleukin-6 inhibitor (tocilizumab) (14, 58.3% of patients). Five (20.8%) patients died of COVID-19-related complications during treatment for endophthalmitis; one eye progressed to pan ophthalmitis and orbital cellulitis; eight eyes regained vision >20/400. Fourteen of 19 (73.7%) vitreous biopsies were microbiologically positive (culture, PCR, and microscopy), and the majority (11 patients, 78.5%) were fungi.

Conclusion:
Intraocular infection in COVID-19 patients is predominantly caused by fungi. We suggest a routine eye examination be included as a standard of care of COVID-19.
Detection of SARS-CoV-2 RNA in a conjunctival swab sample in real-time-polymerase chain reaction positive COVID-19 patients and its association with comorbidity and severity at a designated COVID-19 hospital in Central India
Authors: Chawhan Anagha , Athale Ashish , Khan Khalid , Agarwal Saurabh , Paul Rajdeep , Iyer Karthik , Khadia Anjali , Som Vivek 
Published: November 2021

Purpose:
To evaluate the presence of SARS-CoV-2 RNA in the conjunctival swab sample of positive confirmed COVID-19 patients and to find out its association with comorbidity and severity of COVID-19 disease.

Methods:
We conducted an observational cross-sectional study at a dedicated tertiary COVID-19 hospital in central India for a period of 8 weeks from February 2021to March 2021. We included patients who tested positive for SARS-CoV-2 RNA through nasopharyngeal swab and were above 18 years of age. Swab samples have been collected within 48 h of admission. Conjunctival swab was taken from the lower fornix of both eyes and sent to microbiology laboratory for real-time- polymerase chain reaction (RT-PCR).

Results:
Out of 150 patients, conjunctival swab RT-PCR was positive in five patients (3.33%). Two patients had conjunctival manifestations in the form of conjunctivitis but conjunctival swab RT-PCR was negative in those patients. Among the RT-PCR positive patients, two (40%) were from mild, one (20%) was from moderate, and two (40%) were from severe category. No association could be established between conjunctival swab RT-PCR positivity and severity of the disease or associated comorbidity.

Conclusion:
Our study provides evidence that SARS-CoV-2 RNA could be detected in conjunctival secretions, and though the risk is relatively low, the eye may act as source of transmission. Extra caution should be taken by healthcare workers, and use of proper precautions like face shields and goggles should be encouraged.
Incidence, cumulative mortality and factors affecting the outcome of COVID-19-associated mucormycosis from Western India
Authors: Vare Archana Ajay , Yellambkar Snehalata , Farheen Asma , Nandedkar Varsha , Bhombe Swati S , Shah Rachana 
Published: November 2021

Purpose:
To report the incidence, cumulative mortality, and factors influencing the outcomes from a large series of COVID-19-associated mucormycosis (CAM) from western India.

Methods:
Consecutive patients with CAM between March 1 and May 10, 2021, with a minimum follow-up of 1 month were included. We recorded the presence of diabetes, use of steroids, and need for non-invasive ventilation (NIV) from the case files. The features of orbital involvement, treatment administered, and outcomes, i.e., death, orbital exenteration, or recovery were noted. Cumulative probability of adverse outcomes, defined as either death or exenteration, was reported using survival analysis.

Results:
We treated 67 cases of CAM and found an incidence of 13.6 cases per 1,000 patients post-moderate to severe COVID-19. Uncontrolled diabetes (90%) with ketoacidosis (40%) and prior systemic steroids (84%) were the strongest predispositions. The onset of CAM was 15.1 ± 9.5 days (range: 6–42 days) after recovery from COVID-19. The cumulative probability of an adverse outcome was 38% (95% confidence intervals [CI] = 23.7–56.9%) on day 20. The patients who required NIV during COVID-19 were at seven times higher risk of experiencing an adverse outcome (hazard ratios [HR] = 6.92, 95% CI = 2.9–16.2) while those who received amphotericin– -B had a 61% lower risk (HR = 0.39, 95% CI = 0.16–0.97).

Conclusion:
The current outbreak of CAM was seen predominantly in uncontrolled diabetics, especially with ketoacidosis and steroid intake. The cumulative probability of death or orbital exenteration was 38% at day 20 of the infection and those who required NIV and did not receive amphotericin-B were at a high risk of these outcomes.