bluuebunny/crossref_metadata_2025_split huggingface dataset:
Late Bleeding Following Cleft Palate Repair: An Under-Reported Finding?
Authors: Wheeler Jonathan S. , Sanders Megan 
Published: September 2021

Abstract
The objective of this article is to assess the incidence of late bleeding following cleft palate repair (palatoplasty) in children. This is a retrospective review of a prospectively maintained database of patients treated for Cleft Lip and Palate in a tertiary academic pediatric hospital setting over 2 hospitals (Middlemore and Starship Hospitals) under the same multidisciplinary team of the Auckland Regional Cleft and Craniofacial Service, New Zealand. All patients with a diagnosis of Cleft Lip and/or Palate undergoing primary cleft palate repair over an 11 year period until March 2020 were included in the study. Our results found there were 482 patients with a new diagnosis of Cleft Lip and/or Palate from Jan 2009 through to March 2020. Three hundred sixty-six of those patients underwent primary palatoplasty at an average age of 10.5 months (range 8–18 months). The sub-types of cleft palate diagnoses were one-third Veau I, one-third Veau II, and the remaining one-third were Veau III, IV, and submucous cleft palate. One-third were syndromic. A total of 6 patients were re-admitted to hospital after discharge from their primary admission with bleeding from the cleft palate surgical site. Of the 6 patients re-admitted, 5 needed blood transfusions and 4 required an urgent return to the operating room. The authors found the rate of late bleeding following primary cleft palate repair in our unit is 1:61 operations or 1.6%. Late bleeding following cleft palate surgery is not well reported in the literature.
Infraeyebrow Blepharoplasty Using Dynamic Suspension Technique Between Dermis-Fascia Flap and Frontalis in Upper Eyelid Lifting and Eyebrow Augmentation
Authors: Cao Zilong , Liu Liqiang , Fan Jincai , Tian Jia , Gan Cheng , Jiao Hu , Yang Zengjie , Zhang Tiran 
Published: September 2021

Objective:Upper eyelid laxity affects facial aesthetics and the eyebrow arch in the East Asian population is generally low. The authors developed infraeyebrow blepharoplasty using a dynamic suspension technique between the dermis-fascia flap and frontalis for upper eyelid lifting and eyebrow augmentation.Methods:A retrospective study was performed on 43 female patients with upper eyelid laxity from August 2015 to October 2019. The epidermis and superficial dermis of the infraeyebrow was removed from the surgical marking area with the deep dermis and fascia preserved. The eyebrow skin flap was separated from the frontalis surface which fully exposed the area around eyebrow arch. The preserved dermis-fascia flap was folded and suspended to frontalis in the superior margin of eyebrow arch.Results:Forty-three patients (median age 54 years [range, 38–70]) underwent this operation. Mean follow-up was 25 months (range, 8–42) was assessed. All incisions healed well and were almost invisible. The eyebrow area improved with upper eyelid skin lift and eyebrow augmentation; 40 cases were “very satisfied” with their appearance. Three cases were “not very satisfied,” including 1 case with numbness in surgical area. 2 cases had slight bilateral asymmetry of the upper eyelids.Conclusions:The dynamic suspension technique is worthy of clinical application because it can correct upper eyelid laxity, augment the low eyebrow arch, and obtain an invisible scar by reducing the incision tension.
Implementation of a Surgical Critical Care Service Reduces Failure to Rescue in Emergency Gastrointestinal Surgery in Rural Kenya
Authors: Many Heath R. , Otoki Kemunto , Parker Andrea S. , Parker Robert K. 
Published: September 2021

Objective:
We aimed to evaluate the implementation of a dedicated Surgical critical care service (SCCS) on failure to rescue (FTR) rates in rural Kenya.

Summary Background Data:
FTR adversely impacts perioperative outcomes. In the resource-limited contexts of low- and middle-income countries, emergency gastrointestinal surgery carries high morbidity and mortality rates. Quality improvement initiatives that decrease FTR rates are essential for improving perioperative care.

Methods:
All patients who underwent emergency gastrointestinal surgery between January 2016 and June 2019 at Tenwek Hospital in rural Kenya were reviewed. Critical care capabilities were constant throughout the study period. A supervised surgical resident was dedicated to the daily care of critically ill surgical patients beginning in January 2018. The impact of the SCCS initiation on the outcome of FTR was evaluated, controlling for patient complexity via the African Surgical Outcomes Study Surgical Risk Score.

Results:
A total of 484 patients were identified, consisting of 278 without and 206 with an active SCCS. A total of 165 (34.1%) patients experienced postoperative complications, including 49 mortalities (10.1%) yielding an FTR rate of 29.7%. The FTR rate decreased after SCCS implementation from 36.8% (95% CI: 26.7%–47.8%) to 21.8% (95% CI: 13.2%–32.6%) (P = 0.035) despite an increase in the average patient African Surgical Outcomes Study score from 14.5 (95% CI, 14.1–14.9) to 15.2 (95% CI, 14.7–15.7) (P =0.03).

Conclusions:
The implementation of an SCCS in rural Kenya resulted in decreased rates of FTR despite an increase in patient complexity and severity of critical illness.
BACTERIAL INFECTION AND ANTIBIOTIC RESISTANCE IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS PRESENTING LOWER RESPIRATORY TRACT INFECTION IN NIGERIA
Authors: Oguche Joel Iko-ojo , Bolaji Rebecca Olajumoke , Onaolapo Josiah Ademola , Abah Samuel Eneojo , Kwaghe Vivian Gga , Akor Shedrack Egbunu , Shaibu Sarah , Salami Tijani , Eneojo-Abah Gloria Eleojo 
Published: September 2021

ABSTRACTLower Respiratory Tract Infection (LRTI) is associated with mortality and prolonged antibiotics use among HIV/AIDS patients. Sputum samples were collected from 134 HIV/AIDS patients with LRTI and productive cough, visiting University of Abuja Teaching Hospital, Nigeria, to determine the bacterial aetiologies and antibiotic resistance profile. Adequate for culture sputum samples were observed in only 119 subjects (75 females and 44 males) and cultured using standard procedure. Isolates were identified by biochemical method and 16SrRNA gene amplification, purification, sequencing and database nucleotide blast. Antibiotic susceptibility tests were performed and interpreted according to Clinical and Laboratory Standard Institute (CLSI) procedures. Bacteria associated LRTI was found in 20.2% of the patients and Klebsiellapneumonia(29.7%);Enterobacter cloacae(16.7%);Enterobacter hormaecheisubsp.xiangfangensis(12.5%);Pseudomonas parafulva;Pseudomonas aeruginosa;Pseudomonas alcaliphila; Klebsiella aerogenes(8.3%);Comamonas testosteroni;Escherichia coli;Acinetobacter junii;Acinetobacter soliandAcinetobacter baumanniiwere implicated. Isolates show high resistance to amoxicillin-clavulanic acid at 94.1%, trimethoprim-sulfamethoxazole at 75.0% and cefotaxime at 70.0%. The Multiple Antibiotic Resistance (MAR) index of most isolates (62.5%) is within 0.3-0.8 in a range of 0.0 to 0.8. Isolates of the same species were found to have different MAR index in different patients. However,E. cloacae, E. hormaecheisubsp.xiangfangensis, A. baumanniand 71.4% ofK. pneumoniawere Multi-drug Resistant (MDR). Interestingly, Gentamycin, Ciprofloxacin and Imipenem were effective against MDR isolates and showed significant negative correlation with MAR index. We propose that antibiotics with efficacy against MDR isolates could be used to down regulate the selective pressure of other antibiotics, and these MDR pathogens, including those rarely associated with human infection poses potential threat, similar to Methicillin ResistantStaphylococcus aureus(MRSA). Particularly, among the immunocompromised. Furthermore, HIV/AIDS patients present good metrics for profiling the burden and spread of antibiotic resistant bacteria in poor countries.
Adjuvant Testosterone Therapy in Chronic Heart Failure (ATTIC) – A Randomised Open-Label Trial
Authors: Dhar Minakshi , Mittal Kartik , Parchani Ashwin , Sharma Manu , Bahurupi Yogesh , Kalra Sanjay , Bhat Nowneet K 
Published: September 2021

ABSTRACTIntroductionHeart failure is a major contributor to morbidity and mortality in the geriatric population, with no promising therapy currently available with considerable benefit. Testosterone therapy is an emerging viable treatment option given its beneficial effects, including improving cardiac functional capacity, alleviating symptoms, and low cost, amongst others.MethodsWe have planned an open-label, parallel design, 1:1 randomized controlled trial which aims to recruit 160 adult males above the age of 60 diagnosed with chronic stable heart failure fulfilling the eligibility criteria. The participants will be randomized into two groups of 80 each. Both groups will receive standard recommended treatment regime of chronic stable heart failure and intervention arm participants will receive additional testosterone gel. All participants will be assessed at baseline, 4 weeks, 6 weeks and 12 weeks. The primary endpoints will assess the difference in functional capacity, frailty and quality of life at 3 months compared to baseline. The secondary endpoints will include the mean change from baseline at 3 months in cardiac remodelling using echocardiography, serum brain natriuretic peptide levels, the incidence of adverse drug reaction.Statistical AnalysisThe data will be analysed with the help of SPSS software. Primary objectives of change in 6MWT, Frailty index and quality of life will be analysed using the student t-test. The statistical significance will be defined as p-value <0.05 and taking confidence level as 95%.Ethical clearanceInstitutional Ethics Committee clearance taken via letter no AIIMS/IEC/20/847, dated 21/11/2020
Decoding hand and wrist movement intention from chronic stroke survivors with hemiparesis using a user-friendly, wearable EMG-based neural interface
Authors: Meyers Eric C , Gabrieli David , Tacca Nick , Wengerd Lauren , Darrow Michael , Friedenberg David 
Published: September 2021

AbstractProsthetics and orthotics have been recognized for decades as a potential means to restore hand function and independence to individuals living with impairment due to stroke. However, 75% of stroke survivors, caregivers, and health care professionals (HCP) believe current practices are insufficient, specifically calling out the upper extremity as an area where innovation is needed to develop highly usable prosthetics/orthotics for the stroke population. A promising method for controlling upper limb technologies is to infer movement intent non-invasively from surface electromyography (EMG) activity. While this approach has garnered significant attention in the literature, existing technologies are often limited to research settings and struggle to meet stated user needs. To address these limitations, we have developed the NeuroLife® EMG System, which consists of a wearable forearm sleeve with 150 embedded electrodes and associated hardware and software to record and decode surface EMG. Here, we demonstrate accurate decoding of 12 functional hand, wrist, and forearm movements, including multiple types of grasps from participants with varying levels of chronic impairment from stroke, with an overall accuracy of 77.1±5.6%. Importantly, we demonstrate the ability to decode a subset of 3 fundamental movements in individuals with severe hand impairment at 85.4±6.4% accuracy, highlighting the potential as a control mechanism for assistive technologies. Feedback from stroke survivors who tested the system indicates that the sleeve’s design meets various user needs, including being comfortable, portable, and lightweight. The sleeve is in a form factor such that it can be used at home without an expert technician and can be worn for multiple hours without discomfort. Taken together, the NeuroLife EMG System represents a platform technology to record and decode high-definition EMG for the eventual real-time control of assistive devices in a form factor designed to meet user needs.
Implicit, Intrinsic, Extrinsic, and Host Factors Attributing the Covid-19 Pandemic. Part 1- Intrinsic Factor Nitrous Oxide Emissions: A Systematic Analysis
Authors: Thapliyal Nikita , Joshi Gaurav , Gahtori Prashant 
Published: September 2021

AbstractDespite Nitrous oxide (N2O) being the most widely used anesthetics in dental and other medical applications, it is associated with global warming and stratospheric ozone destruction. With globalization, a larger amount of N2O emissions arearticulated especially from human activities (30%, 6.7 Tg N per year), which are primarily dominated by agriculture that is even above the emissions of all oceans (26%). The synthesis of N2O reflects the general chemistry and readily from a substrate Nitric oxide (NO) in the environment. The modeling of infectious disease dynamics covering common pathogen-transmission factors, for example intrinsic (or microbes nutrient supply) at a population level, is indeed imperative to curb the menace of any disease. Nonetheless, in areas where novel coronavirus disease (COVID-19) was at its worst, for example, Wuhan China, Mumbai India, Milan Italy, Washington USA etc., the reduction in N2O emissions was well noticed. Nonetheless, viruses exhibit greater mobility than humans and hijack nutrients including nitrogen to complete their epidemiological cycle all due to limited sequence space of viral genomes, the high probability of genetic drift, extremely large population sizes, the high mutation and recombination rates. In consequence of drastic fall in N2O emissions, lower human transport can not be an all alone contributor, but contrarily it may also be associated with coronavirus intrinsic factors. This prompted us to analyze freely accessible and large global data from two authenticated sources, the World Health Organization and World Bank. We hereby argue that intrinsic factor N2O emissions fueling the COVID-19 progression significantly. Entire predictions were found consistent with the recently observed shreds of evidence. These insights enhanced scientific ability to interrogate viral epidemiology and recommended a 7-points framework covering all-natural lifestyle and dietary supplements for COVID-19 prevention before the arrival of a front-line therapeutic(s) or preventable vaccine.
Iron related biomarkers predict disease severity in a cohort of Portuguese adult patients during COVID-19 acute infection
Authors: Moreira Ana C. , Teles Maria J. , Silva Tânia , Bento Clara M. , Alves Inês Simões , Pereira Luísa , Guimarães João T. , Porto Graça , Oliveira Pedro , Gomes Maria Salomé 
Published: September 2021

ABSTRACTBACKGROUNDGrowing evidence indicates a link between iron metabolism and COVID-19 clinical progression, supporting the use of iron and inflammatory parameters as relevant biomarkers to predict patients’ outcomes.METHODSWe evaluated iron metabolism and immune response in 303 patients admitted to the main hospital of the northern region of Portugal with variable clinical pictures, from September to November 2020. Of these, 127 tested positive for SARS-CoV-2 and 176 tested negative. Iron-related laboratory parameters and cytokines were determined in blood samples collected soon after admission and, in a subgroup of patients, throughout hospitalization. Demographic data, comorbidities and clinical outcomes were recorded. Patients were assigned into 5 groups according to disease severity.RESULTSSerum iron and transferrin levels at admission were lower in COVID-19-positive than in COVID-19-negative patients. Conversely, the levels of interleukin(IL)-6 and monocyte chemoattractant protein 1 (MCP1) were increased in COVID-19-positive patients. The lowest serum iron and transferrin levels at diagnosis were associated with the worst outcomes. Iron levels negatively correlated with IL-6 and higher levels of this cytokine were associated with a worse prognosis. Serum ferritin levels at diagnosis were higher in COVID-19-positive than in COVID-19-negative patients but did not correlate with disease severity. Longitudinal determinations of iron and ferritin made in a subgroup of patients (n=23) revealed highly variable results.CONCLUSIONSSerum iron is the simplest laboratory test to be implemented as a predictor of disease progression in hospitalized acute COVID-19-positive patients. Variation of ferritin with time should be revisited in larger cohorts.Key pointsCOVID-19-positive patients have lower serum iron and higher ferritin than COVID-19-negative patients in variable clinical contexts. Lowest serum iron and highest IL-6 levels at hospital admission associate with the poorest outcomes. Association of serum ferritin with disease progression is debatable.
Long-term air pollution exposure and diabetes risk in American older adults: a national cohort study
Authors: Sade Maayan Yitshak , Shi Liuhua , Colicino Elena , Amini Heresh , Schwartz Joel D , Di Qian , Wright Robert O 
Published: September 2021

ABSTRACTBackgroundType 2 diabetes is a major public health concern. Studies show that both genetics and environmental exposures play a significant role in developing the disease. We assessed the association between air pollution and first documented diabetes occurrence in a national U.S. cohort of older adults to estimate diabetes risk.MethodsWe included all Medicare enrollees 65 years and older in the fee-for-service program, part A and part B, in the contiguous United States (2000-2016). Participants were followed annually until the first recorded diabetes diagnosis, end of enrollment, or death (264,869,458 person-years). We obtained annual estimates of fine particulate matter (PM2.5), nitrogen dioxide (NO2), and warm-months ozone (O3) exposures from highly spatiotemporally resolved prediction models. We assessed the simultaneous effects of the pollutants on diabetes risk using survival analyses. We repeated the models in cohorts restricted to ZIP codes with air pollution levels not exceeding the national ambient air quality standards (NAAQS) during the study period.ResultsWe identified 10,024,879 diabetes cases of 41,780,637 people (3.8% of person-years). The hazard ratio (HR) for first diabetes occurrence was 1.074 (95% CI 1.058; 1.089) for 5 µg/m3 increase in PM2.5, 1.055 (95% CI 1.050; 1.060) for 5 ppb increase in NO2, and 0.999 (95% CI 0.993; 1.004) for 5 ppb increase in O3. Both for NO2 and PM2.5 there was evidence of non-linear exposure-response curves with stronger associations at lower levels (NO2 ≤ 40 ppb, PM2.5 ≤ 9 µg/m3). Furthermore, associations remained in the restricted low-level cohorts. The O3-diabetes exposure-response relationship differed greatly between models and require further investigation.ConclusionExposures to PM2.5 and NO2 are associated with increased diabetes risk, even when restricting the exposure to levels below the NAAQS set by the U.S. EPA.
Study of effect modifiers of genetically predicted CETP reduction
Authors: Legault Marc-André , Barhdadi Amina , Gamache Isabel , Lemaçon Audrey , Perreault Louis-Philippe Lemieux , Grenier Jean-Christophe , Sylvestre Marie-Pierre , Hussin Julie G. , Rhainds David , Tardif Jean-Claude , Dubé Marie-Pierre 
Published: September 2021

AbstractGenetic variants in drug targets can be used to predict the effect of drugs. Here, we extend this principle to assess how sex and body mass index may modify the effect of a genetically predicted lower CETP levels on biomarkers and cardiovascular outcomes.We found sex and BMI to be modifiers of the association between genetically predicted lower CETP and lipid biomarkers in UK Biobank participants. Female sex and lower BMI were associated with higher HDL-cholesterol and lower LDL-cholesterol for a same genetically predicted reduction in CETP concentration. We found that sex also modulated the effect of genetically lower CETP on cholesterol efflux capacity in samples from the Montreal Heart Institute Biobank. However, these modifying effects did not extend to sex-differences in cardiovascular outcomes in our data.Our results provide insight on the clinical effects of CETP inhibitors in the presence of effect modification based on observational genetic data. The approach can support precision medicine applications and help assess the external validity of clinical trials.
Y380Q novel mutation in receptor-binding domain of SARS-CoV-2 spike protein together with C379W interfere in the neutralizing antibodies interaction
Authors: Sauthier Sartor Ivaine Tais , Varela Fernanda Hammes , Meireles Mariana Rost , Kern Luciane Beatriz , Azevedo Thaís Raupp , Tumioto Giannini Gabriela Luchiari , da Silva Mariana Soares , Demoliner Meriane , Gularte Juliana Schons , de Almeida Paula Rodrigues , Fleck Juliane Deise , Zavaglia Gabriela Oliveira , Fernandes Ingrid Rodrigues , de David Caroline Nespolo , Santos Amanda Paz , de Almeida Walquiria Aparecida Ferreira , Gomes Porto Victor Bertollo , Scotta Marcelo Comerlato , Vieira Gustavo Fioravanti , Spilki Fernando R. , Stein Renato T. , Polese-Bonatto Márcia ,   COVIDa study group
Published: September 2021

AbstractBackgroundThe emergence of SARS-CoV-2 variants is a current public health concern possibly impacting COVID-19 disease diagnosis, transmission patterns and vaccine effectiveness.ObjectivesTo describe the SARS-CoV-2 lineages circulating early pandemic among samples with S gene dropout and characterize a novel mutation in receptor-binding domain (RBD) of viral spike protein.Study designAdults and children older than 2 months with signs and symptoms of COVID-19 were prospectively enrolled from May to October 2020 in Porto Alegre, Brazil. All participants performed RT-PCR assays for diagnosing SARS-CoV-2, samples with S gene dropout and Ct < 30 (cycle threshold) were submitted to whole genome sequencing (WGS), and homology modeling and physicochemical properties analysis were performed.Results484/1,557 participants tested positive for SARS-CoV-2. The S gene dropout was detected in 7.4% (36/484) as early as May, and a peak was observed in early August. WGS was performed in 8 samples. The B.1.1.28, B.1.91 and B.1.1.33 lineages were circulating in early pandemic. The RBD novel mutation (Y380Q) was found in one sample occurring simultaneously with C379W and V395A, and the B.1.91 lineage in the spike protein.ConclusionMutations in the SARS-CoV-2 spike region were detected early in the COVID-19 pandemic in Southern Brazil, regarding the B.1.1.28, B.1.91 and B.1.1.33 lineages identified. The novel mutation (Y380Q) with C379W, modifies important RBD properties, which may interfere with the binding of neutralizing antibodies (CR3022, EY6A, H014, S304).HighlightsCharacterization of novel mutation (Y380Q) in RBD of SARS-CoV-2 spike proteinThe Y380Q and C379W modify important properties in the SARS-CoV-2 RBD regionThe RBD mutations may interfere with the binding of neutralizing antibodiesThe B.1.1.28, B.1.91 and B.1.1.33 lineages were circulating in early pandemic