bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nosocomial sepsis and drug susceptibility pattern among patients admitted to adult intensive care unit of Ayder Comprehensive Specialized Hospital, Northern Ethiopia
Authors: Dawit Tsega Cherkos , Mengesha Reiye Esayas , Ebrahim Mohamedawel Mohamedniguss , Tequare Mengistu Hagazi , Abraha Hiluf Ebuy 
Published: August 2021

Abstract
Objective
Developing nosocomial sepsis within intensive care unit (ICU) is associated with increased mortality, morbidity, and length of hospital stay. But information is scarce regarding nosocomial sepsis in intensive care units of Northern Ethiopia. Hence, this study aims to determine the incidence of nosocomial sepsis, associated factors, bacteriological profile, drug susceptibility pattern, and outcome among patients admitted to the adult ICU of Ayder Comprehensive Specialized Hospital (ACSH), which is the largest tertiary hospital in Northern Ethiopia.

Method
Facility-based longitudinal study was conducted by following 278 patients who were admitted for more than 48 h to adult ICU of ACSH, from October 2016 to October 2017. Data were collected from charts, electronic medical records, and microbiology registration book using a checklist. The collected data were subjected to descriptive statistics and multivariable logistic regression using SPSS version 25. Statistical significance was declared at p < 0.05.

Result
Of all the patients, 60 (21.6%) of them acquired nosocomial sepsis. The risk of mortality was about two times higher among adult ICU patients who acquired nosocomial sepsis (RR = 2.2; 95% CI of RR = 1.3–3.5; p = 0.003). The odds of acquiring nosocomial sepsis among those who were on a mechanical ventilator (MV) and stayed more than a week were 5.7 and 9.3 times higher, respectively, than their corresponding counterparts. Among 48 isolates, Klebsiella was the most common pathogen. The isolates had a broad antibiotic resistance pattern for cephalosporins, penicillins, and methicillin.

Conclusion
The incidence of nosocomial sepsis in the adult ICU patients of ACSH was higher when compared to the incidence reported from some African and Asian countries. Mortality was higher among patients who acquired nosocomial sepsis. Use of MV and longer length of ICU stay were the significant predictors of nosocomial sepsis. The isolates were resistant to several antibiotics. Therefore, strict application of infection prevention strategies and appropriate use of antibiotics is so crucial. As well, priority should be given to patients who develop nosocomial sepsis in ICU.
Use of monitoring indicators in hospital management of antimicrobials
Authors: da Silva Ravena Melo Ribeiro , de Mendonça Simonize Cunha B. , Leão Ingrid Novaes , dos Santos Quesia Nery , Batista Alessandra Macedo , Melo Matheus Santos , Xavier Milena da Motta , Quintans Júnior Lucindo José , da Silva Wellington Barros , Lobo Iza Maria Fraga 
Published: August 2021

Abstract
Background
According to the literature, 25% to 50% of antimicrobials prescribed in hospitals are unnecessary or inappropriate, directly impacting antimicrobial resistance. Thus, the present study aimed to evaluate the use of antimicrobials in a university hospital in Northeast Brazil, using days of therapy (DOT) and length of therapy (LOT) indicators in accordance with the latest national and international recommendations for monitoring the use of antimicrobials.

Methods
This is an observational, prospective analytical study conducted in a teaching hospital, with 94 active beds, distributed between the intensive care unit (ICU), the surgical clinic (SUR), the medical clinic (MED), the pneumology/infectology department (PNE/INF) and pediatrics (PED). The duration of the study was from the beginning of January to the end of December 2018.

Results
During the study period, a total of 11,634 patient-days were followed up and 50.4% of the patients were found to have received some antimicrobial, with a significant reduction in use of 1% per month throughout the year. Patients were receiving antimicrobial therapy for 376 days in every 1000 days of hospitalization (LOT = 376/1000pd). Overall, the 1st-generation cephalosporins and fluoroquinolones were the most used in respect of the number of prescriptions and the duration of therapy. The calculated global DOT/LOT ratio showed that each patient received an average of 1.5 antimicrobials during the hospital stay. The incidence of antimicrobial resistance, globally, for both methicillin-resistant Staphylococcus aureus (methicillin R), Carbapenem-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii (Carbapenem R), was 1 per 1000 patient-days.

Conclusions
The results obtained from the analyses revealed that half of the patients admitted to the hospital who took part in the study were exposed to the use of antimicrobials at some point during their stay. Although moderate, it is noteworthy that there was a decline in the use of antimicrobials throughout the year. The indicators used in this study were found to be very effective for gathering data on the use of antimicrobials, and assessing the results of the initiatives taken as part of the Stewardship program.
Epidemiology of patients with central nervous system infections, mainly neurosurgical patients: a retrospective study from 2012 to 2019 in a teaching hospital in China
Authors: Zhang Zheng , Song Yan , Kang Jianbang , Duan Surong , Li Qi , Feng Fuqiang , Duan Jinju 
Published: August 2021

AbstractBackgroundCentral nervous system (CNS) infections are relatively rare but are associated with high mortality worldwide. Empirical antimicrobial therapy is crucial for the survival of patients with CNS infections, and should be based on the knowledge of the pathogen distribution and antibiotic sensitivities. The aim of this study was to investigate the features of pathogens in patients with CNS infections in North China and evaluate the risk factors for mortality and multi-drug-resistant (MDR) bacterial infections.MethodsA retrospective study was conducted with patients with positive cerebrospinal fluid (CSF) cultures in a teaching hospital from January 2012 to December 2019. The following data were collected: demographic characteristics, laboratory data, causative organisms and antimicrobial sensitivity results. Data were analyzed with SPSS 16.0. Univariate analysis and binary logistic regression analyses were performed to identify the risk factors for mortality and MDR bacterial infections.ResultsA total of 72 patients were diagnosed with CNS infections, and 86 isolates were identified. The proportions of Gram-positive bacteria, Gram-negative bacteria and fungi were 59.3, 30.2 and 10.5%, respectively. The predominant Gram-positive bacteria was Coagulase-negativeStaphylococci.Acinetobacter baumannii,Escherichia coliandKlebsiellaspp. were the predominant Gram-negative bacteria. Compared to 2012–2015 years, the proportion of Gram-negative bacteria increased markedly during 2016–2019 years. Coagulase-negativeStaphylococci,Streptococcus pneumoniaeandEnterococcus faeciumhad 100% sensitivity to vancomycin, teicoplanin and linezolid.Acinetobacter baumanniiandKlebsiella pneumoniaewere 100% sensitive to tigecycline.Escherichia colihad 100% sensitivity to amikacin, meropenem and imipenem. The overall mortality rate in the 72 patients was 30.6%. In multivariate analysis, age > 50 years, pulmonary infections and CSF glucose level < the normal value were associated with poor outcomes. CSF adenosine deaminase level > the normal value and the presence of external ventricular drainage/lumbar cistern drainage were associated with MDR bacterial infections.ConclusionsThe mortality rate due to CNS infections reached 30.6% in our study. The proportion of Gram-negative bacteria has increased markedly in recent years. We should give particular attention to patients with risk factors for mortality and MDR bacterial infections mentioned above.
Possible role of HPV/EBV coinfection in anoikis resistance and development in prostate cancer
Authors: Nahand Javid Sadri , Khanaliha Khadijeh , Mirzaei Hamed , Moghoofei Mohsen , Baghi Hossein Bannazadeh , Esghaei Maryam , Khatami Ali Reza , Fatemipour Maryam , Bokharaei-Salim Farah 
Published: August 2021

Abstract
Background
This study aimed to evaluate the possible role of human papillomavirus (HPV) and Epstein–Barr virus (EBV) coinfection as an etiological factor for prostate cancer (PCa) development.

Methods
This case-control study was conducted on 67 patients with PCa and 40 control subjects. The expression levels of cellular and viral factors involved in inflammation, tumor progression, and metastasis were quantified, using the enzyme-linked immunosorbent assay (ELISA) and quantitative real-time polymerase chain reaction (qRT-PCR) assay.

Results
The EBV/HPV coinfection was reported in 14.9% of patients in the case group and 7.5% of the control subjects. The high-risk types of HPV, that is, HPV 16 and HPV 18, were responsible for 50 and 30% of HPV/EBV-coinfected PCa cases (n = 10), respectively. No significant relationship was observed between PCa and HPV/EBV coinfection (OR = 2.9, 95% CI: 0.18–45.2, P = 0.31). However, the highest percentage of HPV genome integration was found in the HPV/EBV-coinfected PCa group (8/10; 80%). Also, the mean expression levels of inflammatory factors (IL-17, IL-6, TNF-α, NF-κB, VEGF, ROS, and RNS), anti-apoptotic mediators (Bcl-2 and survivin), and anti-anoikis factors (Twist and N-cadherin) were significantly higher in the HPV/EBV-coinfected PCa group, compared to the non-coinfected PCa cases. Nevertheless, the tumor-suppressor proteins (p53 and pRb) and E-cadherin (inhibitor of anoikis resistance) showed significant downregulations in the HPV/EBV-coinfected PCa group, compared to the non-coinfected PCa cases.

Conclusion
The HPV/EBV coinfection may be an etiological factor for PCa through modulation of cellular behaviors.
Risk of hypertension in school-aged children with different parental risk: a longitudinal study from childhood to young adulthood
Authors: Amiri Parisa , Rezaei Marjan , Jalali-Farahani Sara , Karimi Mehrdad , Cheraghi Leila , Esbati Romina , Azizi Fereidoun 
Published: August 2021

Abstract
Background
Although previous studies have shown the relationship between different parental factors and children’s blood pressure status, there is limited data on the cumulative effect of these factors. Considering parental socio-demographic, behavioral and cardio-metabolic characteristics, the current study aimed to distinguish parental risk clusters and their impact on the incidence of hypertension in school-age children over 13 years.

Methods
Parental characteristics of 1669 children, including age, education, employment, smoking, physical activity, metabolic syndrome (MetS), hypertension (HTN), weight status, and diabetes were considered to categorize parents into low and high-risk clusters. Crude incidence rates (per 10,000 person-years) of HTN in children were assessed in each maternal and paternal cluster. Using Cox proportional hazard model, results on the association between parental risk clusters and HTN incidence in children were reported in five different models.

Results
Mean age of children was 13.96 ± 2.89 years, and 51.2% (n = 854) were girls. MetS, HTN, and weight status were the most important factors distinguishing low and high-risk parental clusters, respectively. Crude incidence rates (per 10,000 person-years) of HTN were 86 (95% CI: 71–106) and 38 (95% CI, 29–52) in boys and girls, respectively. Moreover, incidence rates (per 10,000 person-years) of HTN were 50 (95% CI, 40–63) and 80 (95% CI, 64–102) in maternal low and high-risk clusters, respectively. The incidence rates (per 10,000 person-years) of HTN in paternal low and high-risk clusters were 53 (95% CI, 41–70) and 68 (95% CI, 56–84), respectively.

Conclusion
Our findings underscore the prognostic value of maternal characteristics in predicting the incidence of HTN in their offspring. The current results could be valuable in planning related programs to prevent hypertension in similar communities.
Objectively measured physical activity and sedentary time in children with overweight, obesity and morbid obesity: a cross-sectional analysis
Authors: ten Velde Gabrielle , Plasqui Guy , Dorenbos Elke , Winkens Bjorn , Vreugdenhil Anita 
Published: August 2021

Abstract
Background
Limited physical activity (PA) and a high level of sedentary time (ST) are associated with childhood obesity and are a target for intervention. This study aimed to assess objectively measured PA and ST in Dutch children across weight categories, age groups and sex.

Methods
202 children with overweight, obesity and morbid obesity (55% girls, 12 ± 3y of age, BMI z-score + 3.15 ± 0.73), referred to the Centre for Overweight Adolescents and Children’s Healthcare (COACH, Maastricht UMC+) were included. PA (total PA, light PA and moderate to vigorous PA (MVPA)) and ST were measured with the GT3X Actigraph accelerometer. Wear time validation was set to include at least four days, 480 min/day, including one weekend day.

Results
PA levels in children with morbid obesity were higher compared to children with obesity, also after correction for age and sex (corrected difference (B) 118 counts per minute (cpm), p = .006). ST was lower in children with morbid obesity compared to children with obesity (B − 51 min/day, p = .018). Girls performed significantly less MVPA than boys (B − 11 min/day, p < .001) and for each year increase of age, children performed less PA (B − 46 cpm, p < .001) and ST increased (B 18 min/day, p < .001).

Conclusion
PA and ST is different in subgroups of children with overweight, obesity and morbid obesity, depending on sex, age and overweight severity. In particular, children with obesity perform less PA and more ST compared to children with morbid obesity. Future research could explore the preferences and needs for PA and ST in children in the different weight categories.

Trial registration
The trial is registered with Clinicaltrials.govNCT02091544 at March 19, 2014.
Gait biomechanics in patients with intra-articular tibial plateau fractures – gait analysis at three months compared with age- and gender-matched healthy subjects
Authors: Fändriks Anna , Tranberg Roy , Karlsson Jón , Möller Michael , Zügner Roland 
Published: August 2021

Abstract
Introduction
Tibial plateau fractures involve the knee joint, one of the most weight-bearing joints in the body. Studies have shown that gait asymmetries exist several years after injury. Instrumental gait analysis, generating both kinematic and kinetic data from patients with tibial plateau fractures, is uncommon.

Aim
To examine walking ability and knee range of motion in patients suffering intra-articular tibial plateau fractures.

Method
Twenty participants, eight males and 12 females, aged 44 years (range 26–60), with unilateral isolated tibial plateau fractures, were examined 12 weeks (range 7–20) after injury. The investigation consisted of passive range of motion (ROM) using a goniometer, six-minute walking test (6 MW), pain estimation using the visual analogue scale (VAS), the “Knee injury and Osteoarthritis Outcome Score” (KOOS) self-assessment questionnaire and instrumental 3-dimensional gait analysis (3DGA). 3DGA included spatiotemporal variables (speed, relative stance time, step length), kinematic variables (knee flexion, knee extension, ankle dorsiflexion) and kinetic variables (generating knee power (extension) and ankle power (plantarflexion)). A skin marker model with twenty reflective markers was used. Non-parametric tests were used for comparisons of the injured leg, the uninjured leg and a reference group.

Result
The participants walked more slowly compared with healthy references (p < 0.001). Stance time and step length was shorter for the injured side compared with the uninjured side (p < 0.014). Step length was shorter compared with the reference group (p = 0.001). The maximum knee extension in the single stance phase was worse in the injured side compared with the uninjured side and the reference group (p < 0.001) respectively. The maximum ankle dorsiflexion during stance phase was higher in the injured leg compared with the uninjured side and the reference group (p < 0.012). Maximum generated power in the knee was lower in the injured side compared with the uninjured side and the reference group (p < 0.001 respectively). The same was true of maximum power generated in the ankle (p < 0.023). The median KOOS value was lower in the study group (p < 0.001). ROM showed decreased flexion and extension in the knee joint and decreased dorsiflexion in the ankle joint compared with the uninjured side (p < 0.006). The average distance in the six-minute walking test was shorter in the study group (p < 0.001).

Conclusion
Patients who have sustained tibial plateau fractures generally display a limitation in their walking pattern 3 months after injury. These limitations are mainly related to the inability to extend the knee.
“Slipped capital femoral epiphysis in a 25-year-old hypogonadic man with a large cranial chondroma: causality or coincidence? “
Authors: Sawicka-Gutaj Nadia , Woźniak Waldemar , Naczk Jakub , Pochylski Mateusz , Kruczyński Jacek , Budny Bartłomiej , Szczepanek-Parulska Ewelina , Ruchała Marek 
Published: August 2021

Abstract
Background
Slipped capital femoral epiphysis (SCFE) is a hip disorder frequently occurring in adolescence. In adults it is rare and so far very few cases have been documented.

Case presentation
This report presents a 25-year-old patient diagnosed with an anterior fossa giant chondroma, hypogonadotropic hypogonadism, and SCFE. The patient underwent surgical and hormonal therapy. His symptoms revealed, and he became a father.

Conclusions
Every patient diagnosed with SCFE in adulthood should undergo endocrinological assessment based on physical examination and laboratory tests.
Predictors of self-medication with herbal remedies during pregnancy based on the theory of planned behavior in Kashan, Iran
Authors: Karimian Zahra , Sadat Zohreh , Afshar Bahareh , Hasani Maryam , Araban Marzieh , Kafaei-Atrian Mahbubeh 
Published: August 2021

Abstract
Background
The incidence of application of medicinal herbs during pregnancy has increased significantly among women over the past years; however, the safety and efficacy of medicinal herbs during pregnancy are still unclear. The aim of the present study was to categorize the predictors of self-medication with herbal remedies during pregnancy based on the theory of planned behavior (TPB).

Methods
The present descriptive-analytical study was conducted on 300 pregnant women referred to Kashan health center to receive prenatal care services in 2020. The study participants were randomly selected using stratified random sampling with proportional allocation. The data collection tool was a two-part researcher made questionnaire. The first part of the questionnaire included demographic information, midwifery information, and questions related to women’s awareness about herbal medicine. The second part of the questionnaire was designed based on the theory of planned behavior including attitudes, perceived behavioral control, subjective norms, intention, and behavior performance. Data were analyzed using descriptive statistics, regression analysis, and SPSS version 18.0.

Results
The mean age of participants was 28. 7±5.4 years (range, 15–45 years), the majority were housewives (88.3%) and had secondary education (39.3%). A total of 164 women (57. 1%) used medicinal herbs during pregnancy. The individual’s attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with behavioral intention (P < 0.05). Similarly, subjective norms were the most predictor of using herbal medicine among pregnant women (P < 0.05).

Conclusion
The findings revealed that more than 50 % of pregnant women used medicinal herbs during pregnancy. The present study showed that the individual’s attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with intention of herbal medicine use among pregnant women. Likewise, subjective norms were the most predictor of herbal medicine use among pregnant women. The TPB should be addressed in planning health education programs and modifying health behaviors, including self-medication, especially during pregnancy.
Barriers to accessing health care among undocumented migrants in Sweden - a principal component analysis
Authors: Mona Hatem , Andersson Lena M.C. , Hjern Anders , Ascher Henry 
Published: August 2021

Abstract
Background
Undocumented migrants face many hardships in their everyday life such as poor living conditions, discrimination, and lack of access to healthcare. Previous studies have demonstrated considerable health care needs for psychiatric disorders as well as physical diseases. The aim of this paper was to find out the main barriers that undocumented migrants experience in accessing the Swedish healthcare system and to explore their relation with socioeconomic factors.

Methods
A cross-sectional study with adult undocumented migrants was performed in the three largest cities of Sweden in 2014–2016. Sampling was done via informal networks. A socioeconomic questionnaire was constructed including 22 barriers to health care. Trained field workers conducted the interviews. A principal component analysis was conducted of all barriers to reveal central components. Then, Pearson’s chi-squared test was used to explore the characteristics of undocumented migrants experiencing barriers to care.

Results
Two main components/barriers were extracted: “Fear of being taken by police/authorities”, which was related to fear of disclosure by or in relation to seeking health care, and “Structural and psychosocial factors” which was related to practical obstacles or shame of being ill. Lower age (74.1 % vs 56.0 %), lower level of education (75.0 % vs. 45.1 %), and having no children (70.3 % vs. 48.1 %) were significantly related to a higher likelihood of experiencing a barrier.

Conclusion
Fear of deportation and practical and psychosocial factors constitute hinderance of access to healthcare for undocumented migrants in Sweden. This highlights the importance of clear instructions, both to undocumented migrants and health professionals about the right to health care according to the international law on human rights as well as the law of confidentiality.