bluuebunny/crossref_metadata_2025_split huggingface dataset:
Topical Cannabinoids for Treating Chemotherapy-Induced Neuropathy: A Case Series
Authors: D’Andre Stacy , McAllister Sean , Nagi Jasdeepa , Giridhar Karthik V. , Ruiz-Macias Eduardo , Loprinzi Charles 
Published: November 2021

Background Chemotherapy-induced peripheral neuropathy is a common and often severe side effect from many chemotherapeutic agents, with limited treatment options. There is no literature on the use of topical cannabinoids for chemotherapy-induced neuropathy. Case Presentations The current manuscript presents a case series of patients presenting in oncology clinics at Sutter Health, CA and Mayo Clinic, Rochester, MN from April 2019 to December 2020 with chemotherapy-induced peripheral neuropathy who used topical creams containing the cannabinoids delta-nine-tetrahydrocannabinol (THC) and/or cannabidiol (CBD). Conclusions This case series suggests that topical cannabinoids may be helpful for patients with chemotherapy-induced peripheral neuropathy. This paper also discusses the potential mechanisms of action by which topical cannabinoids might alleviate established CIPN symptoms. A randomized placebo-controlled trial using a standardized product is planned to study the actual efficacy of such treatment.
Primary healthcare reform for chronic conditions in countries with high or very high human development index: A systematic review
Authors: Alyousef Mohammed , Naughton Corina , Bradley Colin , Savage Eileen 
Published: November 2021

Objective To address the growing burden of chronic disease globally, many countries have developed a national policy for primary healthcare reform. In some countries with high and very high human development index, evaluations of the implementation of these reforms have been published. To date, there has been no systematic review of these evaluations. The objectives of this review are to identify: (a) the vision for primary healthcare; (b) the features of primary healthcare reforms; and (c) evaluation findings of primary healthcare reforms. Methods A systematic literature review was conducted guided by the PRISMA statement. We searched for academic articles and grey literature from 1 March 2008 to 1 September 2020. Screening and data extraction were conducted by two authors. Descriptive analysis and narrative synthesis were applied. Results A vision for integrated primary healthcare shifting chronic disease management from specialist hospital services to primary care was found to require new organization and funding models such as collaborative primary healthcare networks and commissioning along with shared governance across health sectors. The need for general practitioner leadership and engagement to support primary healthcare reform was identified. Although there was evidence of barriers in progressing primary healthcare reform, evaluation results showed some positive outcomes, most notably shifts in services towards increased primary care access and utilization. Discussion A challenge in undertaking the review was the heterogeneity of articles with little consistency in how primary healthcare reform was evaluated and reported on across countries. Evaluation of national health reforms involves complex system-wide projects and is an area that needs further exploration and discussion to determine the most appropriate methodologies for collecting and analysing large-scale data with consideration for service and health outcomes.
Noncontrast Computed Tomography Markers of Cerebral Hemorrhage Expansion: Diagnostic Accuracy Meta-Analysis
Authors: Arba Francesco , Rinaldi Chiara , Boulouis Gregoire , Fainardi Enrico , Charidimou Andreas , Morotti Andrea 
Published: November 2021

Background and purpose Assess the diagnostic accuracy of noncontrast computed tomography (NCCT) markers of hematoma expansion in patients with primary intracerebral hemorrhage. Methods We performed a meta-analysis of observational studies and randomized controlled trials with available data for calculation of sensitivity and specificity of NCCT markers for hematoma expansion (absolute growth >6 or 12.5 mL and/or relative growth >33%). The following NCCT markers were analyzed: irregular shape, island sign (shape-related features); hypodensity, heterogeneous density, blend sign, black hole sign, and swirl sign (density-related features). Pooled accuracy values for each marker were derived from hierarchical logistic regression models. Results A total of 10,363 subjects from 23 eligible studies were included. Significant risk of bias of included studies was noted. Hematoma expansion frequency ranged from 7% to 40%, mean intracerebral hemorrhage volume from 9 to 27.8 ml, presence of NCCT markers from 9% (island sign) to 82% (irregular shape). Among shape features, sensitivity ranged from 0.32 (95%CI = 0.20–0.47) for island sign to 0.68 (95%CI = 0.57–0.77) for irregular shape, specificity ranged from 0.47 (95%CI = 0.36–0.59) for irregular shape to 0.92 (95%CI = 0.85–0.96) for island sign; among density features sensitivity ranged from 0.28 (95%CI = 0.21–0.35) for black hole sign to 0.63 (95%CI = 0.44–0.78) for hypodensity, specificity ranged from 0.65 (95%CI = 0.56–0.73) for heterogeneous density to 0.89 (95%CI = 0.85–0.92) for blend sign. Conclusion Diagnostic accuracy of NCCT markers remains suboptimal for implementation in clinical trials although density features performed better than shape-related features. This analysis may help in better tailoring patients’ selection for hematoma expansion targeted trials.
Leading 20 drug–drug interactions, polypharmacy, and analysis of the nature of risk factors due to QT interval prolonging drug use and potentially inappropriate psychotropic use in elderly psychiatry outpatients
Authors: Das Biswadeep , Ramasubbu Saravana Kumar , Agnihotri Akash , Kumar Barun , Rawat Vikram Singh 
Published: November 2021

Background: Psychotropic medications extend corrected QT (QTc) period in the electrocardiogram (ECG). Psychiatric patients exposed to ⩾1 psychotropic medication(s) represent a group with marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age > 60 years) is connected to greater risk of all-cause and coronary heart disease deaths. This study aimed at investigating pattern of utilization of QTc-interval protracting medications, QT-extending drug interactions, and prevalence of QTc-interval extending hazard factors in elderly patients. Methods: This was a cross-sectional, prospective study at the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from 1 October 2017 to 30 August 2019 employing the pertinent prescriptions. Results: A total of 832 elderly patients (age 60 years or more) visiting the Psychiatry OPD during the aforementioned study duration were investigated. About 420 (50.5%) patients were males while 412 (49.5%) were females. Of the 832 patients, 588 (70.7%) were using interacting agents with capacity to produce TdP. Almost 1152 interacting torsadogenic medication pairs were unraveled. As per AzCERT/CredibleMeds Classification, 1016 (48.8%), 724 (34.8%), and 248 (12%) agents with potential to interact were identified with ‘known’, ‘possible’, and ‘conditional risk of TdP’, respectively. The common interacting medications belonged to antidepressant (288), proton pump inhibitor (364), antipsychotic (340), antinausea (184), antimicrobial (156), and H2 receptor antagonist (60) therapeutic categories. The all-inclusive frequency of potentially inappropriate psychotropic (PIP) agents administered was 62% (1343/2166) with Beers Criteria 2019, and 46% (997/2166) with STOPP Criteria 2015. Conclusion: Many geriatric patients were administered drugs and drug combinations with heightened proclivity toward QT-interval prolongation. Furthermore, reliable evidence-based online drug knowledge resources, such as AzCERT/CredibleMeds Drug Lists, Medscape Drug Interactions Checker, Epocrates Online Interaction Check, and Drugs.com Drug Interactions Checker, can facilitate clinical professionals in selecting drugs for psychiatric patients. A wise choice of medications is imperative to preclude serious adverse sequelae. Therefore, we need to exigently embrace precautionary safety means, be vigilant, and forestall QT-extension and TdP in clinical environments.
Prediction of early clinical response in patients receiving tofacitinib in the OCTAVE Induction 1 and 2 studies
Authors: Lees Charlie W. , Deuring J. Jasper , Chiorean Michael , Daperno Marco , Bonfanti Gianluca , Germino Rebecca , Brown Pritha Bhadra , Modesto Irene , Edwards Roger A. 
Published: November 2021

Introduction: Tofacitinib is an oral, small molecule Janus kinase inhibitor for the treatment of ulcerative colitis (UC). Outcome prediction based on early treatment response, along with clinical and laboratory variables, would be very useful for clinical practice. The aim of this study was to determine early variables predictive of responder status in patients with UC treated with tofacitinib. Methods: Data were collected from patients treated with tofacitinib 10 mg twice daily in the OCTAVE Induction 1 and 2 studies (NCT01465763 and NCT01458951). Logistic regression and random forest analyses were performed to determine the power of clinical and/or laboratory variables to predict 2- and 3-point partial Mayo score responder status of patients at Weeks 4 or 8 after baseline. Results: From a complete list of variables measured in OCTAVE Induction 1 and 2, analyses identified partial Mayo score, partial Mayo subscore (stool frequency, rectal bleeding, and Physician Global Assessment), cholesterol level, and C-reactive protein level as sufficient variables to predict responder status. Using these variables at baseline and Week 2 predicted responder status at Week 4 with 84–87% accuracy and Week 8 with 74–79% accuracy. Variables at baseline, Weeks 2 and 4 could predict responder status at Week 8 with 85–87% accuracy. Conclusion: Using a limited set of time-dependent variables, statistical and machine learning models enabled early and clinically meaningful predictions of tofacitinib treatment outcomes in patients with moderately to severely active UC.
Epidemiological trends of Lassa fever in Nigeria from 2015-2021: A review
Authors: Grace John-Ugwuanya A. , Egoh Ifunanya J. , Udensi Nnenna 
Published: November 2021

Introduction: Lassa fever is a viral haemorrhagic fever with non-specific symptoms that has shown an upward trend in Nigeria and other West African countries, which is depicted by high incidence and case fatality in recent years. There are different reports on the yearly case burden of Lassa fever from the Federal Ministry of Health in Nigeria, through the regulatory body – Nigeria Centre for Disease Control (NCDC). Being the epicentre of the disease, Lassa fever has been exported from Nigeria to both neighbouring and distant countries.Methods: The aim of this review was to carry out a retrospective analysis from January 2015 to 26 September 2021 of the weekly and yearly outbreak of Lassa fever in Nigeria based on selected publications. The focus was on timely diagnosis, treatment option, public health interventions and progress of clinical trials for vaccine candidates, and to identify proactive measures that can be sustained to curb periodic outbreaks. The review was done using percentages, cross-tabulation and graphical charts. Results: The predominant age group infected was 21 to 40 years with a male to female ratio of 1:0.8. A total of 3311 laboratory-confirmed Lassa fever cases out of 20,588 suspected cases were identified from 29 states. Edo, Ondo, Taraba, Ebonyi, Bauchi, Plateau and Nasarawa had yearly Lassa fever incidence over the time frame considered. Contact tracing was done on over 33,804 individuals with about 90% completing follow-up. Case fatality rate within the period ranged from 9.3% to 29.2%. There is a sharp decline in the epidemiological trend of Lassa fever in the yearly seasonal peaks from weeks 1 to 13 with about 75% reduction in incidence between 2020 and 2021. Conclusion: The effective management of Lassa fever needs the implementation of preventive methods, prompt laboratory diagnosis, timely treatment, provision of personal protective equipment, cross-border surveillance, contact tracing, community awareness and vector control in order to minimise spread.
HIV Epidemic in Libya: Identifying Gaps
Authors: Hamidi A. , Regmi P.R. , van Teijlingen E. 
Published: November 2021

Background: HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency syndrome) became a public issue in Libya after the infection of 400 children in El-Fatih Hospital in 1988. Due to the civil war, social and religious barriers, HIV prevalence is hard to establish, but it is generally believed to be increasing. Objective: This review (a) assesses the size and scope of the available literature on the HIV epidemic in Libya; and, (b) identifies the nature and extent of research conducted to date. Methods: A comprehensive search was performed using PubMed, Medline, Web of Science, ScienceDirect, Scopus, Academic Search Ultimate, Cochrane Library and Google Scholar. Primary research studies and official reports that are exclusively on Libya published during 1988−2021 were considered. Results: In total 25 studies were included: Ten primary research studies, four online news articles, six Government reports, one letter to the editor, one manuscript, three online databases Conclusion: Despite the low-quality data, the literature suggests there is an increase in HIV infection rates in Libya. Culturally sensitive research on sexual activities, women, HIV preventative methods and attitudes of the Libyan public will assist in developing an effective National AIDS Programme, reducing HIV stigma, supporting People Living with HIV (PLHIV) and decreasing infection rates.
Treatment of Combined Injuries to the ACL and the MCL Complex: A Consensus Statement of the Ligament Injury Committee of the German Knee Society (DKG)
Authors: Guenther Daniel , Pfeiffer Thomas , Petersen Wolf , Imhoff Andreas , Herbort Mirco , Achtnich Andrea , Stein Thomas , Kittl Christoph , Schoepp Christian , Akoto Ralph , Höher Jürgen , Scheffler Sven , Stöhr Amelie , Stoffels Thomas , Mehl Julian , Jung Tobias , Ellermann Andree , Eberle Christian , Vernacchia Cara , Lutz Patricia , Krause Matthias , Mengis Natalie , Müller Peter E. , Patt Thomas , Best Raymond 
Published: November 2021

Background: Different indications and treatment options for combined injuries to the anterior cruciate ligament (ACL) and medial collateral ligament complex (MCL) are not clearly defined. Purpose: To perform a modified Delphi process with the Committee for Ligament Injuries of the German Knee Society (DKG) in order to structure and optimize the process of treating a combined injury to the ACL and MCL. Study Design: Consensus statement. Methods: Scientific questions and answers were created based on a comprehensive literature review using the central registers for controlled studies of Medline, Scopus, and Cochrane including the terms medial collateral ligament, anterior cruciate ligament, MCL, ACL, and outcome used in various combinations. The obtained statements passed 3 cycles of a modified Delphi process during which each was readjusted and rated according to the available evidence (grades A-E) by the members of the DKG Ligament Injuries Committee and its registered guests. Results: The majority of answers, including several questions with >1 graded answer, were evaluated as grade E (n = 16) or C (n = 10), indicating that a low level of scientific evidence was available for most of the answers. Only 5 answers were graded better than C: 3 answers with a grade of A and 2 answers with a grade of B. Only 1 answer was evaluated as grade D. An agreement of >80% (range, 83%-100%) among committee members was achieved for all statements. Conclusion: The results of this modified Delphi process offer a guideline for standardized patient care in cases of combined injuries to the ACL and MCL.
Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis
Authors: Rykkje Linda , Holm Anne Lise , Hem Marit Helene 
Published: November 2021

Introduction Internationally, aging populations have increased needs for health care services, and often specialized care is required. However, services for older people tend to be underfunded, resulting in lack of qualified staff and poor quality care. Resource shortages lead to ethical challenges and insufficient nursing care. Therefore, quality in daily care for older people also depends upon the nurses’ ability to make complex, ethical decisions in their practice. Objectives To explore ethical challenges experienced by nurses caring for older people in clinical practice, and to provide examples of management for the challenges. Methods The data collected were written reflection notes by Norwegian continuous education students in advanced gerontology. Forty two of 83 notes were included and a thematic analysis in six steps was utilized. Findings There are three main themes: (1) meeting vulnerability, discomfort, and suffering, (2) collaboration with relatives, and (3) struggling to perform professional care. Conclusion Nurses strive to “do what is in the patients’ best interest”, and this is fostered through collaboration, professionalism, care, and presence. Nurses’ ethical competencies may develop when reflecting upon their own care performance. Building ethical competencies should be a priority in both nursing education and clinical practice. However, to improve care quality, nurses also need professional knowledge about older people care and ethical awareness should be supported by the workplace.
suPAR cut-offs for stratification of low, medium, and high-risk acute medical patients in the emergency department
Authors: Santeri Seppälä , Peter Andersen Andreas , Kristiina Nyyssönen , Jesper Eugen-Olsen , Harri Hyppölä 
Published: November 2021

Abstract
Background
Soluble urokinase plasminogen activator receptor (suPAR) levels have previously been associated with readmission and mortality in acute medical patients in the ED. However, no specific cut-offs for suPAR have been tested in this population.

Methods
Prospective observational study of consecutively included acute medical patients. Follow-up of mortality and readmission was carried out for 30- and 90 days stratified into baseline suPAR < 4, 4–6 and > 6 ng/ml. suPAR levels were measured using suPARnostic® Turbilatex assay on a Cobas c501 (Roche Diagnostics Ltd) analyser.

Results
A total of 1747 acute medical patients in the ED were included. Median age was 70 (IQR: 57–79) and 51.4% were men. Adjusted linear regression analysis showed that suPAR, independently of age, sex and C-reactive protein levels, predicted 30- and 90-day mortality (Odds ratio for doubling in suPAR 1.96 (95% confidence intervals: 1.42–2.70) Among patients with suPAR below 4 ng/ml (N = 804, 46.0%), 8 (1.0%) died within 90-day follow-up, resulting in a negative predictive value of 99.0% and a sensitivity of 94.6%. Altogether 514 (29.4%) patients had suPAR of 4–6 ng/ml, of whom 43 (8.4%) died during 90-day follow-up. Among patients with suPAR above 6 ng/ml (N = 429, 24.6%), 87 patients (20.3%) died within 90-day follow-up, resulting in a positive predictive value of 20.1% and a specificity of 78.7%.

Conclusions
suPAR cut-offs of below 4, between 4 and 6 and above 6 ng/ml can identify acute medical patients who have low, medium or high risk of 30- and 90-day mortality. The turbidimetric assay provides suPAR results within 30 min that may aid in the decision of discharge or admission of acute medical patients.
Natalizumab administration in multiple sclerosis patients during active SARS-CoV-2 infection: a case series
Authors: Chisari Clara G. , Toscano Simona , Arena Sebastiano , Finocchiaro Chiara , Montineri Arturo , Patti Francesco 
Published: November 2021

Abstract
Background
The Coronavirus disease 2019 (COVID-19) caused by the new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has become a pandemic, affecting the therapeutic management for Multiple Sclerosis (MS). Any decision regarding the discontinuation of high-potency agents for moderate and highly active MS should be carefully evaluated, taking into account the potential risk of rebound of the disease. In particular, no data about clinical outcome of patients with MS receiving Natalizumab (NTZ) during active COVID-19 infection have been reported yet.

Cases presentation
We reported on 6 patients treated with NTZ for relapsing MS during active COVID-19 infection, who recovered without reporting any worsening or new symptoms. Most of the patients were asymptomatic, with the exception of one patient who had a slight worst COVID-19 clinical course. No patients received O2-therapy or required intensive care. No neurological complications were observed.

Conclusions
This paper reported the clinical outcome of patients with MS receiving NTZ during active COVID-19 infection. This case series suggests that treatment with NTZ during pandemic is relatively safe and might be continued in selected patients who are infected by COVID-19, thereby reducing the risk of MS disease rebound.
Physical inactivity, and its association with hypertension among employees in the district of Colombo
Authors: Gamage A. U. , Seneviratne R. de A. 
Published: November 2021

AbstractBackgroundPhysical inactivity is a leading cause of morbidity and mortality and is a major public health problem. Insufficient activity is responsible for a large proportion of non-communicable diseases such as hypertension.ObjectivesThe purpose of this study was to assess socioeconomic variations in physical activity and to measure the association between physical inactivity and hypertension among government officials in Sri Lanka.MethodsA cross-sectional study was carried out among 275 senior-officers(SOs) and 760 managerial-assistants(MAs) aged 30–60 years and attached to Public Administration institutions in Colombo District in Sri Lanka. Physical-activity(PA) was gathered using the International Physical Activity Questionnaire(IPAQ) adopted and validated to the Sri Lankan context. Blood pressure(measured and classified using JNC-7 guidelines) and anthropometric indices were recorded. Energy utilization of all vigorous and moderated PA and walking was expressed as metabolic-equivalent-of-task(MET) min per week. A total-MET-score was calculated and categorized based on IPAQ guidelines.ResultsSocioeconomic variations in PA levels were observed as 58.1%(n = 158) SOs and 30.6%(n = 226) MAs were involved in inadequate PA. Among the SOs diagnosed with hypertension, more half(59.1%;n = 52) were physically inactive, while among MAs, 65.9%(n = 143) with hypertension were physically inactive. After adjusting for potential confounding factors being physically inactive was associated with a higher risk of hypertension among SOs[OR 2.08 [95% CI 1.07, 4.6] and MAs[OR 2.8 [95% CI 1.8, 4.6]. The main modality of commuting to work for SOs(59%) was private transport, and MAs(64%) public transport Commuting distance was positively correlated(p < 0.05) with total transport MET among SOs and MAs. After adjusting for confounders, commuting distance of > 20 km was found to lower the odds of hypertension among SOs and MAs(OR = 0.713; 95% CI 0.4 to1.3; and OR = 0.63; 95% CI 0.46 to 0.87).ConclusionDespite the current knowledge that being physically active promotes health, the practice was different. Physical inactivity was associated with hypertension and prevalent among both SOs and MAs. Higher commuting distance is positively correlated with total transport MET and associated with lower odds of hypertension among SOs and MAs. Longitudinal studies are required to provide a causative association between physical inactivity and hypertension among these employees.