bluuebunny/crossref_metadata_2025_split huggingface dataset:
Genome-Wide B Cell, CD4+, and CD8+ T Cell Epitopes That Are Highly Conserved between Human and Animal Coronaviruses, Identified from SARS-CoV-2 as Targets for Preemptive Pan-Coronavirus Vaccines
Authors: Prakash Swayam , Srivastava Ruchi , Coulon Pierre-Gregoire , Dhanushkodi Nisha R. , Chentoufi Aziz A. , Tifrea Delia F. , Edwards Robert A. , Figueroa Cesar J. , Schubl Sebastian D. , Hsieh Lanny , Buchmeier Michael J. , Bouziane Mohammed , Nesburn Anthony B. , Kuppermann Baruch D. , BenMohamed Lbachir 
Published: April 2021

Abstract
Over the last two decades, there have been three deadly human outbreaks of coronaviruses (CoVs) caused by SARS-CoV, MERS-CoV, and SARS-CoV-2, which has caused the current COVID-19 global pandemic. All three deadly CoVs originated from bats and transmitted to humans via various intermediate animal reservoirs. It remains highly possible that other global COVID pandemics will emerge in the coming years caused by yet another spillover of a bat-derived SARS-like coronavirus (SL-CoV) into humans. Determining the Ag and the human B cells, CD4+ and CD8+ T cell epitope landscapes that are conserved among human and animal coronaviruses should inform in the development of future pan-coronavirus vaccines. In the current study, using several immunoinformatics and sequence alignment approaches, we identified several human B cell and CD4+ and CD8+ T cell epitopes that are highly conserved in 1) greater than 81,000 SARS-CoV-2 genome sequences identified in 190 countries on six continents; 2) six circulating CoVs that caused previous human outbreaks of the common cold; 3) nine SL-CoVs isolated from bats; 4) nine SL-CoV isolated from pangolins; 5) three SL-CoVs isolated from civet cats; and 6) four MERS strains isolated from camels. Furthermore, the identified epitopes: 1) recalled B cells and CD4+ and CD8+ T cells from both COVID-19 patients and healthy individuals who were never exposed to SARS-CoV-2, and 2) induced strong B cell and T cell responses in humanized HLA-DR1/HLA-A*02:01 double-transgenic mice. The findings pave the way to develop a preemptive multiepitope pan-coronavirus vaccine to protect against past, current, and future outbreaks.
Students’ knowledge and views on pharmacogenomic education in the medical curriculum
Authors: Agrawal Manju , Kirtania Lopamudra , Jha Anuja , Hishikar Rajesh 
Published: April 2021

INTRODUCTION:
Pharmacogenomics is a growing field of science that explores the genetic contributions in an individual's response to the drug, so as to choose the right drug in the right doses tailored to a patient's genetic makeup. Although pharmacogenomics information is incorporated in chapters discussing relevant drugs, it has not been materialized into clinical practice. Further more it remains a challenge due to limited knowledge and accessibility of the pharmacogenomic tests to diagnose these polymorphisms. With this background, the objective of the study was to assess the knowledge and perception of pharmacogenomics among second-year MBBS students and to sensitize them regarding pharmacogenomics.

MATERIALS AND METHODS:
A cross-sectional study was done in which 138 medical students responded to a preformed semi-structured assessment tool. It comprised two main components (1) knowledge and (2) relevance of pharmacogenomics in medical education and clinical practice.

RESULTS:
Ninety-five percent students defined pharmacogenomics correctly, but only 54% were aware of genetic variations in drug targets, metabolizing enzymes, and transporters affecting drug therapy. Only 15% knew about the availability of pharmacogenomics tests in India. Eighty-four percent of students felt that incorporating pharmacogenomics education in the MBBS curriculum is a must for precision medicine.

CONCLUSION:
Second-year MBBS students had good knowledge of pharmacogenomics, but knowledge about the application in clinical practice and interpretation of pharmacogenomics was limited. Therefore, we recommend (1) basic pharmacogenomic education at all levels of medical curricula, (2) development of case-based knowledge application modules, (3) regular continuing medical education to update about available screening tools/biomarkers, and (4) patient and public awareness programs so that they receive personalized/precision medicine with optimum efficacy and reduced side effects and health-care costs.
Cattle-Related Trauma
Authors: Rhind John-Henry , Quinn Dominic , Cosbey Lucy , Mobley Douglas , Britton Ingrid , Lim Justin 
Published: April 2021

Introduction:
Bovine injuries are a common and significant cause of trauma, often requiring admission and operative treatment. We review all bovine-related injuries over 5 years, both emergency and general practitioner (GP) referrals at an adult major trauma center in England.

Methods:
Retrospective evaluation was undertaken using the keywords through radiology referrals and hospital admissions speciality databases. By searching patient notes, demographics were collected as well as the mechanism and the situation of injury; trauma scores were calculated using: injury severity score (ISS) and probability of survival (Ps19). The results were divided into emergency patients and GP referrals.

Results:
Sixty-seven patients were identified retrospectively over 5 years, 44 emergency patients (including 23 major traumas), and 23 GP referrals. Combined (emergency and GP) mean age 52 years old; 67% male; and mean ISS 11. Most common combined mechanism of injury, kicked (n = 23). In emergency patients, trampling injuries were the most common. Eighty-six percent of the trampled patients were major traumas and associated with increased ISS (mean 13). Indirect injuries mainly involved farm gates (92%). Seventy-three percent of bull-related injuries were major traumas and had increased ISS scores (mean 17). Orthopaedics was the most common admitting speciality followed by cardiothoracic and neurosurgery. In emergency patients, fractures were the most common primary injury (n = 20), upper limb followed by spine. In GP, soft-tissue injuries were the most common primary injury. Seventy percent of the emergency referrals required admission and 50% operations. Fracture fixation was the most common operative procedure. Only, one GP referral required an operation. There were significant delays in GP patients presenting. Two patients had a Ps19 score <90. There were two mortalities.

Conclusion:
Cattle-related injuries are a significant cause of severe morbidity and mortality. They are under-reported. Patterns of injury are similar to high-velocity road traffic collisions and bull-related injuries or trampling in particular, should alert the clinician to more significant trauma. Farm gates are a frequent cause of trauma associated with cattle. GP referrals with ongoing symptoms for more than 2 weeks seeking medical advice should alert the clinician to a more serious diagnosis.
Determination of risk factors and cumulative effects of the maternal and neonatal risk factors in relation to preterm labor
Authors: Tavoli Zahra , Tajdar Ali , Kheiltash Azita , Rabie Maryam 
Published: April 2021

Background:
Preterm labor is the leading cause of neonatal morbidity and mortality this study aimed to determine single and combined effects of all risk factors in relation to preterm labor.

Methods:
This was a case-control study that included patients from a teaching hospital affiliated to Tehran University of Medical Sciences. Women who came to this hospital for delivery were divided into two groups: 200 in preterm delivery (before 37 weeks) and 195 in term delivery (after 37 weeks).

Results:
In all 409 pregnant women were delivered. 217 were preterm (group A) and 192 were term (group B). The mean age of mothers in group A was 30.04 ± 5.74 and the mean age of mothers in group B was 27.28 ± 5.90 (P < 0.001). The risk of preterm labor was 4.22 higher in mother with any risk factor before or during pregnancy (P < 0.001), it was 3.67 higher in mother with complication of pregnancy (P < 0.001) and it was 3.40 higher in neonate with any complication (P = 0.002) compared to mother without any risk factors. For each mother, we calculated risk score for preterm labor by counting the number of risk factors. The risk of preterm labor was significantly higher in mother with risk factors compared to those without any risk factors (P for trend = 0. 002). Mother with two risk factors had a 5.60 (P = 0.01) and mother with three or more risk factors had a 23.48 (P = 0. 001) times higher risk for preterm labor than those who did not have any risk factors.

Conclusion:
The screening and identification of mothers with risk factors for preterm delivery can increasing mother's attention and participation to better manage of these condition to have more safe pregnancy period.
A prospective study to evaluate antimicrobial prescribing pattern among admitted patients in hilly Himalayan region of northern India
Authors: Ravi Gandham , Chikara Gaurav , Bandyopadhyay Arkapal , Handu Shailendra 
Published: April 2021

Background and Aim:
Global scenario of antimicrobial (AM) utilization depicts 20–50% inappropriateness. Majority of the hospital admissions are due to unwanted effects because of non-judicial usage of these drugs. The present study focuses on utilization pattern of antimicrobials (AMs) in a tertiary care hospital in northern India.

Materials and Methods:
A prospective observational study was conducted over a period of one year in seven departments of a tertiary care hospital in hilly Himalayan region. Aim of the study was to analyze the AM utilization pattern using World Health Organization (WHO) indicators and instruments.

Results:
A total 700 prescriptions were analyzed in the present study. Injectable antibiotics (71%) followed by oral (29%) were most commonly prescribed. Beta lactams (79%) were the most frequently used antibiotic class. Most commonly prescribed AM was Ceftriaxone (30%). Majority of the time AMs were given empirically (44.8%), where most common indication was respiratory infections (42%). Culture and sensitivity tests were done for guiding curative therapy in 34.71% cases. The average duration of patient hospital stay was 8.81 days in the study population. The mean duration of prescribed antimicrobial treatment was 5.12 days. On an average 1.93 AMs were prescribed per patient. AMs were prescribed by International nonproprietary name (INN) in 62.19% of the admissions. The most common AM related adverse drug reaction was gastritis (96%) and skin rash (4%) with Amoxicillin + clavulanic acid being the most common causative agent. Total antimicrobial consumption was 148.24 DDD/100 bed days with Medicine department showing the highest consumption (36.25/100 bed days).

Conclusion:
The present study is the first and largest antimicrobial utilization study in the hilly Himalayan region of northern India. Our study found an urgent need for improvement of prescribing patterns, patient care indicators and strict adherence to standard guidelines.
Everything is not on track in management of diarrhoea in under-five children
Authors: Srivastava Prerna , Mishra C. P. , Nath Gopal 
Published: April 2021

Context:
Diarrhea is one of the leading causes of death and morbidity in under-five children. Effective management can significantly influence survival of children with diarrhea.

Objectives:
This study was carried out to assess extent of diarrhea, its source of treatment, and type of therapy.

Settings and Design:
This snapshot study was conducted in rural setting of India.

Methods and Material:
This study was conducted on 217 under-five children selected through multistage sampling procedure.

Statistical analysis used:
Statistical association of diarrhea with age and gender of children was established by computing Chi-square.

Results:
Period prevalence (Recall period 2 weeks of visit) of diarrhea in rural under-five children was 35.9% (95%C.I. 29.3–42.2%). Highest prevalence in age group 0–12 months (47.8%) and lowest in 49–59 months (18.2%). Number of episode per child is 1.08. Diarrhea was watery in 69.4%. Quacks were treatment provider for 36.4% cases. In 17.6% episodes, no treatment was taken. Only 9.4% episodes were treated in government facilities. For the treatment of diarrhea, antibiotic was used in 71.8% cases, ORS use was 33.3% cases, and zinc was used 21.8% of diarrhea episodes.

Conclusions:
Diarrhea is a significant problem in under-five children from a rural area of India. In spite of existence of National Program for Control of Diarrheal Diseases (NPCDD) since four decades, management of diarrhea is not on track. Focusing on primary care provision to under-five children can help in bringing the management of diarrhea on track.
Stakeholder perspectives on the integration of oral health into national health schemes
Authors: Malhotra Sneha , Mohanty Vikrant , Balappanavar Aswini Y. , Gupta Vaibhav , Kapoor Shivam , Kapoor Surbhi 
Published: April 2021

Aim and Objectives:
To assess the factors and perception of various stakeholders on the integration of oral health into the national health schemes using a mixed-method research design.

Materials and Method:
A mixed-method study was carried out in 2018 in two phases. In the first phase of the study, a pretested and prevalidated self-designed close-ended questionnaire was used to assess the knowledge, attitude, perception, barriers, myths, and feasibility of the integration of oral health in national health schemes. This questionnaire was administered to 96 stakeholders consisting of a medical officer (MO), accredited social health activists (ASHA), auxiliary nurse midwifery (ANM), and dental surgeon in nine Delhi Government dispensaries. The questionnaire consisted of 42 close-ended questions and four open-ended questions. The domains and themes were identified along with the challenges and opportunities of integration for focus group discussion (FGD) after analyzing the results of the first phase. The FGD consisted of seven members representing each of the above stakeholders along with one moderator and one recorder.

Results:
88.3% of the ASHA workers and 85.7% of the ANM accepted that oral screening should be incorporated in their routine practice. The major barrier to the incorporation of oral health in general health was the lack of training and insufficient provision of monetary incentives. Job burnout, work situation, inadequate pay, opportunities, workload, and limited carrier development were the demotivators, whereas respect, goodwill, and recognition from the general public were the inducers.

Conclusion:
There was a strong agreement for National Oral Health schemes to be given space and priority in India. The majority agreed that they can be used as a medium for imparting oral health education. The majority of the stakeholders believed that oral health should be a part of general health and they are open to any scheme or program which would add an oral health component.
Too little and too late. Initiation of breast feeding in Odisha, India
Authors: Kuchi Sravya , Sahu Suchanda , John Joseph 
Published: April 2021

Objectives:
To assess of the time of breastfeeding initiation, identify reasons for delay, if any and to assess if any prelacteal feeds were offered.

Methods:
An observational study was conducted among the inpatients of a tertiary care centre in Bhubaneswar, India. A total of 385 mothers, without contraindications to breastfeeding were interviewed at the earliest after childbirth.

Results:
Only 36.4% mothers initiated breastfeeding “timely.” Those who had undergone vaginal delivery scored better than cesarean sections with 41.3% (CI 95%; P = 0.016). Rooming in helped at 37.6% (CI 95%; P = 0.006). Multiparous homemakers from nuclear families and those who had previously breast fed initiated earlier than their counterparts. Less than 5% (CI 95%; P = 0.056) offered prelacteal feeds, mostly water.

Conclusions:
Our study reveals an alarming decline in the timely initiation of breastfeeding in Odisha, India from 68.5% to 41.6%.
Limited role of GeneXpert in peritoneal fluid in the diagnosis of genital tuberculosis in infertile women
Authors: Agrawal Smriti , Kant Surya , Das Vinita , Jain Amita , Mishra Shambhavi 
Published: April 2021

Background and Objectives:
Genital tuberculosis (TB) is an important cause of infertility in women that poses many challenges in diagnosis. The study is done to understand the utility of GeneXpert test in peritoneal fluid in the diagnosis of genital TB in infertile women.

Methods:
All infertile women in postmenstrual phase who were planned for laparoscopy in study period were included. Women who were already on anti-TB therapy were excluded. Peritoneal fluid/washings were retrieved during laparoscopy to test for Mycobacterium tuberculosis by GeneXpert. A note was made of laparoscopy evidence of TB. Endometrial sample was sent for microbiological testing of mycobacterium on smear and liquid culture. Histopathological test of endometrium was also done to look for granulomas.

Results:
In a total of 57 women, 8 (14.03%) women were diagnosed with TB on the basis of laparoscopy or microbiological or histopathological tests. Six women had caseating tubercles in pelvis, of them two women had presence of mycobacterium on smear, one woman also had positive liquid culture. In two women endometrial smear was positive. None of the women had a positive GeneXpert test in peritoneal fluid.

Conclusion:
Genital TB is a clinical problem in infertile women. Even in women with confirmed genital TB the peritoneal fluid/washings were negative for mycobacterium. GeneXpert did not pick Mycobacterium in peritoneal fluid in women with genital TB. Hence, it is not a sensitive and good tool for the diagnosis of female genital TB.
A retrospective study on the microbial spectrum and antibiogram of uropathogens in children in a secondary care hospital in Rural Vellore, South India
Authors: Tryphena Cherryl , Sahni Rani Diana , John Sushil , Jeyapaul Shalini , George Anne , Helan Jasmine 
Published: April 2021

Background:
Urinary tract infection (UTI) is common among children. Empiric antibiotics have to be started as early as possible or it may lead to an irreversible renal parenchymal damage and renal scarring in children. The objectives were to determine the prevalence and microbial profile of paediatric UTI and to determine the antimicrobial susceptibility pattern.

Methodology:
This is a retrospective study which looked at urine cultures of children below 15 years that were sent during the study period.

Results:
Among the total urine cultures sent only 21.2% showed significant growth of organisms. The most common organism isolated was E. coli (75.5%). E. coli was least sensitive to cefpodoxime and co-trimoxazole, whereas highly sensitive to nitrofurantoin. Of the total children who had significant growth, 46% had ESBL.

Discussion:
The prevalence of culture-proven UTI among children was found to be 21.2%. The most common organism isolated among the study population was E. coli (75.5%) followed by Enterococcus species (19.0%) and Klebsiella species (14.5%). It was also found that E. coli was least sensitive to cefpodoxime (31.6%) and co-trimoxazole (26.3%), moderately to amoxicillin-clavulanate (52.4%), whereas highly sensitive to nitrofurantoin (82.9%). This was similar with the studies done at other secondary care hospitals, in Oman and Oddanchathram, South India.

Conclusions:
With the increasing resistance, cephalosporins should not be used in treating paediatric UTI, whereas nitrofurantoin can be started as an empiric antibiotic, which can later be changed according to the susceptibility pattern.
Parental awareness of headaches among elementary school-aged children in Riyadh, Saudi Arabia
Authors: Altwaijri Waleed Abdulaziz , Almazyad Tuline A. , Abuzaid Yara Ahmad , Alkhater Jumanah Nasser , Ashmawi Dalal M. , Alnami Ghadah Khalid , Almazyad Lujain A. , Alnami Sadeem Khalid , Abuzaid Rawan Ahmad , Alkhater Lujeen Nasser 
Published: April 2021

Context:
Headaches can negatively impact children's quality of life. Nevertheless, data on the parental awareness of childhood headache is very limited.

Aim:
The objective was to estimate the prevalence of childhood headaches and parental awareness of headaches among their elementary school children.

Settings and Design:
A cross-sectional study was conducted among parents who were shopping in five malls in Riyadh between March and July 2019.

Methods and Material:
Data were collected using a self-completed questionnaire, which included data on socio-demographic characteristics of the parents and their children, the presence of headache in children, and parental awareness about headache susceptibility, possible causes, associated symptoms, and management.

Statistical Analysis Used:
Descriptive and inferential statistics were employed as appropriate using the software SPSS.

Results:
A total of 292 parents were included. The majority were mothers (75.3%) in the age range of 26–45 years (83.2%). Approximately 62.3% of the parents reported headaches in their children. Approximately 47.6% of the headaches were attributed to “the use of electronic devices”. The overall parental awareness of headaches was 55.1%, with scores being highest for management questions (67.0%) and lowest for susceptibility questions (45.4%). In a multivariate logistic regression analysis adjusted for socio-demographic characteristics, parental awareness was positively associated with the presence of children with headaches in the family and negatively associated with Saudi nationality of the children.

Conclusions:
Parental awareness of childhood headache is insufficient. There is a need to increase the awareness of parents about childhood headaches and the problems associated with heavy electronic device use.
Knowledge, attitudes, and practices regarding wound care among general population in Aseer region
Authors: Jan Muneer , Almutairi Khalid Hussein , Aldugman Maha Abdullah , Althomali Rawan Naif , Almujary Fahad Mohammed , Mughaedh Norah Abdullah Abu , Alhadi Lama Nasser 
Published: April 2021

Background:
Wound care is observed to be one of the major challenge in health-care system. Wound infection is one of the major issues in medical treatment. There is limited information regarding knowledge and attitude of patients regarding care of traumatic wound. This study was conducted to assess the knowledge, attitudes, and practices regarding wound care among general population in Aseer Region, Saudi Arabia.

Materials and Method:
This cross-sectional study was a questionnaire-based study conducted on general population from time period from September 2020 to November 2020. The demographic data collected were age, gender distribution, marital status, residence, job profile, income, education, habit of smoking and any comorbidities. To analyze the knowledge, attitude and practice of general population regarding wound care, 28 well-constructed questions were framed and asked. The response to all these questions was recorded and subjected to statistical analysis.

Results:
A total of 897 participants were included in the study. In total, 56.74% subjects of age group 41–60 years of age. In around 80% participants, no co-morbidities were observed. Around 29% participants had previous experience of surgical wound, with most common wound site being abdomen. The most common symptom in around 58% participants was excessive bleeding. Use of Alcohol swab and dry gauze were commonly used by participants as wound care measures.

Conclusion:
We observed that knowledge, attitude and practices followed by patients were not up to the standard. As patients' knowledge, good attitude and practices are important in implementing newer management technique; thus, we advice to take necessary steps to improve the attitude and knowledge of general public.