bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceived Burden in Caregivers of Children with Autism Spectrum Disorder in Kathmandu Valley
Authors: Pandey Shrijana , Sharma Chandrakala 
Published: July 2018

Background: Autism Spectrum Disorder is a lifelong developmental disorder that affects children and results in deficit in social interaction, communication and display of unusual pattern of behavior. Though caregiving is a normal parental duty, providing intensive care to a child with long-term problem is burdensome and impacts both physical and mental health of caregivers. The aim of this study was to obtain a picture of burden among caregivers raising children with Autism Spectrum Disorder.Methods: We conducted a descriptive cross-sectional study to assess the burden of caregiving among sixty one parents of children with Autism Spectrum Disorder in the Kathmandu Valley, Nepal, using purposive sampling technique. The burden perceived by caregivers was assessed using standard tool Zarit Burden Interview-22.Results: Average burden score was 41.49±12.25 which indicates that caregivers experienced moderate to severe range of burden. Level of education, anxiety and depression was found to be significantly associated with burden of caregiving.Conclusions: The study concluded that the burden of caregiving is most remarkably associated with emotional status and social life of the caregivers.
Chest Ultrasound- Update 2018
Authors: Blank Wolfgang , Mathis Gebhard 
Published: July 2018

The scope of applications of chest ultrasound has been significantly widened in the last few years. Effusions as little as 5 ml can be identified without problems in a standing or sitting position laterodorsal in the angle between the chest wall and the diaphragm.Portable ultrasound systems are being used to an increasing extent in preclinical sonography, at the site of trauma, in the ambulance of the emergency physician or in helicopters. In the emergency room, at the intensive care unit and in clinical routine, chest ultrasound has proved its worth as a strategic instrument to be used directly after the clinical investigation. Several diagnoses such as pneumothorax, (no sliding sign, no B-lines, no lung pulse, lung point) pneumonia (liver like consolidation with bronchoaerogram) rib fractures (step in cortical bone and hematoma) pulmonary embolism (typical subpleural lesions) can be established immediately. In combination with echocardiography and leg vein compression ultrasound (triple organ ultrasound), the accuracy is more than 90%. The evidence of interstitial syndrome has shown a significant correlation with extravascular lung water in cases of pulmonary edema and noncardiogenic pulmonary edema.Chest ultrasound helps in the diagnosis and staging of lung cancer. Contrast ultrasound (CEUS) is a new tool for the differentiation of sub pleural lung lesions. Ultrasound guided interventions (biopsy, drainage) are very successful. The rate of complications is low when the procedure is performed by trained therapists.Ultrasound is a fixed element of several international guidelines.
Deep Hubble Space Telescope Imaging of Globular Clusters toward the Galactic Bulge: Observations, Data Reduction, and Color–magnitude Diagrams*
Authors: Cohen Roger E. , Mauro Francesco , Alonso-García Javier , Hempel Maren , Sarajedini Ata , Ordoñez Antonio J. , Geisler Douglas , Kalirai Jason S. 
Published: July 2018

Abstract
The Galactic globular clusters (GGCs) located toward the Galactic bulge have generally been excluded from large-scale photometric GGC surveys due to severe total and differential extinction. Here we present an overview of a Hubble Space Telescope (HST) program designed to obtain deep, high spatial resolution multiband imaging of 16 poorly studied GGCs located toward the inner Galactic bulge and disk. In this first paper of a series resulting from these observations, we give an overview of target cluster selection, observations, and data reduction procedures for optimizing the resulting photometric catalogs. Artificial star tests are used to compare the respective advantages of different data reduction strategies in terms of photometric and astrometric precision and photometric incompleteness. We present the resulting color–magnitude diagrams (CMDs) of all target clusters in several color–magnitude planes, along with CMDs of comparison fields from parallel observations. For each target cluster, we summarize existing studies and discuss their CMDs qualitatively in the context of these results.
Comparative evaluation of susceptibility testing methods for colistin and polymyxin B among clinical isolates of carbapenem- resistant Klebsiella pneumoniae and Acinetobacter baumannii
Authors: Bakthavatchalam Yamuna Devi , Shankar Abirami , Thukaram Bhuvaneswari , Krishnan Dhanabhagyam Naveena , Veeraraghavan Balaji 
Published: July 2018

Susceptibility testing (ST) of colistin and polymyxin B is challenging. Disc diffusion testing is not reliable for polymyxin ST, because of poor diffusion. Currently, for polymyxin ST, the EUCAST-CLSI joint commission recommending broth microdilution (BMD) as the reference method. In this study, reliability of E-test and Vitek 2 was compared with BMD, using the susceptible breakpoint of ≤ 2μg/ml for both colistin and polymyxin B. Overall, essential agreement (EA) for colistin between E-test, Vitek2 and BMD were 37% and 74% respectively. EA for polymyxin B between E-test and BMD were 65%. Very major error (VME) for colistin and polymyxin B with E-test were 42% and 55% respectively. An unacceptable VME of 11% was seen for colistin with Vitek2. Major errors (MEs) were rather limited with both E-test and Vitek2. E-test and Vitek2 may lead to inappropriate decision-making for colistin/polymyxin B therapy. Thus, clinical laboratories should consider BMD for polymyxin ST.
Bacterial profile and antibiogram of blood stream infections in febrile neutropenic patients with haematological malignancies
Authors: Kokkayil Prathyusha , Agarwal Reshu , Mohapatra Sarita , Bakshi Sameer , Das Bimal , Sood Seema , Dhawan Benu , Kapil Arti 
Published: July 2018

Introduction: Studies have shown a shift in the prevalence from Gram-positive to Gram-negative bacteraemia in patients with haematological malignancies who develop febrile neutropenia. There are also reports on the spread of drug resistant bacteria among these patients. Information about locally prevalent bacteria and their resistance is important to guide empirical therapy. The aim of this study was to characterise the bacterial spectrum and antibiotic resistance pattern of bacteraemia in neutropenic patients with haematological malignancies
Methodology: In this retrospective study, patients admitted to Haematology and Oncology units over a period of 6 months with laboratory-confirmed positive blood cultures were enrolled. Information regarding demographic profile, clinical features, and microbiological profile were recorded. Standard procedures were applied to identify the isolates and their resistance patterns. The data collected was analysed statistically.
Results:56 isolates from 53 patients were isolated of which majority were gram negative bacilli (GNB; n = 52 or 93%). Klebsiella pneumoniae (43%, n = 24) was the most frequently isolated bacteria followed by Enterobacter sp (20%, n = 11) and Escherichia coli (12%, n = 7). All isolates were susceptible to colistin. Susceptibility to cefaperazone-sulbactam, piperacillin-tazobactam and carbapenems were 32%, 28.6% and 26.8% respectively. The outcome was fatal for 25 patients.
Conclusions: The study documented an alarming rise in the prevalence of GNB and their resistance. Though the results of the study may represent only the tip of the iceberg, the results demonstrate the need for treatment options for drug resistant isolates and for surveillance cultures.
High resistance to tetracycline and ciprofloxacin in bacteria isolated from poultry farms in Ibadan, Nigeria
Authors: Ayandiran Tunmise O. , Falgenhauer Linda , Schmiedel Judith , Chakraborty Trinad , Ayeni Funmilola Abidemi 
Published: July 2018

Introduction: Resistance to ciprofloxacin and tetracycline is increasing in the food chain especially in E. coli strains and more worrisome will be occurrence of extended-spectrum beta-lactamase (ESBL) producers among ciprofloxacin- and tetracycline-resistant isolates. This study was undertaken to investigate the occurrence and mechanism of ciprofloxacin-, tetracycline- and ESBL-resistant bacteria in poultry in Ibadan, Nigeria.
Methodology: Bacteria were isolated from poultry feces in two farms in Ibadan and identified by MALDI-TOF. Antibiotic susceptibility patterns of the isolates were determined by disc diffusion and Minimum Inhibitory Concentration (MIC) using Vitek-2 apparatus. Four tetracycline genes and six plasmids mediated quinolone resistance genes (PMQR) were investigated by PCR. Whole genome sequencing was done for strains that were ESBL producers.
Results: Bacterial strains (≥ 105 cfu/mL) were counted on ciprofloxacin and tetracycline supplemented plates. 106 bacteria from 14 different species were identified with high resistance to quinolones, tetracycline and trimethoprim. 49% of the strains were E. coli with 90% resistance for nalidixic acid, moxifloxacin (94%), ciprofloxacin (88%) levofloxacin (78%) and tetracycline (77%). The genes tetA, tetB, qnrB, qnrS and qepA were detected with 37%, 4%, 35%, 4% and 2% prevalence in E. coli respectively. Three ESBL-producing E. coli of the sequence type ST-6359 were found and harboured blaCTX-M-15 located in the chromosome, at the same insertion site. All the ESBL producers harboured mutations in gyrA (S83L/D87N/D678E) and parC (S80I).
Conclusion: The observed high quinolones and tetracycline resistance with ESBL producers in this study calls for caution in the use of these antibiotics in poultry feeds.
Hurricane Maria and its Impact on the Zoological and Botanical Collections of the University of Puerto Rico
Authors: Schizas Nikolaos 
Published: July 2018

With a total of more than 150,000 specimens, the 85-year old collections of insects and terrestrial, freshwater, and marine invertebrates of the University of Puerto Rico at Mayagüez (UPRM), western Puerto Rico, are among the most significant repositories for these groups in the Caribbean region. Located in Mayagüez and on Magueyes Island, these collections were created by outstanding insect and invertebrate specialists working in Puerto Rico and surrounding islands. Holdings are particularly strong in the Hemiptera, Lepidoptera, Coleoptera, Collembola, Crustacea, Mollusca, Echinodermata, and Cnidaria. Collecting and curatorial activities, initiated in the 1920s, were maintained throughout the 1980s, resulting in many taxonomically and historically valuable records for the region. From 1990 to 2005, the invertebrate collections were increasingly neglected, with certain parts scattered throughout multiple buildings and rooms, inaccessible, or inadequately stored and at risk of becoming damaged or lost. The support for these collections was not sustained at high levels due to a variety of factors, including changes in the research profile of new academic appointments and the shortsightedness of administrators to fully understand the cultural, educational and scientific value of the museum holdings. With the exception of a federal grant through NSF - DBI (National Science Foundation - Biological Research Collections - PI Frantz - 2007-2010), which initiated a flurry of Museum related activities to improve the deteriorating museum facilities throughout the UPRM campus, the Museum collections are now facing even more challenges, some anthropogenic and very recently, some natural.
Major Hurricane Maria (Category 4), delivered a devastating blow to the island of Puerto Rico on 20 September 2017. Both terrestrial and marine ecosystems were heavily impacted. Extensive structural damage to roads, telecommunications, water systems, the energy grid and approximately 60,000 houses/buildings made Hurricane Maria the most damaging Hurricane (estimated cost ~ 90 billion dollars) in the USA after Katrina and Harvey. Flooding caused by the direct impact of Hurricane Maria (5 to 40 inches of rain fell during the first 48 hours in Puerto Rico) and subsequent extensive loss of electricity caused unfavorable conditions for the collections. The University of Puerto Rico in Mayaguez closed for approximately 45 days and limited electricity, if any, was available through diesel generators. High levels of humidity and heat can cause further structural damage as well as favor the growth of fungus in enclosed areas of UPRM, including the Museums. Efforts to safeguard the collections will be outlined here to ensure the collections remain a valuable natural asset of the people of Puerto Rico as part of their natural patrimony and as an irreplaceable education tool.
Continued Improvements in Quadriceps Strength and Biomechanical Symmetry of the Knee After Postoperative Anterior Cruciate Ligament Reconstruction Rehabilitation: Is It Time to Reconsider the 6-Month Return-to-Activity Criteria?
Authors: Curran Michael T. , Lepley Lindsey K. , Palmieri-Smith Riann M. 
Published: July 2018

Context: Patients who undergo anterior cruciate ligament reconstruction (ACLR) present with strength and biomechanical deficits at return to activity (RTA). Deficits in strength and biomechanical symmetry impair function during activity and may predispose patients to subsequent injury.Objective: To compare strength and biomechanical function in patients with ACLR at RTA and more than 12 months post-ACLR.Design: Descriptive laboratory study.Setting: Research laboratory.Patients or Other Participants: A total of 20 participants (12 females, 8 males; age = 21.40 ± 5.60 years, height = 171.3 ± 10.2 cm, mass = 73.21 ± 19.41 kg) who had undergone ACLR and were cleared to RTA were recruited.Intervention(s): Strength was measured during knee extension and evaluated by the isometric and isokinetic quadriceps index. Biomechanical function was evaluated using symmetry values for sagittal-plane knee-joint rotations, changes in sagittal-plane knee-joint rotation, knee-extension moments, and changes in knee-extension moment that were recorded during a single-legged forward hop.Main Outcome Measure(s): Self-reported function was measured using the International Knee Documentation Committee Subjective Knee Evaluation Form. Participants were assessed at RTA (212.25 ± 28.11 days) and more than 12 months post-ACLR (556.25 ± 230.89 days).Results: At RTA, strength and biomechanical values were less than 80% symmetric. We observed improvements from RTA to more than 12 months post-ACLR for the isometric quadriceps index (F1,18 = 29.22, P &lt; .001), isokinetic quadriceps index (F1,18 = 10.88, P = .004), sagittal-plane knee-joint rotations (F1,19 = 9.58, P = .006), change in sagittal-plane knee-joint rotations (F1,19 = 7.83, P = .01), knee-extension moments (F1,19 = 5.73, P = .03), change in knee-extension moments (F1,19 = 21.10, P &lt; .001), and self-perceived function (F1,19 = 11.50, P = .003). Of the 7 variables that showed improvement at more than 12 months post-ACLR, only 3 met the recommended criteria (≥90%).Conclusions: Patients with ACLR showed asymmetry in strength and biomechanics at RTA. These asymmetries, along with self-perceived function, improved over time. However, despite improvements in strength and biomechanics at RTA, asymmetries of more than 10% were still present more than 12 months post-ACLR.
Use of Tramadol for Management of Opioid Use Disorders: Rationale and Recommendations
Authors: Balhara Yatan Pal Singh , Parmar Arpit , Sarkar Siddharth 
Published: July 2018

ABSTRACTOpioids are one of the most common illicit psychoactive substances being used in India. In fact, opioid use disorders are the most common disorder presenting to the substance use disorder treatment centers across the country. Effective and evidence-based interventions are available for management of opioid use disorders. However, the treatment for opioid use disorders remains difficult to access for most of those in need in India. The current article presents the literature on the use of tramadol for the management of opioid use disorders. It also makes recommendations on the use of tramadol for the management of opioid use disorders. Tramadol offers a viable alternative to the existing options for the management of opioid use disorders. It has been found effective when used for this indication. It offers certain major advantages such as easy and wide availability and low abuse liability. It offers a good option to expand the treatment services for opioid use disorders across the country.
Migration of Self-Introduced Acupuncture Needle into the Brainstem
Authors: El-Wahsh Shadi , Efendy Johnny , Sheridan Mark 
Published: July 2018

ABSTRACTAcupuncture-related injuries to the central nervous system are a rare but well-documented occurrence. This report describes the case of a self-introduced acupuncture needle migrating into the brainstem following an initial failed attempt at surgical extraction. The patient displayed no neurological deficits, and the needle was eventually successfully removed under direct vision intraoperatively. We discuss the role of various imaging modalities in pre- and post-operative assessment of penetrating foreign bodies in the brainstem. We also discuss the options available for the management of such foreign bodies, including possible approaches for operative intervention, and the risks involved with both surgical and conservative management.
Comparison of Four Radiographic Angular Measures of Lumbar Lordosis
Authors: Okpala Francis Osita 
Published: July 2018

ABSTRACT
Background: Several attempts (radiographic and nonradiographic) have been made to measure the lumbar lordosis (LL), but the results differ substantially as investigators have used different parameters. Radiography is the gold standard, and the methods include lumbosacral angle (LSA), lumbosacral joint angle (LSJA), Cobb angle, and tangential radiologic assessment of LL (TRALL) angle. The traditional method, the Cobb technique, has a wide range of normal mean values, with a large standard deviation. Using a more reliable radiographic angle will hopefully simply and standardize LL measurement in the diagnosis, treatment, and follow-up of patients. Aim: To compare in normal individuals with fully developed LL the LSA, LSJA, TRALL, and Cobb angles, by determining (a) if any correlation exists between them and (b) the most reliable measures of LL, based on, least (i) number of measurement lines, (ii) range of values, (iii) mean, (iv) standard deviation, and (v) variance. Materials and Methods: The four angles were retrospectively measured in each supine lateral lumbosacral radiograph of 100 males and 100 females, aged 15 years and above. Data were analyzed with IBM SPSS Statistics 23.0 (NY, USA); P < 0.05 was considered statistically significant. Results: No correlation existed between the mean values of the four angles, and in each angle, there was no male-versus-female correlation. LSJA had the best reliability criteria for LL measurement. Conclusion: The mean LSA, LSJA, TRALL, and Cobb angles have no significant Pearson's correlation, and of the four angular measures of LL, LSJA was the most reliable.
Impact of Progression of Parkinson's Disease and Various Other Factors on Generalized Anxiety Disorder
Authors: Rana Abdul Qayyum , Ansari Hamza , Qureshi Abdul Rehman M. , Rahman Eraad 
Published: July 2018

ABSTRACT
Objective: While much research has been conducted toward understanding the relationship between prevalence of Parkinson's disease (PD) and generalized anxiety, little has been done considering additional influential factors in the relationship by means of a large ethnically diverse sample. Our study strives to fulfill these deficits in the literature as we set out to determine the impact of progression of PD, age, gender, and Hoehn and Yahr (H and Y) staging of PD on generalized anxiety. Methods: A retrospective chart review analysis was performed on PD patients who were regularly examined in a community-based PD and movement disorders center from 2005 to 2010. Results: This study consisted of 310 patients with PD among whom 12% had generalized anxiety. Neither age nor gender was significant onset predictors at P = 0.05. The impact of progression of H and Y Stages 2–3 and 2–4 increased the odds of generalized anxiety disorder (GAD) prevalence though it was statistically insignificant at P = 0.05. Conclusions: Clinicians should not expect the risk of developing anxiety to depend on gender nor change as a function of age though it may increase with symptomatic progression of PD as outlined by H and Y. To the best of our knowledge, this is the largest and most ethnically diverse prevalence study with a focus on generalized anxiety and PD. Significant Outcomes and Limitations: The symptomatic progression of PD, but not age or gender, may be associated with an increased risk for GAD. This study lacked adjustment for potential confounders such as depression and PD medications.
A Case of Morvan's Syndrome Associated with Heavy Metal Poisoning after Ayurvedic Drug Intake
Authors: Perumal Sowmini R. , Velayudham Sakthi , Jeyaraj K. Malcolm , Arunan S. ,   Mohanakkannan S
Published: July 2018

ABSTRACTMorvan's syndrome is an autoimmune disorder of peripheral and central nervous system mediated by VGKC antibody. Here we report a case of Morvans syndrome who presented 1 month after ayurvedic drug intake. She presented with symptoms of peripheral nerve hyperexcitablity and autoimmune testing revealed positive result for VGKC antibody. Heavy metals level was also significantly raised. She improved after a course of steroids. This case report tries to highlight the association of VGKC mediated Morvans syndrome with heavy metal poisoning and its incidental occurence after Ayurvedic drug intake.
Versatility of Repetitive Transcranial Magnetic Stimulation in the Treatment of Poststroke Dysphagia
Authors: Papadopoulou Soultana L. , Ploumis Avraam , Exarchakos G. , Theodorou S. J. , Beris A. , Fotopoulos A. D. 
Published: July 2018

ABSTRACTVarious techniques and courses of treatment have been researched, proposed, and implemented to evaluate and treat poststroke dysphagia (PSD) which is one of the main medical conditions affecting not only elderly people, as previously assumed, but also in recent years younger populations as well. The effectiveness of therapeutic methods depends mainly on the expertise of an interdisciplinary team of therapists, as well as on the timely application of the treatment. The present review discusses the therapeutic benefits of repetitive transcranial magnetic stimulation (rTMS) in patients suffering from PSD regardless of the location of the lesion. The use of rTMS directly manipulates cortical brain stimulation to restore neuroplasticity in the affected brain areas. This review presents a synopsis of the available literature on the patient along with a discussion on the effectiveness of rTMS as a safe and easy to use promising technique in the rehabilitation of dysphagic patients. Although the results from the studies so far have been largely positive in that direction, the question still remains whether larger scale and longitudinal studies will be able to corroborate the aspiring future of rTMS. Therefore, research questions to advance further investigation on the application and future of this technique are much in need.