bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of frailty and associated factors among Saudi community-dwelling older adults: a cross-sectional study
Authors: Alqahtani Bader A. , Alenazi Aqeel M. , Alshehri Mohammed M. , Osailan Ahmed M. , Alsubaie Saud F. , Alqahtani Mohammed A. 
Published: March 2021

Abstract
Background
Prevalence of frailty has been previously established in different Western countries; however, the prevalence and the burden of in the aging populations of Saudi Arabia has not been examined. Therefore, the aim of this study was to examine the prevalence of frailty, and associated factors among Saudi older population.

Methods
The study included a total of 486 community-dwelling elderly adults aged 60 years and over living in the Riyadh area. This study took place from August 2019 to June 2020. The prevalence of frailty was determined using the Fried’s frailty phenotype. Association between sociodemographic features and clinical factors and frailty was estimated by Odds Ratio and confidence intervals (OR, IC 95%) using a multinomial logistic regression model.

Results
The overall prevalence of pre-frailty and frailty were 47.3 and 21.4%, respectively. The following factors were associated with being frail: age (OR: 6.92; 95%CI 3.11–15.41); living alone (OR: 2.50; 95%CI: 1.12–5.59); had more chronic conditions (OR: 1.96; 95%CI: 1.16–3.30); and cognitive impairment (OR: 7.07; 95%CI: 3.92–12.74).

Conclusions
The Compared with other populations, the prevalence of frailty and pre-frailty in the Riyadh region of Saudi Arabia was high. The implications of frailty in this population should be discussed in future study.
Knowledge and attitude towards cutaneous leishmaniasis among rural endemic communities in Shara’b district, Taiz, southwestern Yemen
Authors: Alharazi Talal H. , Haouas Najoua , Al-Mekhlafi Hesham M. 
Published: March 2021

Abstract
Background
Cutaneous leishmaniasis (CL), a neglected tropical disease, represents a significant public health problem in many endemic countries including Yemen. The ongoing armed conflict that started in March 2015 has had a negative impact on the entire healthcare system as well as on infectious disease control programmes. Therefore, this cross-sectional study aimed to assess knowledge and attitude towards CL among rural endemic communities in southwestern Yemen.

Methods
Five hundred households in five areas of Shara’b district of Taiz governorate were randomly selected to participate in a quantitative survey. A pretested structured questionnaire was used to collect data on the sociodemographic characteristics of the participants, their knowledge and attitude towards CL and their knowledge on the sand fly vector.

Results
The analysis was conducted on a final sample of 466 individuals (62.7% males and 37.3% females) aged between 18 and 70 years. Among the participants, 21.5% were non-educated while 39.7 and 20.8% had completed secondary school and tertiary education, respectively. Although the participants were aware of CL, about three quarters (77.7%) of them had poor overall knowledge about disease transmission, clinical presentation, treatment, and prevention. Interestingly, approximately half of the participants (49.1%) were able to differentiate sand flies from other flies and mosquitoes. However, only 14.8% of the participants knew about the role of the phlebotomine sand fly in the transmission of CL. Only 36.6% believed that CL can be prevented and 49.6% had a negative attitude towards the disease. Univariate and multivariate analyses showed that age and gender were the significant determinants of knowledge about CL and the sand fly vector among the studied population.

Conclusion
A poor level of knowledge about the different epidemiological aspects of CL was found among rural CL-endemic communities in Taiz. This factor, together with the major collapse of the healthcare infrastructure due to the ongoing civil war in Yemen, may be contributing to the continued endemicity of CL in the governorate. It is therefore recommended that health education on CL transmission and prevention should be provided to the targeted communities.
Impact of 18F-FDG PET/CT, CT and EBUS/TBNA on preoperative mediastinal nodal staging of NSCLC
Authors: Al-Ibraheem Akram , Hirmas Nader , Fanti Stefano , Paez Diana , Abuhijla Fawzi , Al-Rimawi Dalia , Al-Rasheed Ula , Abdeljalil Riad , Hawari Feras , Alrabi Kamal , Mansour Asem 
Published: March 2021

Abstract
Background
Staging of non-small-cell lung cancer (NSCLC) is a multidisciplinary process involving imaging, endoscopic and surgical techniques. This study aims at investigating the diagnostic accuracy of 18F-FDG PET/CT, CT scan, and endobronchial ultrasound/transbronchial needle aspirate (EBUS/TBNA) in preoperative mediastinal lymph nodes (MLNs) staging of NSCLC.

Methods
We identified all patients who were diagnosed with NSCLC at the King Hussein Cancer Center in Amman, Jordan, between July 2011 and December 2017. We collected their relevant clinical, radiological, and histopathological findings. The per-patient analysis was performed on all patients (N = 101) and then on those with histopathological confirmation (N = 57), followed by a per-lymph-node-station basis overall, and then according to distinct N-stage categories.

Results
18F-FDG PET/CT, in comparison to CT, had a better sensitivity (90.5% vs. 75%, p = 0.04) overall and in patients with histopathological confirmation (83.3% vs. 54.6%), and better specificity (60.5% vs. 43.6%, p = 0.01) overall and in patients with histopathological confirmation in MLN staging (60.6% vs. 38.2%). Negative predictive value of mediastinoscopy, EBUS/TBNA, and 18F-FDG PET/CT were (87.1%), (90.91%), and (83.33%) respectively. The overall accuracy was highest for mediastinoscopy (88.6%) and EBUS/TBNA (88.2%), followed by 18F-FDG PET/CT (70.2%). Dividing patients into N1 disease vs. those with N2/N3 disease yielded similar findings. Comparison between 18F-FDG PET/CT and EBUS/TBNA in patients with histopathological confirmation shows 28 correlated true positive and true negative findings with final N-staging. In four patients, 18F-FDG PET/CT detected metastatic MLNs that would have otherwise remained undiscovered by EBUS/TBNA alone. Lymph nodes with a maximal standardized uptake value (SUVmax) more than 3 were significantly more likely to be true-positive.

Conclusion
Multimodality staging of the MLNs in NSCLC is essential to provide accurate staging and the appropriate treatment. 18F-FDG PET/CT has better overall diagnostic utility when compared to the CT scan. The NPV of 18F-FDG PET/CT in MLNs is reliable and comparable to the NPV of EBUS/TBNA. SUVmax of MLNs can help in predicting metastases, but nevertheless, a positive 18F-FDG PET/CT MLNs particularly if such a result would change the treatment plan, should be verified histopathologically.
Exploring factors associated with pain in hemodialysis patients: a multicenter cross‐sectional study from Palestine
Authors: Marzouq Maha K. , Samoudi Aseel F. , Samara Ahmad , Zyoud Sa’ed H. , Al-Jabi Samah W. 
Published: March 2021

Abstract
Background
Chronic kidney disease (CKD) is a rising medical concern around the world. End-stage kidney disease (ESKD) is the last stage of CKD stages that necessitates renal replacement therapy (RRT), such as hemodialysis (HD), which seems to be the most commonly used type. However, patients on HD still suffer from high mortality and morbidity rates compared to those who receive a kidney transplant. Therefore, we aimed in this study to assess the prevalence of pain among ESKD patients on HD, as well as to explore the factors that were associated with this complaint.

Methods
We conducted a multicenter cross-sectional study in the West Bank, Palestine, between August and November 2018. We used questionnaire-based direct interviews with subjects. After reviewing previous studies in the field, we developed our questionnaire and included items on patients’ social, demographic, and clinical characteristics, including dialysis-related data. It also contained the Brief Pain Inventory (BPI) to assess different aspects of pain symptoms. A convenience sampling technique was used to collect data.

Results
Of the 300 participants, 66.3 % reported having chronic pain. HD sessions themselves were the most commonly cited cause for pain (21.6 %). The most commonly cited site of pain was the upper and lower limbs (37.3 %). Paracetamol was the most frequently used pharmacotherapy for pain alleviation. Multiple regression analysis showed that BMI (p = 0.018), gender (p = 0.023), and the number of comorbidities (p < 0.001) were independently associated with pain severity score.

Conclusions
Pain is a highly prevalent symptom among HD patients in Palestine. Subpopulations with higher pain severity include females, patients with higher BMI, and those with multiple comorbidities. Healthcare providers should routinely assess pain in HD patients as it is considered a significant concern. This would involve pain assessment and development of a treatment plan to improve clinical outcomes. The nephrology associations should also push for pain management in HD patients as a clinical and research priority to improve pain-related disability.
Comparing the diagnostic value of Echocardiography In Stroke (CEIS) – results of a prospective observatory cohort study
Authors: Schnieder Marlena , Chebbok Mohammed , Didié Michael , Wolf Frieder , Badr Mostafa , Allam Ibrahim , Bähr Mathias , Hasenfuß Gerd , Liman Jan , Schroeter Marco Robin 
Published: March 2021

Abstract
Background
Echocardiography is one of the main diagnostic tools for the diagnostic workup of stroke and is already well integrated into the clinical workup. However, the value of transthoracic vs. transesophageal echocardiography (TTE/TEE) in stroke patients is still a matter of debate. Aim of this study was to characterize relevant findings of TTE and TEE in the management of stroke patients and to correlate them with subsequent clinical decisions and therapies.

Methods
We evaluated n = 107 patients admitted with an ischemic stroke or transient ischemic attack to our stroke unit of our university medical center. They underwent TTE and TEE examination by different blinded investigators.

Results
Major cardiac risk factors were found in 8 of 98 (8.2%) patients and minor cardiac risk factors for stroke were found in 108 cases. We found a change in therapeutic regime after TTE or TEE in 22 (22.5%) cases, in 5 (5%) cases TEE leads to the change of therapeutic regime, in 4 (4%) TTE and in 13 cases (13.3%) TTE and TEE lead to the same change in therapeutic regime. The major therapy change was the indication to close a patent foramen ovale (PFO) in 9 (9.2%) patients with TTE and in 10 (10.2%) patients with TEE (p = 1.000).

Conclusion
Major finding with clinical impact on therapy change is the detection of PFO. But for the detection of PFO, TTE is non inferior to TEE, implicating that TTE serves as a good screening tool for detection of PFO, especially in young age patients.

Trial registration
The trial was registered and approved prior to inclusion by our local ethics committee (1/3/17).
Design and psychometric evaluation of epilepsy-related apathy scale (E-RAS) in adults with epilepsy: a sequential exploratory mixed methods design
Authors: Shamsalinia Abbas , Moradi Mozhgan , Rad Reza Ebrahimi , Ghadimi Reza , Farahani Mansoureh Ashghali , Masoudi Reza , Rabiei Leili , Ghaffari Fatemeh 
Published: March 2021

AbstractBackgroundApathy in patients with epilepsy is associated with a wide range of consequences that reduce the patient’s ability to perform social functions and participate in self-care and rehabilitation programs. Therefore, apathy is one of the important diagnoses of the healthcare team in the process of caring for epileptic patients and its dimensions need to be examined and recognized. Therefore, appropriate instruments with the sociocultural milieu of each community should be provided to health care providers. The aim of the present study was to design and measure epilepsy–related apathy scale (E-RAS) in adults with epilepsy.MethodsThis study of sequential exploratory mixed methods design was conducted in Iran from April 2019 to December 2019. In the Item generation stage, two inductive (face-to-face and semi-structured interviews with 17 adult epileptic patients) and deductive (literature review) were used. In item reduction, integration of qualitative and literature reviews and scale evaluation were accomplished. For Scale Evaluation, face, content, construct [exploratory factor analysis (EFA) (n = 360) and confirmatory factor analysis (CFA) (n = 200)], convergent and divergent Validity and reliability (internal consistency and stability) were investigated.ResultsThe results of EFA showed that E-RAS has four factors, namely, motivation; self-regulatory; cognition and emotional-effective. These four latent factors accounted for a total of 48.351% of the total variance in the E-RAS construct. The results of CFA showed that the 4-factor model of E-RAS has the highest fit with the data. The results of convergent and divergent validity showed that the values of composite reliability (CR) and average variance extracted (AVE) for the four factors were greater than 0.7 and 0.5, respectively, and the value of AVE for each factor was greater than CR. The Cronbach’s alpha coefficient for the whole scale was obtained 0.815. The results of the test-retest showed that there was a significant agreement between the test and retest scores (P < 0.001).ConclusionE-RAS is a multidimensional construct consisting of 24 items, and has acceptable validity and reliability for the study of epilepsy-related apathy in adult epileptic patients.
The association between economic indicators and the incidence of tetraplegia from traumatic spinal cord injury in Taiwan
Authors: Lien Wei-Chih , Wang Wei-Ming , Wang Jung-Der , Wang Fuhmei 
Published: March 2021

Abstract
Background
Economic performance may affect public health parameters. This study aimed to determine the time trend of incidence of traumatic spinal cord injury (SCI) and its association with income, presented by GDP (gross domestic product) per capita.

Methods
This study was a retrospective observational study in Taiwan. Newly diagnosed SCI patients with moderate to severe disability from 2002 to 2015 were identified from the reimbursement database of the National Health Insurance (NHI) system (1998–2015). CIR16–99 (cumulative incidence rate, aged 16–99 years, per 103 person-years) and CIR16–59 (aged 16–59 years) of SCI from 2002 to 2015 were measured.

Results
There were 5048 newly diagnosed SCI patients during the study period. After controlling the factors of sex, urbanization level, literacy, income inequality, and global financial crisis (mixed effects models), the CIR16–99 of SCI, traumatic SCI, motor vehicle (MV)-related SCI, fall-related SCI, tetraplegia, traumatic tetraplegia, MV-related tetraplegia, and fall-related tetraplegia were inversely associated with GDP per capita; the β coefficients ranged from − 4.85 (95% confidence interval − 7.09 to − 2.6) for total SCI to − 0.8 (− 1.3 to − 0.29) for fall-related tetraplegia. We restricted our comparison to Taipei City and the 4 lowest densely populated counties, which also corroborated with the above results. The income elasticity analysis revealed when GDP per capita increased by 1%, the total SCI decreased by 1.39‰; which was also associated with a decrease of 1.34‰, 1.55‰, 1.36‰, 1.46‰, 1.54‰, 1.54‰, and 1.62‰ for traumatic SCI, MV-related SCI, fall-related SCI, tetraplegia, traumatic tetraplegia, MV-related tetraplegia, and fall-related tetraplegia respectively. The β coefficients show that the compared areas of urbanization level were also inversely correlated with CIR16–59 in the SCI population.

Conclusions
We conclude that the incidence of tetraplegia of traumatic SCI in Taiwan decreases with good economic performance, which may be resulted from the provision of public goods and services, possibly through improvements in the infrastructure of transportation and construction.
Improvement in mild anti-IgLON5 encephalopathy without immunotherapy: a case report
Authors: Wang Yuting , Wu Xiuling , Lu Baoquan 
Published: March 2021

Abstract
Background
Anti-IgLON5 antibody-related encephalopathy is a recently discovered and rare autoimmune disease, and its diagnosis and treatment are more challenging than for other autoimmune encephalopathic diseases. Sleep disorder is the most prominent symptom of the disease. It can also present with gait instability, dysarthria, dysphagia, dementia, ataxia, autonomic nervous system dysfunction, chorea, vertical gaze paralysis, and other symptoms. Immunotherapy remains the primary treatment for this disease; however, there is no definitive conclusion regarding the effect of immunotherapy. The clinical symptoms of the reported cases of anti-IgLON5 antibody-related encephalopathy were generally severe. However, the symptoms in our patient were mild and relieved without immunotherapy, unlike the previously reported cases.

Case presentation
A 62-year-old man presented with behavioural abnormalities and involuntary movements after nearly 2 months of fever and headache. He also had symptoms of mild sleep disorder. Due to the abnormal levels of infection-related indicators, antiviral treatment was started on the day of admission. The serum analysis confirmed the presence of IgLON5 antibody, and the patient was found to be genetically susceptible. The patient’s symptoms resolved rapidly without immunotherapy and did not recur.

Conclusions
This case demonstrated that IgLON5 antibody-related encephalopathy might have mild manifestations. Infection and a genetic predisposition may be important causes for the disease. Patients with a mild disease may have a better prognosis.
Samba II PCR testing for COVID-19 in pregnant women: a retrospective cohort study and literature review
Authors: Xu Ruiling , Pauley Tara Alicia , Missfelder-Lobos Hannah , Haddon Richard John , Gupta Ravindra Kumar , Chong Hsu Phern 
Published: March 2021

Abstract
Background
Asymptomatic carriage of COVID-19 in pregnant women has been reported and could lead to outbreaks in maternity units. We sought to ascertain the impact of rapid isothernal nucleic acid based testing for COVID-19 in an unselected cohort of pregnant women attending our maternity unit. We also assessed the correlation between community prevalence and asymptomatic carriage.

Methods
Data for the retrospective cohort study were collected from a large UK tertiary maternity unit over a 4-week period using computerised hospital records. Literature searches were performed across multiple repositories. COVID-19 prevalence was extracted from online repositories.

Results
Nasopharyngeal and oropharyngeal swabs were obtained from 457/465 (98%) women during the study period. The median turnaround time for results was 5.3 h (interquartile range (IQR) 2.6–8.9 h), with 92% of the results returned within 24 h. In our cohort, only one woman tested positive, giving a screen positive rate of 0.22% (1/457; 95% CI: 0.04–1.23%). One woman who tested negative developed a fever postnatally following discharge but was lost to follow-up. From our literature review, we did not find any correlation between asymptomatic carriage in pregnant women and the reported regional prevalence of COVID-19.

Conclusions
Testing using the SAMBA-II machine was acceptable to the vast majority of pregnant women requiring admission and had a low turnaround time. Asymptomatic carriage is low, but not correlated to community prevalence rates. Screening pregnant women on admission will remain an important component in order to minimise nosocomial infection.
Marginal cord insertion among singleton births at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia
Authors: Aragie Hailu , Oumer Mohammed 
Published: March 2021

Abstract
Background
Umbilical cord may insert abnormally i.e. marginal insertion to a placenta which can cause different birth and perinatal complications. Despite the increased effort taken by different responsible bodies, the prevalence of birth and perinatal complications are still high, possibly due to anomalous cord insertion. So far, anomalous cord insertion lacks proper attention in different medical settings. Hence, the present study aims to assess the magnitude, risk factors, and adverse birth outcomes of marginal cord insertion among singleton births.

Methods
An institution-based cross-sectional study design was conducted. A systematic random sampling technique was used to select study participants. Data were collected by using a structured questionnaire and it was entered into epi-data version 3.1 then exported to SPSS version 20 for data cleansing and analysis. Bi-variable and multivariable logistic regressions were employed to identify risk factors and adverse outcomes associated with marginal cord insertions. Crude and adjusted odds ratio (P-value < 0.05) with a 95% confidence interval were calculated.

Result
The magnitude of marginal cord insertion was 6.4% (95% CI = 4.4–8.8%) in singleton pregnancies. Independent risk factors for marginal cord insertion were advanced maternal age (AOR = 2.24, 95% CI: 1.35–11.08), primiparity (AOR = 1.98, 95% CI: 1.37–8.69), maternal chronic hypertension (AOR = 3.07, 95% CI: 1.66–9.76), previous cesarean delivery (AOR = 2.51, 95% CI: 1.43–10.21), and use of intrauterine contraceptive device before pregnancy (AOR = 2.22, 95% CI: 1.36–12.30). Pregnancies complicated by marginal cord insertion are at higher risk to develop low birth weight (AOR = 2.89, 95% CI: 1.23–6.80), preterm birth (AOR = 4.00, 95% CI: 1.44–11.14), and emergency cesarean delivery (AOR = 3.68, 95% CI: 1.03–13.81).

Conclusion and recommendation
Marginal cord insertion is a mistreated potential risk for low birth weight, preterm birth, and emergency cesarean delivery. Routine screening of marginal cord insertion should be considered in pregnancies with advanced age, nulliparity, hypertensive disorder, history of cesarean section, and intrauterine contraceptive device usage before pregnancy.