bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence, clinical presentation and outcome of tuberculosis in patients with chronic kidney disease at a tertiary care hospital in Nepal
Authors: Pradhan Ravi Ranjan , Sigdel Mahesh Raj 
Published: July 2019

Abstract
Background:
Tuberculosis (TB) is a serious public health threat in low- and middle-income countries like Nepal. Chronic kidney disease (CKD) patients are at higher risk of developing new infection as well as reactivation of TB. We aimed to determine the prevalence, clinical presentations, and outcome of TB in patients with CKD in Nepal.

Methods:
A hospital-based cross-sectional study was performed at Tribhuvan University Teaching Hospital (TUTH), a tertiary level referral centre in Kathmandu, Nepal. We included patients older than 16 years with the diagnosis of CKD stage 3, 4, 5, and 5D (CKD 5 on maintenance dialysis); renal transplant recipients and patients living with HIV/AIDS were excluded. Tuberculosis was diagnosed based on clinical, radiological and laboratory findings. Prior written informed consent was obtained. Approval was obtained from Institutional review Board of Institute of Medicine. Data entry and statistical analysis were performed using SPSS v21.

Results:
A total of 401 patients with CKD were included in the study (mean age, 50.92 ±17.98 years; 64.8% male). The prevalence of TB in CKD patients was found to be 13.7% (55), out of which 49 were newly diagnosed cases. Most common clinical presentations of TB in CKD were anorexia (85.7%), fever (83.7%), weight loss (51%), and cough (49%). Thirty eight patients (69.1 %) had extrapulmonary TB (EPTB), 12 (21.8%) had pulmonary TB, 3 (5.5%) had disseminated TB and 2 (3.6%) had miliary TB. Only 4.1% cases were sputum smear positive. Pleural effusion (34.2%) was the most common EPTB. At 2 months of starting anti-tubercular therapy, 29 patients out of the 49 newly cases of TB (59.2%) had responded to therapy. Mortality at 2 months was 28.6% (14 died amongst 49 patients). Four out of 49 patients (8.2%) didn’t improve, and 2 (4%) patients were lost to follow up.

Conclusion:
Prevalence and mortality of TB was higher in cohort of CKD. Special attention must be given to these people for timely diagnosis and treatment as the presentation is different and diagnosis can be missed.
The first survey on defensive medicine among Iranian surgeons: prevalence and its related factors
Authors: Zarei Ehsan , Ashtar-Nakhaei Faezeh , Daneshkohan Abbas , Zali Alireza 
Published: July 2019

Abstract
Introduction

Defensive medicine (DM) is defined as the deviation of a physician from normal behavior or what is good practice aimed at decreasing or preventing from the complaints and criticism by the patients or their families. The current study aimed at examining DM behaviors in a sample of Iranian surgeons.

Methods

In this cross-sectional study, 235 surgeons were selected by systematic random sampling method. The data gathering tool was a researcher-made questionnaire which its validity and reliability were confirmed. For data analysis, Fisher's exact test, Kruskal-Wallis test, Chi-square and logistic regression tests were used in SPSS 21 software.

Results

The most common positive DM behaviors including unnecessary biopsy (78.7%), imaging and laboratory tests (72.3% and 70.6%), and refusing to accept high-risk patients (61.7%) was also the most common negative DM behavior among surgeons. The likelihood of DM behaviors was more in young and less experienced surgeons. Other variables such as gender, specialty and complaint history also had a positive effect on some DM behaviors (p <0.05).

Conclusion

Strategies such as reforming the rules and regulations for medical errors and patient complaints, increasing monitoring of service delivery, developing and implementing medical guidelines and evidence-based medicine, and reforming medical liability insurance system are effective to reduce DM behaviors in order to prevent its adverse effects on the health system and patients.
Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden
Authors: Davis Jason , Saunders Rhodri 
Published: July 2019

Abstract
Background
Bariatric surgery in its various forms has been shown to be an effective intervention for weight management in select patients. Different types of surgery such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy demonstrate different efficacies in weight loss and co-morbidity resolution. Even within a single type of surgery, different patients respond differently and have differing weight-change trajectories post-surgery. The present analysis explores how improving a patient’s post-surgical weight change could impact on co-morbidity prevalence, treatment and associated costs in the Canadian setting.
Methods
Published data were used to derive statistical models to predict weight loss and co-morbidity evolution after RYGB. A 100-patient cohort was compared for an optimal versus a poor weight trajectory over a 10-year time horizon after surgery. Costs (2018 CAD$) were considered from the Canadian public payer perspective for diabetes, hypertension and dyslipidaemia. Robustness of results was assessed using probabilistic sensitivity analyses using the R language.
Results
Models fitted to patient data for total weight loss and co-morbidity evolution (resolution and new onset) demonstrated good fitting. Having a good versus poor weight trajectory resulted in a decreased burden, saving 181, 817, and 530 patient-years of diabetes, hypertension and dyslipidaemia treatment respectively. Cohorts on a good weight trajectory following RYGB had $1.9 million lower costs at 10 years than those on a poor weight trajectory.
Conclusions
Within a cohort of patients receiving the same type of bariatric surgery, achieving a good versus a poor weight loss trajectory can have a significant impact on outcomes by reducing the number of patient years of co-morbidity treatment and corresponding cost. Given the burden associated with a poor weight trajectory, health care systems should consider how best to ensure that more patients achieve a good long-term weight trajectory after bariatric surgery.
Women’s choices for breast cancer surgery in Italy: quality and equity implications
Authors: Ferre Francesca , Seghieri Chiara , Nuti Sabina 
Published: July 2019

Abstract
Background

Equity and quality in healthcare are key goals embraced by universal healthcare systems; however, inequalities in access and unwarranted variations in quality of care are well documented in the Italian healthcare system. To reduce unwarranted variation and improve equal utilization of services at hospital level, national quality standards have been applied for selected clinical procedures including oncological surgery for which there is evidence of a positive relationship between volumes and clinical outcomes. However, high dispersion of surgical interventions across hospitals still exists highlighting the need to understand the determinants behind women’s choice for hospital for breast surgery.

Methods

We apply mixed logit regression to investigate the determinants, both at patient and provider level, associated with women’s choice of hospital for breast surgery. Patient level non-emergency hospital data are used to model breast cancer surgical choices in Tuscany region, Italy. We considered hospitalizations occurring during 2016. We focused on the effects of travel time and hospital performance for breast cancer treatments (elective surgery) in different patient groups. Hospital quality indicators include structural variables (volumes), measurement of process (timeliness) and quality of surgical procedures as recommended by clinical guidelines (proportion of breast-conservative surgery and execution of the sentinel lymph node biopsy).

Results

Results reveal that women prefer hospitals nearby, delivering high volumes of interventions with an appropriate surgical approach. Differences in women choice depend on education and age. Highly educated patients travelled further to seek surgical intervention for breast cancer and were likely to select high performing hospitals. Moreover, older women preferred quicker response compared to younger women when awaiting surgical interventions.

Conclusions

Differences in patient choice highlight equity concerns in access to elective breast cancer surgery. These results could be used to optimize the allocation of resources toward breast cancer units that meet quality and efficacy standards to increase the efficiency and responsiveness of breast cancer care.
A Systematic Review to Assess the Effectiveness of Technology-Based Interventions to Address Obesity in Children
Authors: McMullan Megan , Millar Rachel , Woodside Jayne 
Published: July 2019

Abstract
Background: Childhood obesity is associated with a multitude of co-morbidities, including hypertension, hyperlipidaemia, cardiovascular disease and type 2 diabetes. Childhood obesity can also affect a young person’s social, emotional and mental health if they encounter negative prejudice and social marginalisation. Given the prevalence of overweight and obese children globally, it is imperative that effective interventions are developed. Children are receptive to information conveyed via digital means, therefore, the use of technology may play a crucial role in interventions to reduce childhood obesity. This systematic review aimed to review and critically appraise the literature published to date in relation to the effectiveness of technology-based interventions, employed as secondary prevention, in addressing childhood obesity.
Methods: An electronic search strategy was undertaken in Medline and Embase, covering publications up to and including 12th July 2018. Randomised controlled trials assessing the effectiveness of technology-based interventions on weight-related outcomes in children, aged 8 to 18, published only in the English language, were included.
Results: From an initial search total of 1,012 studies, 11 met the inclusion criteria. They were assessed for methodological quality using the Cochrane Risk of Bias Tool for Randomised Controlled Trials and were analysed using a narrative approach. The findings of this review showed a weak evidence base regarding the role of technology-based interventions, employed as secondary prevention, to address childhood obesity. Of the eleven studies reviewed, three (27%) showed a positive relationship between technology-based interventions and weight-related outcomes in overweight or obese children.
Conclusions: This review suggests that technology-based interventions, primarily active video games, as well as internet or web-based interventions and mobile phone communications, may, with further research, have the potential to impact positively on weight-related outcomes. It is difficult to determine the degree of efficacy of these technology-based interventions, as only two databases were searched, selecting only English language articles. Moreover, the included studies demonstrated a lack of high-quality evidence. The lack and heterogeneity of studies with technology-based interventions is a further limitation.
Liraglutide for the Treatment of Obesity: Analyzing Published Reviews
Authors: Pastor Rosario , Tur Josep A. 
Published: July 2019

Background:
Several drugs have been currently approved for the treatment of obesity. The pharmacokinetic
of liraglutide, as well as the treatment of type 2 diabetes mellitus, have been widely described.

Objective:
To analyze the published systematic reviews on the use of liraglutide for the treatment of obesity.

Methods:
Systematic reviews were found out through MEDLINE searches, through EBSCO host and the Cochrane
Library based on the following terms: "liraglutide" as major term and using the following Medical Subject
Headings (MesH) terms: "obesity", "overweight", "weight loss". A total of 3 systematic reviews were finally
included to be analyzed.

Results:
From the three systematic reviews selected, only two included the randomized clinical trials, while the
third study reviewed both randomized and non-randomized clinical trials. Only one review performed statistical
tests of heterogeneity and a meta-analysis, combining the results of individual studies. Another review showed
the results of individual studies with odds ratio and confidence interval, but a second one just showed the means
and confidence intervals. In all studies, weight loss was registered in persons treated with liraglutide in a dose
dependent form, reaching a plateau at 3.0 mg dose, which was reached just in men. Most usual adverse events
were gastrointestinal.

Conclusion:
More powerful and prospective studies are needed to assess all aspects related to liraglutide in the
overweight and obesity treatment.
Impact of Antioxidant Natural Compounds on the Thyroid Gland and Implication of the Keap1/Nrf2 Signaling Pathway
Authors: Paunkov Ana , Chartoumpekis Dionysios V. , Ziros Panos G. , Chondrogianni Niki , Kensler Thomas W. , Sykiotis Gerasimos P. 
Published: July 2019

Background:Natural compounds with potential antioxidant properties have been used in the form of food supplements or extracts with the intent to prevent or treat various diseases. Many of these compounds can activate the cytoprotective Nrf2 pathway. Besides, some of them are known to impact the thyroid gland, often with potential side-effects, but in other instances, with potential utility in the treatment of thyroid disorders.Objective:In view of recent data regarding the multiple roles of Nrf2 in the thyroid, this review summarizes the current bibliography on natural compounds that can have an effect on thyroid gland physiology and pathophysiology, and it discusses the potential implication of the Nrf2 system in the respective mechanisms.Method & Results:Literature searches for articles from 1950 to 2018 were performed in PubMed and Google Scholar using relevant keywords about phytochemicals, Nrf2 and thyroid. Natural substances were categorized into phenolic compounds, sulfur-containing compounds, quinones, terpenoids, or under the general category of plant extracts. For individual compounds in each category, respective data were summarized, as derived from in vitro (cell lines), preclinical (animal models) and clinical studies. The main emerging themes were as follows: phenolic compounds often showed potential to affect the production of thyroid hormones; sulfur-containing compounds impacted the pathogenesis of goiter and the proliferation of thyroid cancer cells; while quinones and terpenoids modified Nrf2 signaling in thyroid cell lines.Conclusion:Natural compounds that modify the activity of the Nrf2 pathway should be evaluated carefully, not only for their potential to be used as therapeutic agents for thyroid disorders, but also for their thyroidal safety when used for the prevention and treatment of non-thyroidal diseases.
Drug Target Group Prediction with Multiple Drug Networks
Authors: Che Jingang , Chen Lei , Guo Zi-Han , Wang Shuaiqun , Aorigele  
Published: July 2019

Background:
Identification of drug-target interaction is essential in drug discovery. It is
beneficial to predict unexpected therapeutic or adverse side effects of drugs. To date, several
computational methods have been proposed to predict drug-target interactions because they are
prompt and low-cost compared with traditional wet experiments.

Methods:
In this study, we investigated this problem in a different way. According to KEGG,
drugs were classified into several groups based on their target proteins. A multi-label classification
model was presented to assign drugs into correct target groups. To make full use of the known drug
properties, five networks were constructed, each of which represented drug associations in one
property. A powerful network embedding method, Mashup, was adopted to extract drug features
from above-mentioned networks, based on which several machine learning algorithms, including
RAndom k-labELsets (RAKEL) algorithm, Label Powerset (LP) algorithm and Support Vector
Machine (SVM), were used to build the classification model.

Results and Conclusion:
Tenfold cross-validation yielded the accuracy of 0.839, exact match of
0.816 and hamming loss of 0.037, indicating good performance of the model. The contribution of
each network was also analyzed. Furthermore, the network model with multiple networks was
found to be superior to the one with a single network and classic model, indicating the superiority
of the proposed model.
Computational Prospecting for the Pharmacological Mechanism of Activity: HIV-1 Inhibition by Ixoratannin A-2
Authors: Olubiyi Olujide O. , Idowu Thomas O. , Ogundaini Abiodun O. , Orhuah Goodness 
Published: July 2019

Background:Ixora coccinea is a tropical ornamental shrub employed in ethnomedicine for the treatment of a number of diseases none of which include the Human Immunodeficiency Virus (HIV) infection. Ixoratannin A-2, one of the constituents, was previously identified via virtual-screening and experimentally confirmed to possess significant anti-HIV-1 activity in an in vitro CD4+ replication assay. This activity was observed to be significantly reduced in degree in viruses lacking the protein Vpu. This suggests the involvement of Vpu as well as other extra-Vpu macromolecules in its antiviral activity.Methods:In the present computational search for the identity of the other macromolecules that could possibly explain the observed activity, a panel of fourteen established HIV-1 macromolecular targets was assembled against which ixoratannin A-2 and other major phytoconstituents of I. coccinea were virtually screened.Results:Structural analyses of the computed ligand-bound complexes, as well as the careful investigation of the thermodynamic attributes of the predicted binding, revealed subtle selectivity patterns at the atomistic level that suggest the likely involvement of multiple macromolecular processes. Some of the binding interactions were found to be thermodynamically favourable, including the multidrug-resistant HIV protease enzyme, CXCR4 and the human elongin C protein all of which formed reasonably strong interactions with ixoratannin A-2 and other constituents of I. coccinea.Conclusion:Ixoratannin A-2’s ability to favourably interact with multiple HIV-1 and human targets could explain its observed extra-Vpu antiviral activity. This, however, does not imply uncontrolled binding with all available targets; on the other hand, molecular size of ixoratannin A-2 and combination of functional groups confer on it a decent level of selectivity against many of the investigated HIV/AIDS targets.
Three Pt-Pt Complexes with Donor-acceptor Feature: Anticancer Activity, DNA Binding Studies and Molecular Docking Simulation
Authors: Ashoo Pezhman , Yousefi Reza , Nabavizadeh Syed M. , Aseman Marzieh D. , Paziresh Sareh , Ghasemi Atiyeh , Saboury Ali A. 
Published: July 2019

Background:
Due to their unique properties and potential applications in variety of areas, recently, a
special attention is given to the binuclear platinum (II) complexes. They reveal a highly tunable features upon
the modification of their cyclometallating and bridging ligands.

Objective:
The aim of this study was to evaluate the anticancer activity and DNA binding affinity of three binuclear
platinum (II) complexes, including ht-[(p-FC6H4)Pt(µ-PN)(µ-NP)PtMe2](CF3CO2)(1), ht-[(p-
MeC6H4)Pt(µ-PN)(μ-NP)Pt(p MeC6H4) Me] (CF3CO2)(2) and ht-[Pt2Me3(µ-PN)2](CF3CO2) (3).

Methods:
MTT assay was performed to study the cell viability of Jurkat and MCF-7 lines against synthesized
complexes, followed by apoptosis detection experiments. Several spectroscopic methods with molecular docking
simulation were also used to investigate the detail of interaction of these platinum complexes with DNA.

Results:
Cell viability assay demonstrated a notable level of cytotoxicity for the synthetic platinum complexes.
Further studies proved that a pathway of cell signaling initiating the apoptosis might be activated by these complexes,
particularly in the case of complexes 1 and 2. The results of both UV-visible and CD measurements
showed the significant ability of these complexes to interact with DNA. While fluorescence data revealed that
these complexes cannot enter DNA structure by intercalation, molecular docking assessment proved their DNA
groove binding ability.

Conclusion:
The remarkable apoptosis inducing activity of the binuclear platinum complexes 1 and 2 and their
considerable interaction with DNA suggest them as the potential antitumor medicines.
Evaluation of the Synergism Mechanism of Tamoxifen and Docetaxel by Nanoparticles
Authors: Zhu Zhihong , Pan Hao , Li Yuenan , Pan Weisan 
Published: July 2019

Background:
Our previous studies have shown that Docetaxel (DTX) and Tamoxifen (TMX) loaded
nanoparticles(Co-NPs) could exhibit a synergistic effect on estrogen receptor positive cell lines. In the current
study，we have studied the synergistic effect of Co-NPs and underlying possible molecular mechanism.

Methods:
Cell apoptosis assay, pharmacokinetic experiment and immunohistochemistry experiment were used
to explore the synergistic effect and underlying possible mechanism in vitro and in vivo.

Results:
Cell apoptosis assay revealed that Co-NPs could mediate cell sensitization to a cytotoxic agent, resulting
in remarkable cell apoptosis. In addition, pharmacokinetic experiment research showed that Co-NPs have
longer circulation time in vivo, which could prolong the treatment time of the chemotherapeutic drugs. Immunohistochemistry
experiment revealed that the Co-NPs could downregulate the expression of P-gp level to reduce
the drugs’ efflux.

Conclusion:
The possible mechanism of the synergistic effect of DTX and TMX by Co-NPs was attributed to
the longer in vivo circulation time, significantly increased rate of cell apoptosis and downregulated expression of
P-gp level to the tumor cells.