bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilising snake rescue data to understand snake–human conflict in Hooghly, West Bengal, India
Authors: Kuttalam Sourish , Owens John Benjamin , Santra Vishal , Ahmed Molla T , Das Biswajit , Das Surojit , Koley Ayan , Koley Rakesh , Barlow Axel , Malhotra Anita 
Published: January 2025

Abstract

Background
Snakebite envenoming, classified as a neglected tropical disease, poses a significant threat to life in India, where it is estimated to cause 58 000 fatalities as well as 140 000 morbidities annually. To reduce the occurrence of snakebite, we need a comprehensive understanding of human–snake conflict ecology. Snake rescue networks represent a vital resource for gathering such ecological data.

Methods
In this study, we utilised snake rescue data from 520 rescue encounters carried out by a local rescue network in Hooghly, West Bengal, from July 2020 to October 2022, to investigate patterns of human–snake conflict and the influence of climatic factors on these patterns.

Results
The spectacled cobra Naja naja was the most encountered of the five venomous species involved in 365 rescues. Our analysis revealed a significant correlation between rescue location and venomous/non-venomous encounters, with non-venomous encounters being more prevalent inside built-up locations. Rainfall on the previous day significantly increased encounters and influenced the species involved, while daily minimum temperature also influenced encounters with venomous species. We also found that both Bungarus (krait) species present were mostly encountered between 18:00 h and midnight.

Conclusions
This study highlights the multifaceted factors influencing human-snake conflicts in the region, including seasonality, geographic location, rainfall patterns, and temperature dynamics. It underscores the potential of snake rescue data as a valuable resource for deepening our understanding of regional variations in snake–human interactions.
Detection of diarrhoeagenic Escherichia coli in the abattoir wastewater-impacted Iyi-Etu River and other water types at the Amansea livestock market settlement, Anambra State, Nigeria: a matter of public health concern
Authors: Nfor Gilbert Karngong , Omatola Cornelius Arome , Emurotu Olubunmi Marvelous , Mofolorunsho Kehinde Charles 
Published: January 2025

Abstract

Background
Globally, diarrhoeagenic Escherichia coli (DEC) has been implicated in the spread of waterborne diseases and abattoir wastewater has played a role in its dissemination into watersheds. This study isolated and characterised DEC from the abattoir wastewater-impacted Iyi-Etu River and other water sources at the Amansea livestock market settlement.

Methods
A total of 96 water samples comprising river water (upstream, downstream 1, downstream 2), borehole, well, sachet and abattoir wastewater samples were tested for DEC. In the inoculation process, membrane filtration was used, and selective media such as Eosin Methylene Blue, Chromoselect agar and Sorbitol Maconkey agar were used to screen for E. coli and Shiga toxin-producing E. coli (STEC) O157. Escherichia coli pathotypes were characterised using molecular techniques.

Results
Overall, E. coli was presumptively detected in 28.1% (27/96) of all samples. Of the 27 isolates, three (11.1%) were non-sorbitol fermenters (typical of E. coli O157), while 20 (74.1%) were confirmed as E. coli based on uidA housekeeping gene positivity. The detected circulating pathotypes were enteropathogenic E. coli (EPEC) (35.0%; 7/20), enteroinvasive E. coli (EIEC) (40.0%; 8/20), enterotoxigenic E. coli (15.0%; 3/20), STEC (40.0%; 10/20) and enteroaggregative E. coli (5.0%; 1/20). Escherichia coli as well as EPEC, EIEC and STEC pathotypes were most prevalent at the downstream 1 sampling point compared with the upstream. EPEC, EIEC and STEC were also detected in borehole samples (5.0%, 1/20).

Conclusions
The Iyi-Etu River and borehole water sources used for domestic and drinking purposes, respectively, at Amansea livestock market settlement are contaminated with some pathotypes of E. coli and the level of pollution may pose a public health risk to humans and animals during contact. Thus, public health measures including proper treatment of wastewater before disposal and continuous monitoring may help to learn the associated effect of DEC pollution in the area.
Stimulating Medical Student Professional Identity Formation Through Mentored Longitudinal Partnerships With Patient Teachers
Authors: Busey Lydia , May Natalie , Martindale James R. , Bradley Elizabeth B. , Plews-Ogan Margaret , Kon Rachel H. 
Published: January 2025

Abstract

Problem

Longitudinal patient relationships can positively affect medical students’ professional identity formation (PIF), understanding of illness, and socialization within medical practice, but a longitudinal integrated clerkship (LIC) model is not always feasible. The authors describe the novel Patient Student Partnership (PSP) program, which provides authentic roles for students in mentored longitudinal patient relationships while maintaining a traditional block clerkship model.

Approach

The PSP program at the University of Virginia School of Medicine pairs all matriculating medical students with a patient living with chronic illness to follow across multiple health care settings until graduation. The 4-year required program is rooted in the conceptual frameworks of PIF, experiential learning, and communities of practice. This program evaluation used survey data collected from the first full cohort of students (Class of 2022) at 5 timepoints during the initial 4 years of implementation (2018–2022).

Outcomes

At graduation, 152 students had completed the PSP program. Students’ narrative responses on surveys indicated PSP participation helped them connect classroom learning to clinical practice, play meaningful roles in patient care, practice communication skills via electronic health records, and practice self-reflection about their future roles as physicians. On the survey administered as students approached graduation, 54/67 (80.6%) of responding students agreed or strongly agreed that the PSP program allowed them to observe the general trajectory of a patient’s chronic illness and its impact on daily life.

Next Steps

This initial evaluation demonstrates the feasibility of integrating a mentored longitudinal experience into an existing block curriculum. Future study of PIF development occurring during PSP activities is needed to explore whether the PSP program stimulates PIF in ways similar to LICs. Additionally, the authors plan to address variability in engagement between medical students and their patient teachers through further student and faculty development regarding role clarification.
Categorizing Stigma as a Barrier to Support Following Nonfatal Overdose: A Qualitative Study
Authors: Larsen Kaylee , Silverstein Sydney , Crawford Timothy , Hassan Shahidul , Mack Nathaniel , Perdue Tasha , Ray Bradley 
Published: January 2025

Objectives
Stigma is known to be a major barrier to treatment for people who use drugs (PWUD). This study uses the Stigma and Health Discrimination Framework to analyze how different forms of stigma shape experiences in the wake of an overdose incident, and perceptions of the efficacy and utility of postoverdose interventions among a sample of PWUD in Dayton, Ohio—a location with a high overdose rate.

Methods
Interviews were conducted with 23 individuals who self-reported past-month illicit opioid, crack/cocaine, or methamphetamine use who had experienced or witnessed a drug overdose in the past 6 months. Interviews were recorded, transcribed, and thematically analyzed using Taguette software.

Results
Discrete forms of stigma were identified as barriers to postoverdose interventions intended to link PWUD with support and services to help them access treatment. Individuals identified experiences of enacted stigma through medical mistreatment, exploitation, and judgment. They identified anticipated stigma through mistrust and unsustainable treatment. Internalized stigma was identified through the effect of loss on mental health, feeling “stuck,” and the role of race on support-seeking behaviors. Experiences of structural stigma included desensitization of addiction as a disease and lack of feasible, long-term treatment options.

Conclusions
The results suggest that enacted, anticipated, internalized, and structural forms of stigma act as barriers to the efficacy of postoverdose outreach programs, and the initiation and sustainability of treatment. Understanding how each form of stigma adversely impacts PWUD can improve public health and clinical interventions to reduce stigma and overdose death.
Radiographic Predictors of Difficult Fiberscopic Intubation During General Anesthesia in Patients With a Cervical Collar to Simulate a Difficult Airway
Authors: Jo Woo-Young , Park Sang Joon , Shin Kyung Won , Park Hee-Pyoung , Oh Hyongmin 
Published: January 2025

Background:
Predictors of difficult fiberscopic intubation have not been fully elucidated. This study focused on identifying radiographic predictors of difficult fiberscopic intubation during general anesthesia in patients with a cervical collar.

Methods:
This retrospective study included unconscious patients who underwent orotracheal intubation using a flexible fiberscope while wearing a cervical collar to simulate a difficult airway. Easy fiberscopic intubation was defined as successful fiberscopic intubation within 120 seconds on the first attempt without desaturation below 90%. The patients were divided into easy (n=133) and difficult (n=24) fiberscopic intubation groups. Demographic, mask ventilation-related, upper airway-related, and radiographic variables measured on sagittal images of preoperative cervical x-ray and magnetic resonance imaging were analyzed.

Results:
The difficult fiberscopic intubation group had a smaller oral cavity area (2.1 [1.2-2.5] vs. 2.9 [2.1-3.7] cm2, P<0.001), higher tongue area divided by oral cavity area (9.3 [6.5-13.3] vs. 6.4 [4.6-8.3], P<0.001), smaller epiglottis angle (33±10° vs. 37±8°, P=0.02), and longer skin-glottis distance (1.3 [1.1-1.6] vs. 1.1 [1.0-1.3] cm, P=0.004). Tongue area/oral cavity area (odds ratio per 1 [95% CI]: 1.24 [1.09-1.40]) and skin-glottis distance (odds ratio per 1 cm [95% CI]: 13.0 [2.69-62.4]) were independently associated with the difficulty in fiberscopic intubation.

Conclusions:
High tongue area/oral cavity area and long skin-glottis distance were predictive of difficult fiberscopic intubation during general anesthesia in patients with a cervical collar.
Learnings From an Audit of Anesthesia Information Management System for Neurosurgery Operating Room Utilization
Authors: Malhotra Rohit , Sriganesh Kamath , Venkataramaiah Sudhir , Chakrabarti Dhritiman 
Published: January 2025

Background:
An anesthesia information management system (AIMS) can be used to assess operating room utilization. The aim of this study was to assess neurosurgery OR utilization patterns using an AIMS.

Methods:
This retrospective audit was performed at a tertiary neurosciences university hospital over a 1-year period. The time taken for various OR activities were identified from the timestamps recorded in the AIMS and used to assess whether the type of surgical procedure, patient’s American Society of Anesthesiologists (ASA) physical status score, case schedule order, or surgeons’ experience impacted operating room utilization.

Results:
Data from 1800 patients were available for analysis. Utilization times for various operating room activities were different based on the type of surgery, ASA grade, case order, and surgeon seniority. The main differences were found in the durations of surgery and anesthesia, and the time from the arrival of a patient into the operating room and the start of surgery, which were significantly impacted by the type of surgery, case order, and surgeon seniority (P<0.001), but not by ASA score.

Conclusions:
AIMS can effectively track and identify operating room utilization patterns by analyzing the durations of various operating room activities. Prospective multicenter studies are required to validate these findings in different surgical populations and centers.
Ring Fixator Bone Transport is Associated With Fewer Unplanned Major Reoperations than Masquelet in the Treatment of Segmental Bone Defects of the Tibia
Authors: Whitlock Keith G. , Brodke Dane J. , Khoury Philip H. , Li Vivian , Bell Alice , Okhuereigbe David , Sciadini Marcus F. , Nascone Jason W. , O’Toole Robert V. , O’Hara Nathan N. , Gage Mark J. 
Published: January 2025

OBJECTIVE:
To determine whether bone transport or Masquelet results in higher rates of major unplanned reoperations for the treatment of segmental tibial bone defects ≥4 cm in length.

METHODS:

Design: Retrospective cohort.

Setting:
Level I trauma center.

Patient Selection Criteria:
Adult patients with segmental tibial defects (OTA/AO 41,42,43) ≥4 cm who underwent surgical treatment with ring fixator bone transport or Masquelet between 2011–2022 with a minimum 1-year follow-up were included.

Outcome Measures and Comparisons:
The primary outcome was a major unplanned reoperation after corticotomy (bone transport) or autografting (Masquelet), including below knee amputation, surgical debridement for deep infection, or surgical intervention for nonunion. Ring fixator bone transport and Masquelet were compared using multivariable logistic regression, adjusting for defect size as a potential confounder.

RESULTS:
24 patients treated with bone transport (mean age 40yo (18-66), 100% male) and 22 patients treated with Masquelet (mean age 42yo (22-71), 91% male) were included. Defect etiology was identified as acute traumatic in 25 patients (54%) and post-infectious in 21 patients (46%) (P = 0.23). The median defect size was 7.2 cm (IQR 6.1–10.1) for transport and 5.8 cm for Masquelet (IQR 4.7–8.0) (P = 0.08). Bone transport was associated with an 85% reduction in the odds of a major unplanned reoperation compared to treatment with the Masquelet technique (OR, 0.15; 95% CI, 0.03–0.58; P = 0.01). Bone transport patients underwent a mean of 0.38 major unplanned reoperations compared to 0.91 in the Masquelet group. Reoperation for deep infection occurred significantly less in the bone transport group (21%) compared to the Masquelet group (46%) (OR, 0.18; 95% CI, 0.03–0.76; P = 0.03).

CONCLUSION:
Bone transport was associated with a reduction in major reoperations compared to Masquelet for segmental tibial bone defects. This finding may have been driven by fewer surgeries for infection in the bone transport group.

LEVEL OF EVIDENCE:
Therapeutic Level III
Anesthesia and Pain Management for Scoliosis Surgery
Authors: Reysner Małgorzata , Kowalski Grzegorz , Geisler-Wojciechowska Alicja , Resyner Tomasz , Wieczorowska-Tobis Katarzyna 
Published: January 2025

Study Design:
This was a narrative review.

Objective:
The objective of this review was to summarize the current evidence and knowledge gaps regarding anesthesia and pain management for scoliosis surgery, including multimodal analgesia, and identify the best anesthetic approach to scoliosis surgery that ensures patient safety and pain relief even in the postoperative period, with minimal influence on SSEP monitoring.

Summary of Background Data:
Spinal surgeries and fusions for scoliosis are associated with high pain levels. Inadequate analgesia can cause patient dissatisfaction, delay recovery, and increase the risk of chronic pain. Despite serious side effects, opioids are the mainstay of pain medication after scoliosis surgery. However, increasing emphasis on minimizing opioids and accelerating recovery has increased the adoption of multimodal analgesic therapy.

Materials and Methods:
The literature review was performed on standards of care, a pain management protocol, current therapeutic options, and innovative treatment options for patients undergoing scoliosis surgery. The literature was reviewed through 4 electronic databases: PubMed, Cochrane Library, Google Scholar, and Embase.

Results:
The initial search yielded 994 articles. Forty-seven relevant articles were selected based on relevance, recentness, search quality, and citations. Ten studies described the influence of different methods of anesthesia on neuromonitoring. Twenty-one researchers studied the effect of analgesics and coanalgesics on pain relief protocol. Nine studies treated regional anesthesia and its influence on pain management.

Conclusions:
The most suitable anesthetic approach that does not disturb the neuromonitoring is obtained by combining total intravenous anesthesia (TIVA) with remifentanil and propofol with regional anesthesia, particularly erector spinae plane block (ESPB), as a part of a multimodal analgesia protocol.

Level of evidence:
Level II.
Drusen Regression after Macula-involving Rhegmatogenous Retinal Detachment Repair
Authors: Green Kyle M. , Mohammed Taariq K. , Russell Jonathan F. , Boyce Timothy M. 
Published: January 2025

Purpose:
To investigate the effect of macula-involving rhegmatogenous retinal detachment (RRD) repair on drusen regression.

Methods:
A retrospective review was performed of patients with drusen who underwent macula-involving RRD repair. Longitudinal optical coherence tomography scans were reviewed by three graders, and each case was grouped into one of three categories: drusen regression, drusen persistence, or mixed.

Results:
14 eyes with drusen that underwent macula-involving RRD repair were identified. Surgical repair consisted of pars plana vitrectomy (PPV) in 7 eyes, combined PPV and scleral buckle in 6 eyes, and primary buckle with cryotherapy in 1 eye. Regression of drusen occurred in 6 eyes (43%), persistence of drusen in 5 eyes (36%), and 3 eyes were categorized as mixed (21%). One patient with drusen regression with long-term follow up resulted in geographic atrophy.

Conclusion:
Although the course of drusen following repair of macula-involving RRDs was highly variable, roughly half of eyes demonstrated marked drusen regression.
A Perspective on Combination of Antibiotic Therapy for Extensively Drug-Resistance Bacterial Infections
Authors: Tuon Felipe Francisco , Zequinao Tiago , Morales Ronaldo , Telles Joao Paulo 
Published: January 2025

Abstract
Evaluation of clinical efficacy in epidemiological studies and even controlled studies with extensively drug-resistant (XDR) organisms is difficult, as it generally encompasses critically ill patients, who are usually prone to high mortality rate. Combination therapy has been used as a strategy to establish synergistic effect. However, the literature has been extremely controversial, and most recent studies have demonstrated that combination therapy should not be used routinely in XDR bacterial infections. This narrative review discusses the combination therapy on XDR bacteria using the pharmacokinetic and pharmacodynamic approach based on several systematic reviews with meta-analysis.
Intestinal Spirochetosis as a Cause of Persistent Rectal Abscess in a Patient With HIV/AIDS
Authors: Khazi-Syed Afeefah , Chi Zhikai , Kelesidis Theodoros 
Published: January 2025

Abstract

Brachyspira is a rare spirochetal infection that can cause a variety of gastrointestinal symptoms. Individuals with HIV/AIDS are at increased risk of developing persistent and severe infection. To our knowledge, rectal abscess due to Brachyspira have not previously been described. Here, we present a case of a HIV-positive patient presenting with chronic rectal pain and drainage over the span of 2 years, who was diagnosed with Brachyspira rectal abscess. We discuss the diagnostic challenge of Brachyspira rectal abscesses mimicking sexually transmitted disease and discuss the utility of prolonged metronidazole treatment due to both antibacterial and anti-inflammatory effects.
Streptococcus pyogenes Bacteremia at a Large Teaching Hospital
Authors: Rich Elizabeth , Hatch Stacy , Oravec Michael , Myers Joseph 
Published: January 2025

Objectives
The aims of the study were to review Streptococcus pyogenes bacteremia (SPB) at our 570-bed teaching hospital from 2018 to 2022 and to report epidemiology, source of SPB, comorbidities, treatment, and mortality.

Methods
This was deemed to be an institutional review board–exempt quality improvement project of our internal medicine residency. We reviewed records of adults (≥16 years) with SPB admitted to hospital during 5-year period from 2018 to 2022. Age, gender, date and source of bacteremia, comorbidities, antimicrobial therapy, and mortality were recorded for each patient. Comparisons to data from our 2007–2016 study were performed using Fisher's exact test with 2-tailed P value.

Results
There were 102 episodes of SPB during the 5-year period: 64 men (62.7%) and 38 women (37.3%). Incidence was 4.39/104 hospital discharges (HD) in 2018, 6.79/104 HD in 2019, 6.67/104 HD in 2020, 6.16/104 HD in 2021 and 5.83/104 HD in 2022. Age range was 21–94 years with mean = 56.5 years. Sources of bacteremia: skin/soft tissue infection in 52/102 (51.0%), pneumonia in 15/102 (14.7%), bone/joint infection in 13/102 (12.7%), and primary infection in 8/102 (7.8%) episodes. Other sources were as follows: endometritis (3 patients), intra-abdominal infection (3 patients), mastoiditis (2 patients), endocarditis (1 patient), and miscellaneous (4 patients). Diabetes mellitus (36.2%), injection drug use (IDU) (29.8%), chronic obstructive pulmonary disease (24.5%), and chronic liver disease (23.4%) were the most common comorbidities. The mortality rate was 15.7%. All patients received appropriate/timely initial antimicrobial therapy.

Conclusions
SPB was more frequent in this 5-year period than during the preceding 10-year period. Skin/soft tissue infection (51.0%) and bone/joint infection (12.7%) were expected sources of SPB but pneumonia (14.7%) was an unexpectedly frequent cause. There was more episodes of bacteremia IDU-related, 29.8% in this study, than the 7.4% in our prior study (P = 0.0004). Mortality was higher (15.7%) than in our prior study (10.3%) but this difference did not achieve statistical significance (P = 0.3663). SPB is not uncommon, is frequently associated with IDU, causes pneumonia more often than expected, and has a 15.7% mortality rate.
Extracorporeal Shock Wave Therapy for Limb Dysfunction after Stroke: A Systematic Review and Meta-analysis
Authors: LIU Wen-fang , ZHANG Shuang-mei 
Published: January 2025

Abstract

Objective
Recently, extracorporeal shock wave therapy (ESWT) has emerged as a novel and noninvasive approach for alleviating spasticity and pain, improving motor dysfunction after stroke. To determine the effectiveness of ESWT and the effects of shock wave parameters in relieving spasticity, pain, and motor dysfunction following stroke.

Design
We conducted a systematic search of PubMed, EBSCOhost, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials on ESWT for limb dysfunction after stroke from inception until February 1, 2023. Two researchers independently searched and screened articles identified from each database, used RevMan v.5.4 analyzing data.

Results
This review included nine articles and 327 patients. ESWT improved the spasticity, pain, and motor function following stroke. They also improved the passive range of motion in the lower limbs. The treatment effect was highest when the shock wave frequency was <8 Hz and pressure was <2 bar. However, the effect was not significantly affected by treatment duration. Compared to focused extracorporeal shock waves, released extracorporeal shock waves were associated with better outcomes.

Conclusion
The treatment outcomes are optimal when a shock wave frequency < 8 Hz, pressure < 2 bar, and released extracorporeal shock waves are used.