bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical nutrition treatment of women with gestational diabetes mellitus by a telemedicine system based on smartphones
Authors: Yang Ping , Lo Wenpin , He Zong‐lin , Xiao Xiao‐min 
Published: May 2018

AbstractAimTo explore whether WeChat platform‐based treatment of women with gestational diabetes mellitus (GDM) reduces the risk of perinatal complications and explore factors affecting gestational age at delivery.MethodsPregnant women with GDM (n = 107) and normal glucose tolerance (n =50, group C) according to oral glucose tolerance test (OGTT) results during gestational weeks 24–28 were included. Women with GDM were divided into groups A (n =57) and B (n =50) according to informed consent. According to GDM treatment norms, group B was given routine outpatient treatment and health education guidance. In addition to the interventions in group B, group A was given access to both a smartphone‐based telemedicine system and articles providing continuous health education. The PBG level in groups A and B was compared, as were differences in maternal and fetal outcomes. Data were analyzed by t‐test, analysis of variance (anova), chi‐square test and multiple linear regression, with P < 0.05 considered significant.ResultsFasting blood glucose (FBG) and 2‐h postprandial blood glucose (PBG) were significantly lower and premature delivery was significantly less likely in group A than in group B (all P < 0.05). Compared with group B, caesarean section was more likely in group A (P < 0.05). Pregnancy‐induced hypertension had a higher incidence in group B than in group C (P < 0.05). Gestational age at delivery was associated with OGTT2h, premature fetal membrane rupture and self‐monitoring of blood glucose.ConclusionGDM treatment based on the WeChat platform effectively reduces FBG and 2‐h PBG and may improve pregnancy outcomes. However, 1‐h PBG was not affected by treatment. Obstetricians should consider the OGTT2h value to increase gestational age at delivery.
Concomitant Acute Toxic Leukoencephalopathy and Posterior Reversible Encephalopathy Syndrome
Authors: Özütemiz Can , Roshan Sarah Khanipour , Kroll Neil Joseph , Rykken Jeffrey B. , Ott Frederick , McKinney Alexander M. 
Published: May 2018

ABSTRACTBACKGROUND AND PURPOSEPosterior reversible encephalopathy syndrome (PRES) and acute toxic leukoencephalopathy (ATL) are both potentially reversible clinicoradiologic entities. Although their magnetic resonance imaging (MRI) findings differ, rarely both may occur simultaneously in acutely encephalopathic patients. Our aim was to determine the incidence and causes of concomitant “ATL‐PRES.”METHODSRetrospective search of suspected acutely encephalopathic adults since 1998 throughout our picture archiving and communication system revealed 167 patients with PRES and 106 patients with ATL. Images of these patients were retrospectively evaluated by two neuroradiologists and a fellow to identify the cases which carry both features of PRES and ATL. Imaging findings were scored based on previously reported scoring system as mild, moderate, and severe. The clinical outcome of the patients was determined according to the modified Rankin scale.RESULTSOur search revealed a series of 6 patients (%2.2) in 273 patients who presented acutely with either encephalopathy or seizures, caused by various etiologies, including immunosuppression following transplantation (n = 2), hypertensive crisis (n = 2), chemotherapy (n = 1), and sepsis (n = 1). MRI demonstrated findings consistent with both PRES and ATL simultaneously on FLAIR and diffusion weighted imaging. Severity of imaging findings of concomitant “ATL‐PRES” was concordant with each other (rho ≈ 1.0, P < .00001), and each patient eventually returned to clinical baseline. This finding, along with their similar etiologies, raises the possibility of an underlying common pathophysiologic thread, perhaps being endothelial toxicity.CONCLUSIONSConcomitant “ATL‐PRES” was found in 2.2% of the patients in a large cohort of ATL and PRES. Etiologies varied. Clinical symptoms and MRI findings were potentially reversible.
Work Opportunities and Organizational Commitment in International Organizations
Authors: Giauque David , Varone Frédéric 
Published: May 2018

AbstractThis article applies social exchange theory to investigate the relationships between work opportunities and organizational commitment in four United Nations agencies. It demonstrates that international civil servants who are satisfied with their altruistic, social, and extrinsic work opportunities are more likely to declare high levels of organizational commitment. Furthermore, perceived organizational support mediates these relationships. The empirical findings highlight the importance of considering the specificity of organizational features in explaining international civil servants' attitudes and behaviors. Their preferences for altruistic, social, and extrinsic work opportunities are not similar to the motivational orientations and rewards valued by public or private sector employees, confirming the hybrid characteristics of international organizations. Drawing on these original results, the research identifies some practical implications for human resource management in international organizations.
Prevalence of peritonitis and mortality in patients treated with continuous ambulatory peritoneal dialysis (CAPD) in Africa: a protocol for a systematic review and meta-analysis
Authors: Moloi Mothusi Walter , Kajawo Shepherd , Noubiap Jean Jacques , Mbah Ikechukwu O , Ekrikpo Udeme , Kengne Andre Pascal , Bello Aminu K , Okpechi Ikechi G 
Published: May 2018

IntroductionContinuous ambulatory peritoneal dialysis (CAPD) is the ideal modality for renal replacement therapy in most African settings given that it is relatively cheaper than haemodialysis (HD) and does not require in-centre care. CAPD is, however, not readily utilised as it is often complicated by peritonitis leading to high rates of technique failure. The objective of this study is to assess the prevalence of CAPD-related peritonitis and all-cause mortality in patients treated with CAPD in Africa.Methods and analysisWe will search PubMed, EMBASE, SCOPUS, Africa Journal Online and Google Scholar for studies conducted in Africa from 1 January 1980 to 30 June 2017 with no language restrictions. Eligible studies will include cross-sectional, prospective observational and cohort studies of patients treated with CAPD. Two authors will independently screen, select studies, extract data and conduct risk of bias assessment. Data consistently reported across studies will be pooled using random-effects meta-analysis. Heterogeneity will be evaluated using Cochrane’s Q statistic and quantified using I2statistics. Graphical and formal statistical tests will be used to assess for publication bias.Ethics and disseminationEthical approval will not be needed for this study as data used will be extracted from already published studies. Results of this review will be published in a peer-reviewed journal and presented at conferences. The Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015) framework guided the development of this protocol.PROSPERO registration numberCRD42017072966.
Alcohol-related presentations to emergency departments in Ireland: a descriptive prevalence study
Authors: McNicholl Brian , Goggin Deirdre , O’Donovan Diarmuid 
Published: May 2018

ObjectivesTo determine the prevalence of alcohol-related presentations in all 29 emergency departments (EDs) in Ireland and compare with non-alcohol-related presentations in order to identify opportunities for improvements in the quality of patient care and related data collection.Design and settingDescriptive prevalence study reviewing all records in the same four 6-hour periods in every 24-hour ED in the country.Participants3194 persons who attended EDs over four specified 6-hour periods.Primary outcome measuresThe prevalence of alcohol-related presentations, comparison with non-alcohol-related presentations and the categorisation of these presentations according to WHO International Statistical Classification of Diseases and Related Health Problems 10th Revision codes.ResultsThe total number of presentations was 3194 in the four 6-hour periods, of whom 189 (5.9%) were alcohol related, varying from 29.0% in the early hours of Sunday morning to 1.2% on Monday morning (p>0.0001). The alcohol-related presentations were more likely to be men, attend on early hours of Sunday morning, arrive by ambulance, leave before being seen by a doctor or leave against medical advice; and they were less likely to be admitted to hospital.ConclusionsAlcohol-related presentations are a significant burden on EDs and ambulance services, especially in the early hours of Sunday mornings. Addressing the alcohol-related burden on EDs requires improvements in data collection and information systems, the development of appropriate interventions and related referral services and better preventive actions for alcohol-related harm.
107 First come, first served: a comparison of first-ever seizure patients and those presenting after recurrent-untreated seizures
Authors: Holper Sarah , Foster Emma , Kwan Patrick 
Published: May 2018

IntroductionFirst seizure diagnosis may be delayed due to financial, geographical or social barriers to healthcare, or misdiagnosis with differentials including syncope or stroke. Seizures may recur until correct diagnosis and appropriate treatment is instituted; meanwhile, patients may experience increased seizure-related morbidity and mortality. We compare patient and seizure characteristics between a first-ever ‘new-onset’ seizure (NOS) cohort, and a recurrent-untreated seizure (RUS) cohort.MethodMedical charts were reviewed to extract information on patient demographics and clinical characteristics using a standardised proforma. Inclusion criteria were patients aged 18 or over who attended a tertiary-level Melbourne hospital between 1 January 2008 and 30 November 2016 with discharge codes ICD-10 G40-Epilepsy, G41-Status epilepticus, or R56.9-Unspecified convulsions.Results367 episodes were identified. 151 episodes met inclusion criteria: new-onset seizures (115) and recurrent-untreated seizures.36 216 excluded cases included pre-existing epilepsy (186), and non-seizure events.30 RUS-cohort experienced a median of two seizures prior to coming to medical attention, most commonly focal impaired awareness seizures (50.00%). Considering the index seizure, focal seizures were more common in RUS-cohort (36.11 vs 24.35%) while primary generalised seizures predominated in NOS-cohort (62.61% vs 50.00%). Compared to NOS-cohort, RUS-cohort was more likely to have unprovoked seizures (72.22% vs 55.65%), identifiable remote risk factors (41.67% vs 26.09%), younger age (69 vs 76), normal MRI and EEG, and be discharged on antiepileptic drugs (86.11% vs 73.91%). RUS-cohort was more likely to receive Neurology outpatient follow-up (72.22% vs 39.99%), and in a more timely manner compared to NOS-cohort (30.56% vs 11.31% saw a Neurologist within a month of discharge).ConclusionRecurrent-untreated seizures often have subtler semiology and are more likely to have normal MRI and EEG results than patients presenting immediately following new-onset seizures. RUS-cohort tend to receive more inpatient investigations and AED prescriptions, and are offered more timely neurology follow-up than NOS-cohort.
112 Blood spot testing for late onset pompe disease
Authors: Dobbins Julia , Pyragius Tim , Brion Kristian , Chin Sharon , Gurner Melissa , Pacyna Janina , Stark Samantha , Fletcher Janice M 
Published: May 2018

IntroductionPompe disease is classified by age of onset and presentation. Late-onset Pompe disease (LOPD) generally presents with progressive limb-girdle and respiratory muscle weakness. Diagnosis is confirmed following dried blood spot (DBS) enzyme assay by a second method, either mutation or glucose tetra-saccharide analysis.MethodsFrom 2000 to 2016, acid α –glucosidase (GAA) activity in DBS was measured using the immuno-capture assay of . Umapathysivam et al. (2001) From 2016 testing used the multiplex tandem mass spectrometry method (6-PLEX LC-MSMS, Perkin Elmer), measuring six lysosomal storage disease enzymes from one DBS. Glucose tetra-saccharides were measured by mass spectrometry and mutation analysis of the GAA gene was performed using either Sanger or Next Generation Sequencing, the latter confirmed by sequencing.ResultsBetween 2000 and 2016, approximately 1500 samples were screened for Pompe disease with 77 positives, a diagnosis rate of 5.1%. Of these, 33 were infantile Pompe disease, with 44 LOPD. Since May 2016, a further 850 patients have been screened for Pompe disease using the MSMS method and of these, 28 patients have screened as positive, with 19 confirmed as having Pompe disease, either by molecular testing or urine tetra-saccharide measurement, a diagnosis rate of 2.2%. Of these 19 patients, 17 are LOPD, with only two infants being diagnosed in this time. Seven adults are still to be confirmed by a second test.ConclusionThe number of patients presenting for testing follows the recent Australian government funding for enzyme replacement therapy for adults with LOPD. The ease of submitting a dried blood spot sample for testing has contributed to an increase in test requests, although this may also reflect an increased recognition of this condition. These patients may have already been diagnosed clinically, but in the absence of a treatment, there was little benefit in a formal diagnosis.
030 A rapidly progressive dermatomyositis with fatality – lessons to learn
Authors: Islam Fariha , Malhotra Abhishek , Sachdev Anish 
Published: May 2018

IntroductionWe report a case of dermatomyositis in a 43 year old male who presented with transient mild proximal muscle weakness but died from rapidly progressive pulmonary disease within 3 months of diagnosis.CaseThe patient presented with proximal muscle weakness, arthralgia and classic dermatomyositis rashes. He had a history of Huntington’s disease mutation with a positive family history. He had raised creatine kinase (CK) and electromyography showed myopathic changes. The diagnosis was confirmed by skin and muscle biopsy and positive anti-myositis antibodies; PM-Scl(75), MDA5 and SRP. Screening for underlying malignancy was negative but a CT chest scan showed bilateral areas of reverse halo-opacity suggestive of interstitial lung disease (ILD) although he had no respiratory symptoms at the time. He had input from dermatology, rheumatology and respiratory teams and commenced on prednisone 1 mg/kg with pneumocystis prophylaxis. He underwent bronchoscopy and broncho-alveolar lavage that did not isolate any organisms and cell differential was normal. His muscle weakness had resolved even prior to starting steroids and his CK normalised on high dose prednisolone but he developed progressive shortness of breath that led to a second admission within two months. Repeat CT chest showed extensive bilateral infiltrative disease and pneumo-mediastinum. No infective cause was found. He deteriorated rapidly despite intubation, broad-spectrum antibiotics, steroids and extracorporeal membrane oxygenation. He died whilst being considered for lung transplantation.ConclusionThis case provides valuable lessons. Even in cases of mild muscle disease, the extra-muscular involvement can be severe and life threatening in dermatomyositis. Anti-myositis antibodies can be helpful in predicting the course of disease including extra-muscular involvement. The anti-MDA5 antibodies are associated with amyopathic dermatomyositis associated with a rapidly progressive ILD and often with pneumo-mediastinum and has a poor prognosis as in our case. One should consider more aggressive therapy for these patients from the outset.
033 Effect of ocrelizumab on upper limb function in patients with primary progressive multiple sclerosis (PPMS) in the oratorio study (ENCORE)
Authors: Fox Edward , Markowitz Clyde , Applebee Angela , Montalban Xavier , Wolinsky Jerry S , Belachew Shebeshih , Fiore Damian , Han Jian , Musch Bruno , Giovannoni Gavin 
Published: May 2018

IntroductionUpper limb (UL) functional impairment is prevalent among PPMS patients and alters quality of life. The nine-hole peg test (9HPT) is a validated quantitative assessment of UL function in MS.Methods9HPT was administered at baseline and every 12 weeks until study end. The average 9HPT-times from two trials of dominant- and non-dominant-hands were compared; the hand with the lower baseline time was termed ‘better-hand’, and the hand with the higher baseline time was termed ‘worse-hand’. Average dominant- and non-dominant-hand times were combined and termed ‘both-hands’. Analyses included time-to-confirmed progression (CP) in hand function, defined as ≥15%, ≥20% or ≥25% increase in 9HPT-time from baseline, confirmed at 12- and 24 weeks, and change in 9HPT-time from baseline to Week-120.ResultsCompared with placebo, ocrelizumab reduced the time-to 12- and 24-week-CP of ≥15% increase on 9HPT by 37% (hazard ratio [HR]=0.627; p=0.001) and 39% (HR=0.607; p=0.002) for both-hands, 30% (HR=0.699; p=0.011) and 40% (HR=0.599; p<0.001) for better-hand and 29% (HR=0.705; p=0.016) and 28% (HR=0.717; p=0.040) for worse-hand. The time-to 12- and 24-week-CP of ≥20% increase on 9HPT was reduced by 44% (HR=0.561; p<0.001) and 45% (HR=0.545; p<0.001) for both-hands, 28% (HR=0.723; p=0.046) and 35% (HR=0.646; p=0.014) for better-hand and 37% (HR=0.632; p=0.005) and 40% (HR=0.599; p=0.004) for worse-hand. Ocrelizumab also reduced the time-to 12- and 24-week-CP of ≥25% increase on 9HPT by 48% (HR=0.520; p<0.001) and 49% (HR=0.507; p<0.001) for both-hands, 30% (HR=0.698; p=0.048) and 39% (HR=0.613; p=0.015) for better-hand, and 48% (HR=0.521; p<0.001) and 42% (HR=0.578; p=0.004) for worse-hand. At week-120, the increase from baseline 9HPT-time for both-hands and worse-hand was significantly smaller with ocrelizumab vs placebo (p<0.001 and p=0.041, respectively); for better hand, the increase was smaller with ocrelizumab; difference was not significant (p=0.056).ConclusionOcrelizumab treatment lowered the risk of progression of upper extremity disability, measured by 9HPT, compared with placebo in PPMS patients.
036 Mobile intraluminal long segment carotid thrombus causing ischaemic stroke
Authors: Nham Benjamin , Hawke Simon 
Published: May 2018

IntroductionMobile or free-floating long segment intraluminal thrombus within the carotid artery is a rare entity that has a high likelihood of causing recurrent ischaemic strokes if left untreated. There is no consensus about whether medical or surgical management of the carotid intraluminal thrombus represents the best management option. We present a case of an 83 year old man who presented with an ischaemic stroke secondary to this condition.CaseAn 83 year old man presented to a regional hospital with acute right arm weakness and facial droop outside the timeframe for thrombolysis. CT carotid angiogram and carotid doppler showed non-occlusive mobile intraluminal thrombus involving a 3 cm segment of the vessel, just distal to the bifurcation. An MRI brain scan demonstrated an acute left MCA infarct. The patient declined carotid endarterectomy and was treated with intravenous heparin infusion. This was stopped one week later after he developed a thigh hematoma. Repeat CT angiogram revealed resolution of the thrombus and an underlying 30% non-calcific carotid plaque. He was treated with secondary prevention stroke agents.Management options of the mobile carotid thrombus include anticoagulation, commonly with intravenous heparin in the acute phase, or surgical management. It is unclear from the evidence which is superior. The literature suggests initial anticoagulation for 7–10 days resulted in a low rate of recurrent ischaemic events and that carotid revascularisation, if indicated, could later be safely performed or delayed if necessary.ConclusionMobile intraluminal carotid thrombus is a rare cause of ischaemic stroke. These mobile thrombi are often secondary to underlying ulcerated carotid plaques. In our case, medical management with intravenous heparin was a safe and effective treatment option with excellent functional recovery and resolution of the thrombus.
037 Post-transplant lymphoproliferative disorder in skeletal muscle arising seven years after allogeneic stem cell transplant
Authors: Powell Alice , Sy Joanne , Barnett Yael , Mosalski Simon , Brew Bruce , Fay Keith , Tomlinson Susan 
Published: May 2018

IntroductionPost-transplant lymphoproliferative disorder (PTLD) is a well-recognised serious complication of transplantation. However, it rarely affects muscle.MethodsA case report detailing presentation, evaluation, management and outcome of a patient with acute on chronic proximal myopathy on a background of allogeneic stem cell transplant is described. The patient was diagnosed with PTLD affecting skeletal muscle.ResultsA 54 year old man presented with painful proximal myopathy seven years after successful allogeneic stem cell transplant for acute myeloid leukaemia. He had been managed with immunosuppression for extensive cutaneous graft versus host disease (GVHD) from the time of transplant. Initial quadriceps muscle biopsy showed changes in keeping with GVHD and features suggestive of drug-related necrotising myositis. The painful myalgia evolved to include bulbar muscles with dysphagia despite pulse steroid and intravenous immunoglobulin therapy. A positron emission tomography (PET) scan demonstrated intense and extensive hyper-metabolism in multiple muscle groups in keeping with diffuse myositis with the most prominent activity involving neck muscles, the left shoulder girdle and left arm musculature. A second biopsy of the sternocleidomastoid demonstrated infiltration with haematolymphoid cells consistent with post-transplant lymphoproliferative disorder. Treatment with reduction in immunosuppression, rituximab and rehabilitation saw improvement in myalgia and weakness. Unfortunately, exacerbation of chronic GVHD ensued following reduction in immunosuppression and contributed to oesophageal stricturing eventually requiring a percutaneous endoscopic gastrostomy tube for feeding.ConclusionThis case highlights the complex morbidity of allogeneic stem cell transplant and the need to consider PTLD in the differential for patients who present with neurological symptoms.