bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immediate outcomes of simultaneous and step-by-step reconstruction of aortic dissection: a single-center study
Authors: Soborov M. A. , Kanadashvili O. V. , Belykh E. N. , Baranov K. S. 
Published: September 2021

The aim. To evaluate the immediate outcomes after complete single-stage or step-by-step reconstruction of the primary and secondary distal aortic dissection using implantation of bare metal stents in the thoracoabdominal aorta.Materials and methods. A prospective study was performed involving 21 patients (19 male) with aortic dissection: 8 had secondary distal dissection (group 1) and 13 had primary distal dissection (group 2). In all patients, indications for intervention were signs of malperfusion in one or more vascular regions. The following factors were evaluated: 30-day survival after surgery, causes of fatal outcomes, frequency and characteristics of non-fatal complications.Results. The average age in group 1 was 43.0 ± 3.1 years, in group 2: 56.0 ± 3.9 years (p < 0.05). The most common cause of dissection in group 1 was connective tissue dysplasia, in group 2 – atherosclerosis in combination with arterial hypertension (p < 0.05). In group 1, 1 (13%) lethal outcome was registered, in group 2 – 4 (31%), the difference between the groups was not significant. Lethal complications were: multiple organ failure, stent implantation in the false aortic canal, aortic rupture, and thrombosis of the superior mesenteric artery. Non-fatal complications developed in group 1 in 3 (38%), in group 2 – in 3 (23%) patients, the difference between the groups is not significant. Among the non-lethal complications, malperfusion of the upper and lower extremities was diagnosed, requiring stent placement, prosthetics or bypass surgery; cerebrospinal circulation disorder, acute cerebrovascular accident, multiple organ failure, conservatively treated.Conclusion. The survival rate for 30 days after a complete single-stage or step-by-step reconstruction of the primary and secondary distal aortic dissection using implantation of bare metal stents in the thoracoabdominal aorta is 76%, the frequency of non – fatal complications is 28%.
Tumour microenvironment markers in spontaneous and induced incubation of breast cancer biopsies
Authors: Gergenreter Yu. S. , Zakharova N. B. , Morozova O. L. 
Published: September 2021

Aim. To study the spontaneous and stimulated production of cytokines in biopsies of breast cancer (BC) depending on the cancer stage.Materials and methods. An experimental study was carried out with cell cultures of breast cancer biopsies of stages I–II (group 1, n = 15) and III–IV stages (group 2, n = 15). The control consisted of 6 healthy women who underwent mastopexy. We used enzyme immunoassay method to access spontaneous and induced by a complex of polyclonal activators (PA: phytohemagglutinin 4 μg / ml, concanavalin A 4 μg / ml, lipopolysaccharide 2 μg / ml) concentration of TNF-α, IFN-γ, G-CSF, GM-CSF, VEGF, MCP-1, TGF-β1. The index of the effect of polyclonal activators (IVPA) on cytokine production (induced production / spontaneous production) was calculated. To compare groups, the Mann-Whitney test and the median test, the chi-square test and the Fisher’s exact test were used.Results. Groups 1 and 2 did not differ in age, histological variant and immunohistochemical type of tumour, predominantly invasive cancer without signs of specificity prevailed. In group 2, a pronounced vascularization was more often observed: in 6 (40%) patients versus 1 (7%) in group 1 (p < 0.05). In both groups, compared with the control, there was a statistically sig-nificant (p < 0.05) increase in spontaneous production of TNF-α by 4.2 and 4.8 times, MCP-1 by 6.7 and 6.3 times, TGF-β1 – 2.2 and 2.5 times, VEGF 11.9 and 14.6 times; GM-CSF 15.6 and 13.4 times, G-CSF 96.8 and 79.5 times, respectively. The concentration of MCP-1 and IFN-γ was higher in group 1 (p < 0.05), VEGF and TGF-β1 – in group 2 (p < 0.05). IVPA in group 2 exceeded similar values in group 1 for G-CSF, VEGF, TGF-β1 (p < 0.05).Conclusion. The production of cytokines (TNF-α, MCP-1, GM-CSF, G-CSF, VEGF, TGF-β1) in breast cancer biopsies is significantly higher than in biopsies of the unchanged mammary gland and depends on the stage of the tumour process.
Post-operative endophthalmitis after immediate sequential bilateral cataract Surgery: a retrospective study from Pakistan.
Authors: Siddiqui Muhammad Abdul Rehman , Hussain Syed Zohaib Maroof , Irfan Jeeva  
Published: September 2021

Objective: The aim of this study was to assess the frequency of post-operative complications after immediate sequential bilateral cataract surgery (ISBSC) in Pakistan, a low-middle income country. Methods: This is a 10-year retrospective study including all consecutive patients who underwent ISBCS between 1st January 2009 and 31st December 2018 at Aga Khan University Hospital (AKUH), Karachi, Pakistan. We identified potential patients through the procedure coding system of the hospital. A structured proforma was used to collect information. The inclusion criterion was bilateral cataract extraction without any additional secondary procedures. Patients who underwent a planned additional procedure on the operated eye on the same day, such as phaco combined with vitrectomy, corneal graft, or glaucoma surgery, were excluded. The primary outcome measure was the incidence of endophthalmitis. The data were analyzed with Statistical Package for the Social Sciences (SPSS) version 23.0, IBM Corporation, Armonk, New York, United States. A p-value of < 0.05 was considered significant.
Results: We identified 352 patients through the coding system of our hospital who underwent ISBCS from January 2009 to December 2018. A total of 298 patients (596 eyes) met the inclusion criteria. The mean age was 33.14±25.83 years. Participants were divided into two age groups: <16 (39.26 %) years and >16 (60.73) years of age. Best-corrected visual acuity improved from -0.5650±8.2027 to -0.0043+4.05. Among 596 eyes, we found no case of post-operative endophthalmitis after ISBCS.
Conclusions: ISBCS is a safe procedure in selected patients undergoing cataract surgery in a low-middle income country.
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Association between intestinal helminthic infections and anaemia status in preschool children in the district Skardu of Pakistan
Authors: Muhammad Faisal Afridi  , Kulsoom Farhat  , Zaheer Ahmed  , Hajra Ahmed  , Shabana Ali  , Mehwish Nawaz Qaisrani  
Published: September 2021

Objective: This study has been aimed to evaluate the prevalence of parasitic infections and evaluate the correlation between intestinal helminth infection and the anemia status of pre-school children in the District Skardu of Pakistan.
Methodology: A community-based, descriptive, cross-sectional analysis was carried out on 300 pre-school children of the district of Skardu. Demographical data was obtained through the structured questionnaire. The stool sample was collected and examined for intestinal parasites at pathology department of healthcare facility in Skardu. Blood Hemoglobin (Hb) was measured from blood sample and anemia was defined as blood Hb <11 g/dL. The data was analyzed using SPSS.
Results: Out of a total of 300 children, 161 (i.e. 53.67%) were found infected and 139 (i.e. 46.33%) were found to be infection free. The overall parasite prevalence was: Ascaris Lumbricoides (22.33%), Cryptosporidium (14%) and Hymenolepis Nana and Giardia (9.3% and 8%) respectively. The 20% preschool children infested with Ascaris Lumbricoides, 13.7% infested with Cryptosporidium, 8.0% and 7.7% infested with Giardia and Hymenolepis Nana were mostly anemic. 15.3% preschool children with no parasite infestation were also found anemic.
Conclusion: There is a high prevalence of these parasitic infections in the pre-school children in Skardu, where they also present with anemia. If there is a realization that these infections effect the Hb levels, then intervention programs be conducted, bringing more awareness about their control and advocating iron supplementation.
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Prevalence of fibromyalgia in medical students and its association with lifestyle factors – a cross-sectional study
Authors: Patel Agastya , Al-Saffar Ahmed , Sharma Manvi , Masiak Anna , Zdrojewski Zbigniew 
Published: September 2021

IntroductionFibromyalgia (FM) is a chronic widespread pain syndrome, known to be associated with several other symptoms. Chronic stress is suspected to be a contributing factor in the pathogene­sis of FM. It is known that medical students are under a constant state of stress originating from personal and social expectations. The aim of the study was to assess the prevalence of FM in this population and identify lifestyle parameters influencing FM severity.Material and methodsAn online survey of first- and final-year medical students was conducted using the ACR modified 2016 criteria and FANTASTIC checklist. The survey acquired demographic information such as age, gender, year, and division of studies. A subgroup analysis based on gender, year of studies, and division of studies was performed.Results439 medical students (71% females) completed the survey. The overall prevalence of FM in our cohort was 10.48%. The ratio of females to males was 3 : 1. A significant negative correlation between better quality of lifestyle and worse FM severity was observed in all subgroups. The “insight”, “sleep and stress”, “behavior” and “career” domains of lifestyle were found to have a significant nega­tive correlation with FM severity on univariate analysis.ConclusionsThe prevalence of FM in medical students seems to be considerably higher than in the general population. Chronic stress levels, sleep problems, social support, and behavior seem to be the major factors influencing FM severity in this population. Our findings suggest that medical students must be considered a “high-risk” group for FM, and hence must be identified, educated, and managed accordingly. It is, therefore, important for medical universities to implement programs educating students about FM, the importance of a healthy lifestyle, and stress coping strategies, while also making systemic changes to curb stressors in medical training.
Elderly-onset adult Still’s disease
Authors: Mzabi Anis , Fakhfakh Rym , Thabet Maissa , Ben Hassine Imen , Anoun Jihed , Karmani Monia , Ben Fredj Fatma , Laouani Chadia 
Published: September 2021

Adult-onset Still’s disease is a rare inflammatory disorder usually affecting young adults. Elderly-onset Still’s disease (EOSD) is reported in some cases, commonly in Japan, the USA and Europe. One of the most commonly used criteria for diagnosing EOSD is Yamaguci criteria. In elderly patients more severe course of the disease and more complications may be expected than in the younger group of patients with Still’s disease. The lungs involvement is rather rare manifestation of this disease. In our article we discuss the problem of both the development of Still’s disease in the elderly and interstitial lung changes in the course of the disease, based on available literature and own cases from one centre.
Challenges of Egyptian patients with systemic lupus erythematosus during the COVID-19 pandemic
Authors: Tharwat Samar , Zohdy Mohamed Sherin , Kamal Nassar Mohammed 
Published: September 2021

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic in Egypt is part of the worldwide COVID-19 pandemic that has contributed to substantial deterioration of healthcare systems. The aim of this study was to assess the challenges faced by Egyptian systemic lupus erythematosus (SLE) patients during the COVID-19 pandemic.Material and methodsThis questionnaire-based study was carried out on 200 patients with SLE from Egypt. The questionnaire provided covered socioeconomic status, lupus disease data, information about COVID-19 infection, and medical and family history of COVID-19 infection.ResultsThe mean age of the participants was 30.1 ±8.4 years. 140/200 (70%) of the participants reported difficulty in obtaining medications during the COVID-19 pandemic, particularly antimala­rials (60%). The lupus disease condition became worse because of the drug shortage in half of the participants. Wearing protective masks (74%) and using disinfectants of the hands several times per day (67%) were the most reported used measures. Forty patients (20%) had to stop or reduce taking nonsteroidal anti-inflammatory drugs while 10 patients (5%) had to start taking antimalarials as a prophylaxis against COVID-19 infection. Among those who needed hospitalization, the main cause was lupus activity, and most of them (71%) experienced difficulty in hospital admission. Thirty-two patients (16%) had confirmed COVID-19 infection. About half of them had lupus flare and had to change the medications used for treatment of lupus.ConclusionsThe current COVID-19 pandemic has a negative impact on the healthcare provided to SLE patients in Egypt. Patients with SLE faced a shortage of their medications, especially antimala­rials, and difficulty in hospital admission.
Alteraciones de visión binocular. Estudiantes del Instituto Nacional de Audición y Lenguaje. Quito, 2019.
Authors: Correa Rojas Osmani , Villar Villamarín Daniela Stefanía , Panchi Cando Johann Xavier , Ulloa Oliva Solaimi 
Published: September 2021

Los problemas visuales son cada vez más comunes, tres de cada cuatro personas los padecen, sobre todo en adolescentes y en la población mayor de 20 años. Se realizó un estudio descriptivo de tipo longitudinal prospectivo con el objetivo de diagnosticar las alteraciones de la visión binocular en estudiantes del Instituto Nacional de Audición y Lenguaje en Quito, Ecuador, 2019. El universo estuvo constituido por los 120 estudiantes del plantel educativo y la muestra por 112 de ellos que, cumplieron los criterios de inclusión. El test de Titmus, demostró que existen 84 pacientes (75%) con una visión binocular normal correspondiente al mayor porcentaje de la muestra, mientras 28 pacientes (25%) presentan alguna alteración de la visión binocular. Existen 76 pacientes (67,86%) con agudeza visual normal, seguido de 26 pacientes (23,22%) con limitación visual, mientras 10 pacientes (8,92%) presentaron limitación visual severa. Predominó el sexo femenino con 61 pacientes (50,89%). El grupo de edades de mayor incidencia fue entre 14-17 con 52 pacientes (46.43%). Se diagnosticaron 15 pacientes ambliopes (10%) y 5 pacientes con estrabismo (3, 33%). Se indicó corrección óptica a 20 pacientes, oclusiones a 10 pacientes (8.93%), penalización a 5 niños y terapia con prismas a 5 pacientes (4.46%).
Prognostic Nutrition Index May Predict Cerebral Embolic Events Following Carotid Artery Stenting Procedure
Authors: Güner Ahmet , Çelik Ömer , Yalçın Ahmet Arif , Örten Murat , Kahraman Serkan , Kalçık Macit , Gültekin Güner Ezgi , Topel Çağdaş , Ertürk Mehmet 
Published: September 2021

Introduction: Cerebral embolism after carotid artery stenting (CAS) remains a matter of concern in frailty patients. The prognostic nutrition index (PNI), which provides an objective assessment of nutritional status, is a useful prognostic indicator in cardiovascular diseases. We aim to determine the value of pre-procedural PNI in predicting cerebral embolism including stroke, transient ischemic attack (TIA), and silent new ischemic cerebral lesions (SNICLs).
Patients and Methods: We retrospectively evaluated 138 patients (mean age= 70.6 ± 6.7 years, male= 99) who underwent CAS. Inclusion criteria were as follows: i) availability of all medical records including albumin value and lymphocyte count, ii) having cranial imaging after CAS, iii) having symptomatic carotid stenosis 50-99% or asymptomatic carotid stenosis ≥60-99%. The study population was divided into two subgroups according to the presence of cerebral embolism as cerebral embolism (+) cerebral embolism (-) groups.
Results: Among the study population, 22 patients (16%) had at least 1 SNICL, seven patients (5.0%) had an ischemic stroke, and five patients (3.6%) had TIA. The cerebral embolism (+) group had a significantly lower PNI, older age, more frequent history of stroke, a higher proportion of type III aortic arch, and longer fluoroscopy time than the cerebral embolism (-) group. Low PNI was identified as one of the independent predictors of cerebral embolism (OR= 0.808; 95% CI= 0.670-0.975; p= 0.026), and PNI lower than 44.7 predicted cerebral embolism with a sensitivity of 70.6% and a specificity of 61.1% (AUC= 0.739; 95% CI= 0.651 to 0.827; p< 0.001).
Conclusion: The current data suggest that PNI is an independent prognostic factor for cerebral embolic complications after CAS procedures.
In-Hospital and Long-Term Outcomes of ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention
Authors: Okşen Doğaç , Sarılar Mert , Demirci Gürsu , Haberal İsmail , Abacı Okay 
Published: September 2021

Introduction: We evaluated in-hospital and long-term outcomes of patients who underwent primary percutaneous coronary intervention (PCI) in a tertiary center.
Patients and Methods: We examined 1550 patients (mean age= 58.5 years, 83.1% male) admitted with acute ST-segment elevation myocardial infarction (AMI) who underwent primary PCI and were followed-up prospectively. The primary outcomes were in-hospital death and major adverse cardiac events (MACE) at follow-up.
Results: The mean duration of ischemia at admission was 2.85 ± 2.49 hours; 10.3% of the patients were Killip class III or IV. The mean door-to-device time was 43 (29-52) minutes. During hospitalization, all-cause mortality occurred in 73 patients (4.7%). Multivariate analysis revealed that advanced age, impaired left ventricular ejection function, high Killip functional class, hemoglobin level at admission, ventricular arrhythmias, and advanced atrioventricular block were independent predictors of poor prognosis (OR= 1.07, 0.93, 15.34, 1.44, 3.79, and 4.26 respectively). Among discharged patients with a median 49.5 (25-73) months follow-up, 12.4% of them died, 12.5% had a recurrent myocardial infarction (MI), and 2.3% had a cerebrovascular accident. The strongest independent MACE predictors were impaired left ventricular function, poor glomerular filtration rate, low albumin level, and a history of cerebrovascular disease (HR= 0.97, 0.99, 0.65, and 2.50, respectively). Secondary outcomes were contrast-induced acute kidney injury (16.7%), ventricular arrhythmias (6.1%), advanced atrioventricular block (3.7%), atrial fibrillation (7.6%), and major bleeding (1.6%).
Conclusion: AMI still has a poor long-term prognosis. These results emphasize the advantages of rapid, non-delayed revascularization. Patients should be followed-up closely after discharge in both the short- and long-term.
Seasonal forecasts of the Saharan heat low characteristics: a multi-model assessment
Authors: Ngoungue Langue Cedric G. , Lavaysse Christophe , Vrac Mathieu , Peyrillé Philippe , Flamant Cyrille 
Published: September 2021

Abstract. The Saharan heat low (SHL) is a key component of the West African Monsoon system at the synoptic scale and a driver of summertime precipitation over the Sahel region. Therefore, accurate seasonal precipitation forecasts rely in part on a proper representation of the SHL characteristics in seasonal forecast models. This is investigated using the latest versions of two seasonal forecast systems namely the SEAS5 and MF7 systems from the European Center of Medium-Range Weather Forecasts (ECMWF) and Météo-France respectively. The SHL characteristics in the seasonal forecast models are assessed based on a comparison with the fifth ECMWF Reanalysis (ERA5) for the period 1993–2016. The analysis of the modes of variability shows that the seasonal forecast models have issues with the timing and the intensity of the SHL pulsations when compared to ERA5. SEAS5 and MF7 show a cool bias centered on the Sahara and a warm bias located in the eastern part of the Sahara respectively. Both models tend to underestimate the interannual variability in the SHL. Large discrepancies are found in the representation of extremes SHL events in the seasonal forecast models. These results are not linked to our choice of ERA5 as a reference, for we show robust coherence and high correlation between ERA5 and the Modern-Era Retrospective analysis for Research and Applications (MERRA). The use of statistical bias correction methods significantly reduces the bias in the seasonal forecast models and improves the yearly distribution of the SHL and the forecast scores. The results highlight the capacity of the models to represent the intraseasonal pulsations (the so-called east–west phases) of the SHL. We notice an overestimation of the occurrence of the SHL east phases in the models (SEAS5, MF7), while the SHL west phases are much better represented in MF7. In spite of an improvement in prediction score, the SHL-related forecast skills of the seasonal forecast models remain weak for specific variations for lead times beyond 1 month, requiring some adaptations. Moreover, the models show predictive skills at an intraseasonal timescale for shorter lead times.
Joe as the Wise Fool in Great Expectations: Dickens's Criticism of the Mid-Victorian Literature of Success and Upward Social Mobility
Authors: Hasegawa Masayo 
Published: September 2021

ABSTRACT
Criticism of Great Expectations often portrays Joe, a gentle blacksmith, as important to the novel's definition of a true gentleman. While this is understandable, Joe plays a more important role in the novel's discussion of the contemporary literature of success to propagate the ideal of the self-made man. This role is as a wise fool and truth-teller, through whom Dickens highlights a contradiction in the literature's messages about the social mobility of working-class people. This contradiction arises as a result of the self-interested desire of the middle classes to bolster their advantageous position in the hierarchical Victorian society, and Dickens censures this self-interestedness. However, Dickens is also aligned with contemporary success stories in their denial of social climbing of the working classes because he believed that working-class social ambitions had the potential to disturb Victorian class society and his own gentlemanly identity. While he advocates a static stratified society, at the same time he wishes to ameliorate the status quo of Victorian class society and address the way it disadvantages the working classes. The means for social betterment proposed in Great Expectations involve the moral betterment of gentlemanly middle-class people.
CUIDADO HUMANIZADO NO PARTO CESARIANA NA ÓTICA DA ENFERMAGEM
Authors: Souza Rocha de Ascenção Carvalho Cintia de , Paula Enimar de , Ribeiro Wanderson Alves 
Published: September 2021

Objetivo: Este artigo visa relatar a importância e benefícios do cuidado humanizado no parto cesariana na ótica da enfermagem. Metodologia: A pesquisa foi realizada por via eletrônica, através de consulta de artigos científicos, veiculados na base de dados Lilacs e BDENF. Resultados e discussões: Sabendo que o cuidado humanizado envolve respeitar a individualidade do Ser Humano e construir um espaço concreto nas instituições de saúde, que legitime o humano das pessoas envolvidas, como por exemplo, ambientes e profissionais de saúde menos formais e mais descontraídos a ponto da parturiente sentir-se a vontade para deixar ser cuidada e abrir-se emocionalmente, sem julgamentos ou constrangimentos. Quando envolvemos a saúde íntima e reprodutiva da mulher, essa questão de atendimento humanizado vai além, pois, durante o processo de gestação e parto, o corpo feminino passa por transformações que, muita das vezes, faz a mulher sentir vergonha do próprio corpo. Conclusão: Considerando que o parto cesáreo não deixa de ser doloroso, invasivo e tão delicado quanto o parto vaginal, é preciso que a assistência de enfermagem tenha empatia e zele por um cuidado trans e pós operatório humanizado.