bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prospective randomized controlled study comparing intravenous dexmedetomidine plus ketamine combination with intravenous dexmedetomidine alone for awake fibreoptic nasotracheal intubation
Authors: Jamgade Deepali , Fultambkar Gajanan , Dara Sudheer , Vijayanand B. , Nair Abhijit 
Published: February 2021

Abstract
Background
The purpose of this study was to compare the efficacy and safety of dexmedetomidine versus dexmedetomidine and ketamine for sedation during awake fibreoptic intubation (FOI) in patients posted for elective surgeries. Ninety-eight American Society of Anesthesiologists Physical Status (ASA-PS) I–II patients with difficult airway and scheduled for elective surgeries were enrolled in this study after institutional ethics committee approval. Patients were randomly allocated into 2 groups, i.e. 49 patients in each group. Group D patients received 1 μg/kg dexmedetomidine IV over 10 min in 100-mL normal saline followed by a continuous infusion at 0.5 μg/kg/h till FOI and 5-mL normal saline followed by saline infusion. Group DK patients received 1 μg/kg dexmedetomidine IV over 10 min in 100-mL normal saline. Further, they received IV ketamine 15 mg as a bolus of 5 mL, followed by continuous infusion of ketamine at 20 mg/h until the end of intubation. The primary objective was to compare the efficacy of the combination of IV dexmedetomidine and ketamine with IV dexmedetomidine alone as sedation for FOI. Vocal cord movement, sedation, coughing, facial grimace score, recall of procedure, and haemodynamics were also compared in both groups.

Results
Demographic data, vocal cord movement, cough score, facial grimace score, total drugs used, hoarseness, sore throat and level of recall were comparable in both groups. Haemodynamics were significantly better in group DK at 2, 3, 4 and 5 min compared to group D.

Conclusions
Addition of ketamine to dexmedetomidine did not improve intubating conditions, reduce cough or improve recall of FOI. However, patients remain sedated when ketamine was used with dexmedetomidine. The study was not registered prospectively in any clinical trial registry.
Is rituximab effective for systemic sclerosis? A systematic review and meta-analysis
Authors: de Figueiredo Caldas Marina Maria Vieira , de Azevedo Kesley Pablo Morais , de França Nunes Ana Clara , de Oliveira Victor Hugo , Pimenta Isac Davidson Santiago Fernandes , de Araújo Isabela Dantas Torres , Neto Francisco Alves Bezerra , da Silveira Gonçalves de Oliveira Ana Katherine , Piuvezam Grasiela 
Published: February 2021

Abstract
Background
Systemic sclerosis (SSc) is a clinically complex and challenging disease, that leads to skin fibrosis. Its most frequent complication is interstitial lung disease (ILD), which leads to a worse prognosis. In this situation, cyclophosphamide is considered the gold standard for its treatment, despite the controversies regarding its efficacy and toxicity. However, studies using rituximab (RTX) have shown that this drug may be a promising therapeutic option.

Objectives
This paper objective was to analyze the scientific evidence on the RTX effects on SSc.

Methods
A systematic review (SR) was performed including clinical trials (CTs) on the use of RTX in SSc, published up to May 2020. The studies were identified through systematic searches in bibliographic databases using a predefined search strategy. The following databases were used: PUBMED, SCOPUS, SCIELO, LILACS, SCIENCE DIRECT, WEB OF SCIENCE, COCHRANE, WHOLIS, PAHO and EMBASE. Also, a manual search was performed. The methodological quality of the studies was determined using Jadad scale, Risk of Bias Tool (RoB 2.0) and Risk of Bias in Non-Randomized Studies - of Interventions tool (ROBINS-I). A meta-analysis of the randomized CTs was performed, using Review Manager.

Results
Ten CTs were included in this SR. Of these, three were randomized and seven were non-randomized. Five showed a statistically significant improvement in forced vital capacity (FVC) at some time during follow-up. Regarding the skin, eight studies showed statistically significant improvements according toa the modified Rodnan skin score. The meta-analysis found positive effects of RTX in SSc, with a statistical significance for lung disease.

Conclusion
Rituximab is a promising strategy for the SSc-associated ILD and cutaneous fibrosis treatment.
PROSPERO registration number: CRD42019132018.
Study of the relation between serum levels of long-acting penicillin and the inflammatory markers: C-reactive protein and interleukin-6 in patients with chronic rheumatic heart disease
Authors: Yousef Ahmad M. , Rifaie Osama A. , Hamza Mohamed A. , Amin Sameh A. 
Published: February 2021

Abstract
Background
There is an evidence of a chronic inflammatory state in patients with chronic rheumatic valvular heart disease (RHD) as shown by high serum levels of high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL6). Despite the efficacy of long-acting penicillin (LAP) in secondary prevention of rheumatic fever, its effect on this inflammatory state is still unknown. So, we sought to study the effect of LAP on the inflammatory markers, CRP and IL-6, in patients with chronic rheumatic heart disease.

Results
Eighty RHD patients coming to our hospital’s outpatient clinic for rheumatic fever secondary prophylaxis by regular administration of LAP were enrolled in the study. Patients were divided into 3 groups: group A, 70 patients with RHD already on prophylactic LAP, group B, 10 patients with RHD who have not yet started prophylactic LAP, and group C, control group of 10 healthy individuals not known to have RHD. Serum levels of LAP, IL-6, and CRP were measured for the three groups.
Group A had significantly lower IL-6 levels than group B (25.22 ± 33.50 vs. 126.1 ± 33.76nng/ml, respectively, p < 0.0001). IL-6 levels were significantly lower in control subjects compared to patients in group B (3.600 ± 2.319, 25.22 ± 33.50 ng/ml, respectively, p < 0.0001). However, IL-6 levels in the control group were lower but non-significantly different compared to group A. CRP level was lower in group A than group B (8419 ± 4935 vs. 14400 ± 3375 mg/dl, respectively, p = 0.0002). CRP levels were significantly lower in control subjects compared to patients in group A and group B. IL-6 values were positively correlated with CRP values (r = 0.6387, p < 0.0001).
CRP values were negatively correlated with LAP values (r = -0.5277, p < 0.0001). IL-6 values were negatively correlated with LAP values (r = − 0.4401, p < 0.0001). There was a highly significant difference between LAP level in compliant and non-compliant patients (1.045 ± 1.270 vs. 0.0785 ± 0.1057 ng/ml, respectively, p value < 0.0001).
There was also a highly significant difference between CRP level in compliant and non-compliant patients (7640 ± 4558 vs. 13090 ± 4717 mg/dl, respectively, p = 0.005). Moreover, there was a significant difference between IL-6 levels in compliant and non-compliant patients (21.53 ± 32.70 vs. 47.40 ± 30.91 ng/ml, respectively, p value 0.03).

Conclusion
Serum LAP has a strong negative correlation with IL-6 and CRP levels. Regular administration of LAP strongly ameliorates the inflammatory state seen in patients with RHD.
CO-RADS versus CT-SS scores in predicting severe COVID-19 patients: retrospective comparative study
Authors: Zayed Niveen E. , Bessar Manar A. , Lutfy Samah 
Published: February 2021

Abstract
Background
The role of CT in assessing and plotting viral pulmonary affection land marking is its potential among other investigation tools, and the aim of the study was to compare the ability of two different CT-based scoring systems in discriminating severe COVID-19 disease.

Results
Retrospective comparative study included 142 confirmed COVID-19 patients by real-time polymerase chain reaction (RT-PCR) test, with different degrees of disease (mild to severe), the data of patients collected from medical records, and patients with their first CT chest read for calculating CO-RADS and severity scoring system (CT-SS) score. The patients with severe COVID-19 disease were significantly older and had different comorbidities. The level of C-reactive protein, ESR, ferritin, and LDH were significantly higher in severe disease, P < 0.001. The ability of CT chest and its score bases (CT-SS and CO-RADS) were accurate in differentiation between mild/moderate and severe disease; AUC were 89% and 97%, respectively. The cutoff value of less than 7.5 and 4.5 for CT-SS and CO-RADS, respectively, can rule out severe COVID-19 by 90% and 97%, respectively.

Conclusions
CT chest play a segregate role in COVID-19 disease, add on an advantage in clinical data in triage, and highlight the decision of hospital admission.
How to Train for a 5K—What Does the Science Say?
Authors: Garcia Jared T. , Kravitz Len 
Published: February 2021

Apply It!
• This article provides a realistic and scientific approach for developing a 12-week training program for an intermediate-level recreational runner preparing for their first 5K race.
• The fitness professional should expect to gain knowledge on an effective field test used to determine initial fitness and estimate the lactate threshold.
• Rating of perceived exertion (RPE) is a valuable tool for prescribing endurance exercise to an intermediate-level runner. RPE is simple to use and relates to the three-zone intensity model.
• Using different tools, such as the Profile of Mood State Questionnaire, will help to monitor your client. This approach may assist in your prevention of overtraining and decreased motivation and may keep training exciting so that the client can meet their goals.
Fitness Watches and Nutrition Apps: Behavioral Benefits and Emerging Concerns
Authors: Scheid Jennifer L. , Lupien Shannon P. 
Published: February 2021

Apply It!
By reading this article, the health and fitness professional will
• be able to understand how fitness watches and nutrition apps can influence self-monitoring and thereby, in turn, behavior change; and
• be able to recognize some of the emerging risks and associations between using fitness watches and nutrition apps and certain disordered behaviors.
Identification of Three Loci Associated with Achilles Tendon Injury Risk from a Genome-wide Association Study
Authors: KIM STUART K. , NGUYEN CONDOR , AVINS ANDY L. , ABRAMS GEOFFREY D. 
Published: February 2021

ABSTRACT

Purpose
This study aimed to screen the entire genome for genetic markers associated with risk for Achilles tendon injury.

Methods
A genome-wide association analysis was performed using data from the Kaiser Permanente Research Board and the UK Biobank. Achilles tendon injury cases were identified based on electronic health records from the Kaiser Permanente Research Board databank and the UK Biobank from individuals of European ancestry. Genome-wide association analyses from both cohorts were tested for Achilles tendon injury using a logistic regression model adjusting for sex, height, weight, and race/ethnicity using allele counts for single nucleotide polymorphisms (SNP). Previously identified genes within the literature were also tested for association with Achilles tendon injury.

Results
There were a total of 12,354 cases of Achilles tendon injury and 483,080 controls within the two combined cohorts, with 67 SNP in three chromosomal loci demonstrating a genome-wide significant association with Achilles tendon injury. The first locus contains a single SNP (rs183364169) near the CDCP1 and TMEM158 genes on chromosome 3. The second locus contains 65 SNP in three independently segregating sets near the MPP7 gene on chromosome 10. The last locus contains a single SNP (rs4454832) near the SOX21 and GPR180 genes on chromosome 13. The current data were used to test 14 candidate genes previously reported to show an association with Achilles tendon injury, but none showed a significant association (all P > 0.05).

Conclusion
Three loci were identified as potential risk factors for Achilles tendon injury and deserve further validation and investigation of molecular mechanisms.
Effect of Static Alignment on Dynamic Knee Abduction Moments in Adolescent Athletes with Recent ACL Reconstruction
Authors: MUESKE NICOLE M. , ABOUSAMRA OUSSAMA , KATZEL MIA J. , VANDENBERG CURTIS D. , PACE J. LEE , FEIFER DANIEL , WREN TISHYA A. L. 
Published: February 2021

ABSTRACT

Purpose
Dynamic limb valgus, particularly high knee abduction moments, is a known risk factor for anterior cruciate ligament (ACL) injury and may result from poor static anatomic limb alignment, faulty biomechanics, or a combination of both. The purpose of this study was to assess the influence of static lower extremity anatomic alignment and dynamic kinematic/kinetic measures on knee abduction moments during sidestep cutting in adolescent athletes with recent ACL reconstruction.

Methods
This retrospective study included 50 adolescents with recent unilateral ACL reconstruction (18/50 female, mean age = 15.8 yr, 7.6 months postsurgery). Frontal plane hip-to-ankle imaging was used to measure mechanical axis deviation and tibial–femoral angle. Three-dimensional motion capture provided lower extremity kinematics and kinetics during quiet standing and during the loading phase (initial contact to peak knee flexion) of an anticipated 45° sidestep cut. Imaging, static motion capture, and dynamic motion capture measures were investigated as potential predictors of average dynamic knee abduction moment using correlation and backward stepwise linear regression.

Results
Dynamic knee abduction moment was best predicted by a combination of younger age and dynamic measures: trunk lean toward the planting limb, knee abduction and external rotation, and ankle inversion. Although static measures were correlated with dynamic knee abduction moment in univariate analysis, no static/anatomic variables entered the model once the dynamic measures were included.

Conclusion
Knee abduction moments during sidestep cutting were related to dynamic factors reflecting frontal and transverse plane motion. Static (anatomic) lower limb alignment did not influence knee abduction moments once these dynamic factors were considered. Knee abduction moments and ACL injury risk are therefore not dictated by anatomic alignment and can be altered through neuromuscular/biomechanical training.
Power Reserve at Intolerance in Ramp-Incremental Exercise Is Dependent on Incrementation Rate
Authors: DAVIES MATTHEW J. , LYALL GEMMA K. , BENSON ALAN P. , CANNON DANIEL T. , BIRCH KAREN M. , ROSSITER HARRY B. , FERGUSON CARRIE 
Published: February 2021

ABSTRACT

Introduction
The mechanism(s) of exercise intolerance at V˙O2max remain poorly understood. In health, standard ramp-incremental (RI) exercise is limited by fatigue-induced reductions in maximum voluntary cycling power. Whether neuromuscular fatigue also limits exercise when the RI rate is slow and RI peak power at intolerance is lower than standard RI exercise, is unknown.

Methods
In twelve healthy participants, maximal voluntary cycling power was measured during a short (~6 s) isokinetic effort at 80 rpm (Piso) at baseline and, using an instantaneous switch from cadence-independent to isokinetic cycling, immediately at the limit of RI exercise with RI rates of 50, 25, and 10 W·min−1 (RI-50, RI-25, and RI-10). Breath-by-breath pulmonary gas exchange was measured throughout.

Results
Baseline Piso was not different among RI rates (analysis of variance; P > 0.05). Tolerable duration increased with decreasing RI rate (RI-50, 411 ± 58 s vs RI-25, 732 ± 93 s vs RI-10, 1531 ± 288 s; P < 0.05). At intolerance, V˙O2peak was not different among RI rates (analysis of variance; P > 0.05), but RI peak power decreased with RI rate (RI-50, 361 ± 48 W vs RI-25, 323 ± 39 W vs RI-10, 275 ± 38 W; P < 0.05). Piso at intolerance was 346 ± 43 W, 353 ± 45 W, and 392 ± 69 W for RI-50, RI-25, and RI-10, respectively (P < 0.05 for RI-10 vs RI-50 and RI-25). At intolerance, in RI-50 and RI-25, Piso was not different from RI peak power (P > 0.05), thus there was no “power reserve.” In RI-10, Piso was greater than RI peak power at intolerance (P < 0.001), that is, there was a “power reserve.”

Conclusions
In RI-50 and RI-25, the absence of a power reserve suggests the neuromuscular fatigue-induced reduction in Piso coincided with V˙O2max and limited the exercise. In RI-10, the power reserve suggests neuromuscular fatigue was insufficient to limit the exercise, and additional mechanisms contributed to intolerance at V˙O2max.
Background Inactivity Blunts Metabolic Adaptations to Intense Short-Term Training
Authors: BURTON HEATH M. , WOLFE ANTHONY S. , VARDARLI EMRE , SATIROGLU REMZI , COYLE EDWARD F. 
Published: February 2021

ABSTRACT

Purpose
This study determined if the level of background physical inactivity (steps per day) influences the acute and short-term adaptations to intense aerobic training.

Methods
Sixteen untrained participants (23.6 ± 1.7 yr) completed intense (80%–90% V˙O2peak) short-term training (5 bouts of exercise over 9 d) while taking either 4767 ± 377 steps per day (n = 8; low step) or 16,048 ± 725 steps per day (n = 8; high step). At baseline and after 1 d of acute exercise and then after the short-term training (posttraining), resting metabolic responses to a high-fat meal (i.e., plasma triglyceride concentration and fat oxidation) were assessed during a 6-h high-fat tolerance test. In addition, responses during submaximal exercise were recorded both before and after training during 15 min of cycling (~79% of pretraining V˙O2peak).

Results
High step displayed a reduced incremental area under the curve for postprandial plasma triglyceride concentrations by 31% after acute exercise and by 27% after short-term training compared with baseline (P < 0.05). This was accompanied by increased whole-body fat oxidation (24% and 19%; P < 0.05). Furthermore, stress during submaximal exercise as reflected by heart rate, blood lactate, and deoxygenated hemoglobin were all reduced in high step (P < 0.05), indicating classic training responses. Despite completing the same training regimen, low step showed no significant improvements in postprandial fat metabolism or any markers of stress during submaximal exercise after training (P > 0.05). However, the two groups showed a similar 7% increase in V˙O2peak (P < 0.05).

Conclusion
When completing an intense short-term exercise training program, decreasing daily background steps from 16,000 to approximately 5000 steps per day blunts some of the classic cardiometabolic adaptations to training. The blunting might be more pronounced regarding metabolic factors (i.e., fat oxidation and blood lactate concentration) compared with cardiovascular factors (i.e., V˙O2peak).
Relationship between Obesity, Sarcopenia, Sarcopenic Obesity, and Dynapenia in the Elderly
Authors: Padilla Colón Carlos J. , Toledo Gerardo Jovet 
Published: February 2021

ABSTRACT
This study aimed to analyze the relationship between obesity, sarcopenia, sarcopenic obesity, and dynapenia in subjects from 65 to 90 yr old in a geriatric center. A population of 45 subjects between 65 and 90 yr was used in this investigation. Body composition was measured through a bioelectrical impedance instrument using data from the NHANES III study of elderly men and women (>60 yr) to identify sarcopenia and the following cutoff points to identify dynapenia (men, <26 kg; women, <16 kg) with manual dynamometer. The statistic used consisted of chi-square for the analysis of two categorical variables. Student’s t-test was used for the analysis of one categorical variable and one continuous variable and the descriptive analysis that included frequencies, proportions, mean, and SD. The relationship between sex with obesity, sarcopenia, and sarcopenic obesity showed a significant relationship, with greater significance in obesity with P = 0.003. In women, the highest percentage was found in the results of dynapenia (56%) and obesity (44%), whereas in men, the highest results were found in dynapenia (50%), sarcopenia (50%), and sarcopenic obesity (55%). Dynapenia is found on a larger scale in both sexes compared with obesity, sarcopenia, and sarcopenic obesity.
Pitfalls in the diagnosis of Gaucher disease in Iraq: A diagnostic experience from a developing country
Authors: Thejeal Rabab Farhan , Abdulwahhab Saja Baheer , Saadi Nebal Waill 
Published: February 2021

Background and Objectives: Gaucher disease (GD) is a rare hereditary disorder caused by deficiency of the lysosomal enzyme β-glucocerebrosidase. An early and definitive diagnosis minimizes the sequelae of misdiagnoses, and unnecessary and invasive diagnostic procedures.
Methods: A cross-sectional descriptive study was conducted in the period from June to August, 2018, to analysing data of thirteen patients, retrospectively. They presented to the gastrointestinal and metabolic clinics in Children Welfare Teaching Hospital in Iraq, and had wrong and delayed diagnosis of GD.
Results: Two groups of patients were identified, based on diagnosis by enzymatic assay (considering the test positive when the enzyme level is below the normal value); those who had false positive (low level of the enzyme) result and received enzyme replacement therapy for long time, and those who had false negative (normal level of the enzyme) results which caused delay in their diagnosis and treatment. Two main factors that misled the diagnosis were identified.
Conclusion: Each patient with Gaucher disease need to be approached by taking a thorough history, a proper clinical examination, and then by being investigated, accordingly. Biomarkers and molecular genetic studies are more accurate and solid additional tools, to the enzymatic assays on dried blood sample (DBS).
doi: https://doi.org/10.12669/pjms.37.3.2930
How to cite this:Thejeal RF, Abdul-Wahhab SB, Saadi NW. Pitfalls in the diagnosis of Gaucher disease in Iraq: A diagnostic experience from a developing country. Pak J Med Sci. 2021;37(3):782-787. doi: https://doi.org/10.12669/pjms.37.3.2930
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.