bluuebunny/crossref_metadata_2025_split huggingface dataset:
The “new-normal” OSCE examination: Executing in the COVID-19 era
Authors: Matin Shazia Babar , Afzal Azam Saeed 
Published: September 2021

In this unprecedented situation of COVID-19 era, the educational institutions have to attune not only the teaching strategies but also the assessment. Similarly, just as COVID precautions have become the “new normal” practice, hence implementation changes during face-to-face examinations may become standard practice in the Post- COVID era. The Objective structured clinical exams (OSCEs) which usually require a face-to-face assessment of skills, posed a special challenge to health professionals in COVID-19. This commentary paper is written on shared experiences of the examination cell principal resource faculty for OSCE and exam coordinators. It addresses how to plan and implement objective, valid, feasible and reliable clinical skills examinations (OSCEs) keeping in place COVID precautions to ensure the utmost wellbeing of all stakeholders involved.
doi: https://doi.org/10.12669/pjms.37.7.4568
How to cite this:Babar S, Afzal A. The “new-normal” OSCE examination: Executing in the COVID-19 era. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4568
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.
Clinical analysis of 33 cases with neonatal cerebral infarction
Authors: Yang Ning , He Xiaojun , Yin Cuixia , Zhao Lihua 
Published: September 2021

Objective: To investigate the etiology, clinical manifestations, diagnosis, treatment and prognosis of neonatal cerebral infarction (NCI) to further improve the understanding of the disease.
Methods: Clinical data and follow-up results of 33 cases of NCI in neonatal intensive care unit of a first-class hospital from September 2009 to September 2019 were retrospectively analyzed.
Results: All 33 patients were diagnosed with NCI by MRI. Among them, 31 cases (93.94%) were full-term infants, 25 cases (75.76%) were mother’s first birth, and 18 (54.55%) cases were males. Pregnancy complications were reported in 18 cases (54.55%), and 19 cases (57.58%) had perinatal hypoxia history. Seizures were the most common first symptom and clinical manifestation in the course of disease (81.8%). There were 27 cases (81.82%) of patent foramen ovale (PFO) among NCI cohort. Ischemic cerebral infarction occurred in 32 cases (96.97%). The middle cerebral artery and its branches were more frequently involved, mainly on the left side. The acute stage of NCI was managed by symptomatic support treatment, and the recovery stage involved mainly rehabilitation treatment. Among the 33 cases, five cases were lost to follow-up, two patients died, 26 patients survived without complications, one case had cerebral palsy, one case had language retardation, and six cases had dyskinesia. Poor prognosis was associated with the involvement of deep gray matter nuclei or multiple lobes, and intrapartum complications. Vaginal mode of delivery and longer hospital stay were associated with better prognosis.
Conclusions: Complications leading to placental circulation disorder during pregnancy and perinatal hypoxia are common high-risk factors of NCI. The seizure is the most common clinical manifestation. There is a possible correlation between PFO and NCI. Involvement of deep gray matter or multiple lobes and intrapartum complications may indicate poor prognosis, while vaginal delivery and prolonged hospitalizations are associated with better prognosis of NCI.
doi: https://doi.org/10.12669/pjms.37.7.4720
How to cite this:Yang N, He X, Yin C, Zhao L. Clinical analysis of 33 cases with neonatal cerebral infarction. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4720
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.
Doctor of Science (D.Sc.): Time to move towards Higher Doctorate Degrees
Authors: Meo Sultan Ayoub , Jawaid Shaukat Ali , Naseem Nadia 
Published: September 2021

The present most modern and highly advanced 21’st century is the era of science and technology. In human history, universities are the basic birthplace of higher education, research, and innovation and play a significant role in the countries’ performance, prosperity, and economic progress. Worldwide, there is a swift shift in the pattern of biological, environmental, economic, and educational systems. This broader change is rotating around the higher academia and its allied innovative research impact. The leading universities develop a culture and curricula as per need and demand and produce knowledge and skills-based professional graduates. The universities prepare graduates to keep in view their country’s requirements and compete with their peers at international levels.Moreover, worldwide, universities are transforming towards higher doctorate degrees (D.Sc / S.Dc) to provide an elevated helipad to the applicant to compete in this modern and highly advanced era. The higher doctoral degree, D.Sc, is earned 6-8 years after the post Ph.D. The candidates with higher academic titles, professional skills, and innovative research could compete and achieve top-ranked positions worldwide. Many universities worldwide, including the United States of America, the United Kingdom, Australia, and New Zealand, promote D.Sc degree programs in various science disciplines, including medical sciences. This manuscript explores the dynamics of a higher doctorate and its significance, need, and demand in academia to compete globally.
doi: https://doi.org/10.12669/pjms.37.7.5119
How to cite this:Meo SA, Jawaid SA, Naseem N. Doctor of Science (D.Sc.): Time to move towards Higher Doctorate Degrees. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.5119
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.
Ranking medical & dental institutions based on accreditation standards: Using thermometer to measure atmospheric pressure
Authors: Chaudhry Saima 
Published: September 2021

doi: https://doi.org/10.12669/pjms.37.7.5229
How to cite this:Chaudhry S. Ranking medical & dental institutions based on accreditation standards: Using thermometer to measure atmospheric pressure. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.5229
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.
Blockchain-basierte Betriebsprüfung am Beispiel der deutschen Finanzverwaltung
Authors: Benke Alessandro , Müller Robert , Houy Constantin , Fettke Peter 
Published: September 2021

ZusammenfassungDie Blockchain-Technologie bietet vielfältige Anwendungspotenziale in den Bereichen des Steuerrechts und der Finanzverwaltung. Der Beitrag analysiert am Beispiel einer Prüfung von steuerlichen Informationen den Einsatz der Blockchain-Technologie in der deutschen Finanzverwaltung. Für die Überprüfung von steuerlichen Sachverhalten ist die Integrität der steuerlichen Informationen des Steuerpflichtigen sowie deren strukturierte Übermittlung an die Finanzverwaltung entscheidend. Aus diesem Grund wird eine Blockchain-basierte Überprüfung von Buchhaltungsdaten mittels Standard Audit Files und der Referenzierung notwendiger Belege entwickelt. Die zunehmende Automatisierung des Informationsmanagements birgt die Gefahr, dass das Steuergeheimnis des Steuerpflichtigen kompromittiert wird. Die Blockchain-Technologie kann durch die manipulationssichere und unveränderliche Dokumentation von Zugriffen auf die steuerlichen Daten einen Geheimnisschutz gewährleisten. Über ein Blockchain-basiertes Berechtigungsmanagement können Zugriffe überwacht und kontrolliert werden.
Accelerating whole-heart 3D T2 mapping: Impact of undersampling strategies and reconstruction techniques
Authors: Zhu Dan , Ding Haiyan , Zviman M. Muz , Halperin Henry , Schär Michael , Herzka Daniel A. 
Published: September 2021

Purpose
We aim to determine an advantageous approach for the acceleration of high spatial resolution 3D cardiac T2 relaxometry data by comparing the performance of different undersampling patterns and reconstruction methods over a range of acceleration rates.

Methods
Multi-volume 3D high-resolution cardiac images were acquired fully and undersampled retrospectively using 1) optimal CAIPIRINHA and 2) a variable density random (VDR) sampling. Data were reconstructed using 1) multi-volume sensitivity encoding (SENSE), 2) joint-sparsity SENSE and 3) model-based SENSE. Four metrics were calculated on 3 naïve swine and 8 normal human subjects over a whole left-ventricular region of interest: root-mean-square error (RMSE) of image signal intensity, RMSE of T2, the bias of mean T2, and standard deviation (SD) of T2. Fully sampled data and volume-by-volume SENSE with standard equally spaced undersampling were used as references. The Jaccard index calculated from one swine with acute myocardial infarction (MI) was used to demonstrate preservation of segmentation of edematous tissues with elevated T2.

Results
In naïve swine and normal human subjects, all methods had similar performance when the net reduction factor (Rnet) <2.5. VDR sampling with model-based SENSE showed the lowest RMSEs (10.5%-14.2%) and SDs (+1.7–2.4 ms) of T2 when Rnet>2.5, while VDR sampling with the joint-sparsity SENSE had the lowest bias of mean T2 (0.0–1.1ms) when Rnet>3. The RMSEs of parametric T2 values (9.2%-24.6%) were larger than for image signal intensities (5.2%-18.4%). In the swine with MI, VDR sampling with either joint-sparsity or model-based SENSE showed consistently higher Jaccard index for all Rnet (0.71–0.50) than volume-by-volume SENSE (0.68–0.30).

Conclusions
Retrospective exploration of undersampling and reconstruction in 3D whole-heart T2 parametric mapping revealed that maps were more sensitive to undersampling than images, presenting a more stringent limiting factor on Rnet. The combination of VDR sampling patterns with model-based or joint-sparsity SENSE reconstructions were more robust for Rnet>3.
Adherence to community versus facility-based delivery of monthly malaria chemoprevention with dihydroartemisinin-piperaquine for the post-discharge management of severe anemia in Malawian children: A cluster randomized trial
Authors: Nkosi-Gondwe Thandile , Robberstad Bjarne , Mukaka Mavuto , Idro Richard , Opoka Robert O. , Banda Saidon , Kühl Melf-Jakob , O. Ter Kuile Feiko , Blomberg Bjorn , Phiri Kamija S. 
Published: September 2021

Background
The provision of post-discharge malaria chemoprevention (PMC) in children recently admitted with severe anemia reduces the risk of death and re-admissions in malaria endemic countries. The main objective of this trial was to identify the most effective method of delivering dihydroartemesinin-piperaquine to children recovering from severe anemia.

Methods
This was a 5-arm, cluster-randomized trial among under-5 children hospitalized with severe anemia at Zomba Central Hospital in Southern Malawi. Children were randomized to receive three day treatment doses of dihydroartemesinin-piperaquine monthly either; 1) in the community without a short text reminder; 2) in the community with a short message reminder; 3) in the community with a community health worker reminder; 4) at the facility without a short text reminder; or 5) at the facility with a short message reminder. The primary outcome measure was adherence to all treatment doses of dihydroartemesinin-piperaquine and this was assessed by pill-counts done by field workers during home visits. Poisson regression was utilized for analysis.

Results
Between March 2016 and October 2018, 1460 clusters were randomized. A total of 667 children were screened and 375 from 329 clusters were eligible and enrolled from the hospital. Adherence was higher in all three community-based compared to the two facility-based delivery (156/221 [70·6%] vs. 78/150 [52·0%], IRR = 1·24,95%CI 1·06–1·44, p = 0·006). This was observed in both the SMS group (IRR = 1·41,1·21–1·64, p<0·001) and in the non-SMS group (IRR = 1·37,1·18–1·61, p<0·001). Although adherence was higher among SMS recipients (98/148 66·2%] vs. non-SMS 82/144 (56·9%), there was no statistical evidence that SMS reminders resulted in greater adherence ([IRR = 1·03,0·88–1·21, p = 0·68). When compared to the facility-based non-SMS arm (control arm), community-based delivery utilizing CHWs resulted in higher adherence [39/76 (51·3%) vs. 54/79 (68·4%), IRR = 1·32, 1·14–1·54, p<0·001].

Interpretation
Community-based delivery of dihydroartemesinin-piperaquine for post-discharge malaria chemoprevention in children recovering from severe anemia resulted in higher adherence compared to facility-based methods.

Trial registration
NCT02721420; ClinicalTrials.gov.
Serum chemerin levels: A potential biomarker of joint inflammation in women with rheumatoid arthritis
Authors: Gonzalez-Ponce Fabiola , Gamez-Nava Jorge I. , Perez-Guerrero Emilio E. , Saldaña-Cruz Ana M. , Vazquez-Villegas Maria L. , Ponce-Guarneros Juan M. , Huerta Miguel , Trujillo Xochitl , Contreras-Haro Betsabe , Rocha-Muñoz Alberto D. , Carrillo-Escalante Maria O. , Sanchez-Rodriguez Esther N. , Gomez-Ramirez Eli E. , Nava-Valdivia Cesar A. , Cardona-Muñoz Ernesto G. , Gonzalez-Lopez Laura ,   on behalf of the Research Group for the Assessment of Prognosis Biomarkers in Autoimmune Disorders
Published: September 2021

Background
Chemerin has a potential role in perpetuating inflammation in autoimmune diseases. Nevertheless, to date, there is no conclusive information on whether high chemerin levels increase the severity of rheumatoid arthritis (RA). Therefore, this study evaluated whether serum chemerin is a biomarker of disease activity in RA patients.

Methods
Study design: cross-sectional. The assessment included clinical and laboratory characteristics, body mass index (BMI) and fat mass. The severity of the disease activity was identified according to the DAS28-CRP index as follows: A) RA with a DAS28-CRP≤2.9 (remission/mild activity) and B) RA with a DAS28-CRP>2.9 (moderate/severe activity). Serum chemerin concentrations were measured by ELISA, and ≥103 ng/mL was considered a high level. Logistic regression analysis was applied to determine whether high chemerin levels were associated with disease activity in RA after adjusting for confounders. Multiple regression analysis was performed to identify variables associated with chemerin levels.

Results
Of 210 RA patients, 89 (42%) subjects had moderate/severe disease activity and had higher serum chemerin levels than patients with low disease activity or remission (86 ± 34 vs 73± 27; p = 0.003). Serum chemerin correlated with the number of swollen joints (r = 0.15; p = 0.03), DAS28-CRP (r = 0.22; p = 0.002), and C-reactive protein levels (r = 0.14; p = 0.04), but no correlation was observed with BMI and fat mass. In the adjusted logistic regression analysis, high chemerin levels (≥103 ng/mL) were associated with an increased risk of moderate/severe disease activity (OR: 2.76, 95% CI 1.35–5.62; p = 0.005). In the multiple regression analysis, after adjusting for potential confounders, serum chemerin levels were associated with higher DAS28-CRP (p = 0.002).

Conclusions
Higher chemerin levels increased the risk of moderate and severe disease activity in RA. These results support the role of chemerin as a marker of inflammation in RA. Follow-up studies will identify if maintaining low chemerin levels can be used as a therapeutic target.
Clinical outcomes of salvage treatment in lymph node-positive prostate cancer patients after radical prostatectomy
Authors: Kim Dowook , Kim Dong-Yun , Kim Jae-Sung , Hong Sung Kyu , Byun Seok-Soo , Lee Sang Eun 
Published: September 2021

Introduction
The optimal salvage treatment strategies for lymph node-positive (LNP) patients after radical surgery have not been clearly defined in prostate cancer with biochemical recurrence or persistence of elevated prostate-specific antigen (PSA). In this study, we compared the clinical outcomes of two different salvage treatments, androgen deprivation therapy (ADT) alone versus ADT with radiotherapy (RT). We also investigated prognostic factors that could support the use of ADT with RT in LNP prostate cancer.

Materials and methods
We retrospectively reviewed 94 LNP prostate cancer patients who underwent radical prostatectomy (RP) followed by salvage treatment between 2004 and 2018. Salvage treatments involved either ADT alone or ADT with RT according to the clinical judgment of the physician. We analyzed clinicopathological and treatment factors related to 2nd biochemical failure (2nd BCF), clinical progression (CP), and progression-free survival (PFS). The cumulative failure after salvage treatment was defined as including both 2nd BCF and CP.

Results
The median duration of follow-up was 55 months (interquartile range, 35–97 months). Thirty-seven (39.4%) patients were treated with ADT alone, and 57 patients (60.6%) were treated with a combination of ADT with RT. During follow-up period, the incidence of failure after salvage treatment in the ADT alone group and the combined treatment group was 89.2% and 45.6%, respectively (HR, 22.4; 95% CI 5.43–92.1; P < 0.001). The combination of ADT with RT was associated with better 2nd BCF and PFS than ADT alone (P = 0.007 and P = 0.015, respectively). In multivariate analyses, number of positive LN ≥ 2 and PSA nadir ≥ 0.005 ng/ml after RP were associated with poor 2nd BCF, CP, and PFS after salvage treatment. Salvage by combined ADT plus RT showed better 2nd BCF and PFS than ADT alone. Specifically, patients with number of positive LN ≥ 2 or PSA nadir ≥ 0.005 ng/ml after RP showed better 2nd BCF (P = 0.004) or PFS (P = 0.011) when treated with ADT plus RT rather than ADT alone.

Conclusions
In patients with LNP prostate cancer, salvage ADT plus RT improved 2nd BCF and PFS compared to ADT alone. In particular, when the patients had more than two positive lymph nodes or PSA nadir ≥ 0.005 ng/ml after RP, ADT with RT seems to be a more beneficial salvage treatment resulting in better 2nd BCF and PFS.
Preparations of Dutch emergency departments for the COVID-19 pandemic: A questionnaire-based study
Authors: O’Connor Rory D. , Barten Dennis G. , Latten Gideon H. P. 
Published: September 2021

BackgroundThe onset of the COVID-19 pandemic was characterized by rapid increases in Emergency department (ED) patient visits. EDs required an appropriate transformation. The main challenges were: adapting capacity to respond to surges in the number of patient visits, protection of high risk (frontline) staff and the segregation of suspect-COVID-19 patients. To date, only a few studies have assessed the nation-wide response of EDs to the COVID-19 pandemic. This study was designed to review the preparations of Dutch EDs during the initial phase of this public health crisis.MethodsThe study was designed as a nation-wide, cross-sectional, questionnaire-based study of Dutch hospital organizations having one or more EDs. One respondent completed the questionnaire for each hospital. The questionnaire was conducted between the first and the second COVID-19 wave in the Netherlands. It contained close-ended and open-ended questions on changes in ED infrastructure, ED workforce adaptions and the role of emergency physicians (EPs) in each hospital crisis management team.ResultsThe questionnaire was completed by 58 respondents. This represented 80% of the total number of EDs. All respondents had made preparations in anticipation of a COVID-19 patient surge. Treatment capacity was expanded in 70% of EDs, with a median increase of 49% (IQR 33–73%). Suspect-COVID-19 was segregated from non-COVID-19 patients in 89% of EDs. Alternative locations (such as outpatient departments) were more often used to assess non-COVID-19 patients, than for suspect-COVID-19 patients. Staff was expanded in 82% of EDs. This largely concerned nursing staff. A formal role for Emergency Physicians (EPs) in the hospital’s crisis management team was reported by 94% of hospital organizations employing EPs.ConclusionAll Dutch EDs responded to the COVID-19 pandemic in a very short time span despite much uncertainty. Preparations predominantly concerned expansion of treatment capacity and segregation of COVID-19 ED care. EPs played a prominent role, both in direct COVID-19 care and in the hospital crises management team. It is vital for EDs to adapt to community needs swiftly. The ability of EDs to respond to the pandemic varied considerably.
Dengue pre-vaccination screening test evaluation for the use of dengue vaccine in an endemic area
Authors: Limothai Umaporn , Tachaboon Sasipha , Dinhuzen Janejira , Hunsawong Taweewun , Ong-ajchaowlerd Prapapun , Thaisomboonsuk Butsaya , Fernandez Stefan , Trongkamolchai Supachoke , Wanpaisitkul Mananya , Chulapornsiri Chatchai , Tiawilai Anongrat , Tiawilai Thawat , Tantawichien Terapong , Thisyakorn Usa , Srisawat Nattachai 
Published: September 2021

BackgroundThe dengue vaccine (Dengvaxia) is only recommended for individuals with prior dengue infection (PDI). This study aimed to perform a serosurvey to inform decision-making for vaccine introduction and identify appropriate target populations. We also evaluated the performance of the serological tests using plaque reduction neutralization test (PRNT) as a reference test in identifying PDI to determine suitability for pre-vaccination screening.MethodsWe enrolled 115 healthy individuals between 10 and 22 years of age living in the Ratchaburi province of Thailand. The serum samples were tested by PRNT to measure the prevalence and concentration of serotype-specific neutralizing antibodies. The performance of the IgG rapid diagnostic test (RDT, SD Bioline, Korea) and IgG enzyme-linked immunosorbent assay (ELISA, EUROIMMUN, Germany) in identifying PDI were evaluated by using PRNT as a reference method.ResultsNinety-four (81.7%) individuals neutralized one or more dengue serotypes at a titer threshold greater than or equal to 10. Multitypic profiles were observed in 70.4% of the samples which increased to 91.9% in subjects aged 19–22. Among monotypic samples, the highest proportion was reactive against DENV-1 followed by DENV-2, DENV-3, and DENV-4. The highest anti-dengue antibody titers were recorded against DENV-1 and increased with age to a geometric mean NT50 titer (GMT) of 188.6 in the 19–22 age group. While both RDT and ELISA exhibited 100% specificity, RDT demonstrated low sensitivity (35%) with ELISA displaying much greater sensitivity (87%).ConclusionsAlmost 80% of adolescents and youth in Ratchaburi province had already been exposed to one or more of the dengue virus serotypes. The dengue IgG RDT displayed low sensitivity and is likely not be suitable for dengue pre-vaccination screening. These results support the use of IgG ELISA test for dengue vaccination in endemic areas.