bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing visual estimation and hematocrit change in the assessment of blood loss among women undergoing cesarean delivery in a tertiary facility in northern Uganda
Authors: Edilu Robert , Sanvu Aaron , Ecuut James , Odong Alban , Bongomin Felix , Nantale Ritah , Ayikoru Jackline , Arwinyo Baifa , Ojara Sande , Pebolo Pebalo Francis 
Published: October 2024

Background: Cesarean section poses a fourfold risk for postpartum hemorrhage (PPH), necessitating accurate blood loss estimation to enable timely interventions. However, the conventional visual estimation method often leads to underestimation, resulting in undiagnosed PPH even in our setting, Uganda. Yet, the quantitative standard techniques remain underutilized. Objective: We compared visual and calculated blood loss among women undergoing cesarean delivery at Gulu Regional Referral Hospital in northern Uganda. Design: We employed a cross-sectional study design. Methods: We enrolled pregnant women scheduled for cesarean section and determined both calculated and visually estimated blood loss. Data analysis involved using Pearson’s moment correlation coefficient to compare the two methods and logistic regression to determine the factors associated with PPH. Results: We included 105 participants, most were primigravida ( n = 100, 43%), aged 15–24 years ( n = 100, 52%), with term gestation ( n = 100, 75%). The mean visual estimated blood loss (vEBL) was 235.3 ± 123.7 ml (interquartile range (IQR) 50–600 ml), while the calculated estimated blood loss (cEBL) was 435.0 ± 1328.2 ml (IQR −11,182.1–2226.7 ml). Visual estimation underestimated blood loss in 90% of cases ( n = 100), and 21% ( n = 21) had undiagnosed PPH (>1000 ml blood loss). None of the respondents had PPH (>1000 ml blood loss) following vEBL. There was a small positive correlation between both methods (vEBL and cEBL; r = 0.1165; p = 0.2482). Women aged >35 years were 1.60 times more likely to experience PPH than their counterparts aged 25–34 years (adjusted odds ratio (AOR): 1.60; 95% CI: 1.11–2.30, p < 0.011). Chorioamnionitis increased the risk of PPH by 2.2 times (AOR: 2.20; 95% CI: 1.20–4.05, p < 0.012). Conclusion: The visual estimation technique significantly underestimated blood loss in up to 90% of cases, particularly during emergency cesarean sections. Among the 21% of cases diagnosed with PPH based on calculated blood loss, advanced maternal age and chorioamnionitis were notable contributing factors. Routine hemoglobin and hematocrit testing in obstetric care can be effectively utilized to objectively assess blood loss, aiding in the accurate diagnosis and management of PPH. Implementing these measures, even in resource-constrained settings, can significantly reduce the morbidity and mortality associated with PPH. Trial registration: Not applicable.
Exploring challenges to the uptake of sexual and reproductive health services among lesbian and bisexual women in Bulawayo, Zimbabwe: a qualitative enquiry
Authors: Khozah Methembe Yotamu , Nunu Wilfred Njabulo 
Published: October 2024

Background: Reproductive healthcare is essential for all people, including lesbian and bisexual women. However, lesbians and bisexual women are among society’s most marginalised and excluded members. Objective: This study aimed to explore the challenges faced by lesbian and bisexual women in accessing Sexual and Reproductive Health (SRH) Services in Bulawayo, Zimbabwe. Design: An exploratory, descriptive qualitative study was conducted on two populations that included eight participants identified through the Voice of the Voiceless organisation in Bulawayo and 10 key informants and probed the challenges faced by lesbians and bisexual women when accessing SRH services. Methods: Data were gathered through 10 key informant interviews and 1 focus group discussion (FGD; with 8 participants). The interviews and FGDs were recorded, transcribed verbatim, coded and thematically analysed. Results: The themes that emerged included the uptake of SRH services among lesbians and bisexual women, the challenges faced by lesbians and bisexual women when accessing SRH services, and strategies to aid the uptake of SRH services by lesbians and bisexual women. The findings showed that the uptake of SRH services was generally low and was influenced by factors such as clinical settings. The challenges mentioned included stigma and the unavailability of specific lesbian and bisexual women’s services. By contrast, the most frequent strategies included affirmative training for healthcare providers and improved clinical settings to become friendly and inclusive. Conclusion: There is an imperative for targeted SRH services that address the distinct needs of lesbians and bisexual women, in line with the 95-95-95 strategy and Sustainable Development Goals target 3.7. The observed low uptake of these services can be attributed to several systemic barriers, including inadequate training of health providers, negative attitudes and lack of inclusive policies. Enhancing the sensitivity of health facilities, strengthening links to sexual health education and implementing supportive legal frameworks are essential steps to improve SRH outcomes in this population. These findings elucidate critical gaps within the current healthcare system and present significant opportunities for policymakers to formulate evidence-based strategies to ensure equitable access to SRH services, thereby advancing public health objectives.
Comparison of the quality of life of comorbid and non-comorbid people living with HIV/AIDS in a Nigerian secondary healthcare facility
Authors: Ahmad Dalhatu Muhammad , Muhammad Haruna Rashid , Aliyu Shuaibu , Lucero-Prisno Don Eliseo 
Published: October 2024

Introduction Quality of life (QoL) is a vital healthcare indicator among people living with human immunodeficiency virus (PLWHA). Assessing the effects of comorbidities on QoL among PLWHA is of clinical and public health importance. This study compared the QoL of comorbid and non-comorbid PLWHA at St. Gerard’s Catholic Hospital (SGCH), Kaduna. Methods This was a prospective cross-sectional study of 178 conveniently selected and stratified comorbid PLWHA and 172 non-comorbid PLWHA receiving care at the facility. Data was collected using a structured, interviewer-administered instrument. The QoL scores were statistically compared using the Mann‒Whitney U test. P<0.05 was considered statistically significant for all the analyses. Results Most respondents were aged 35 – 54 years (65.2% and 66.4% for comorbid and non-comorbid patients respectively), were female (70.8% and 69.2% for comorbid and non-comorbid patients respectively) and married (67.4% and 59.3% for comorbid and non-comorbid patients respectively). For all QoL domains (perception of QoL and general health, physical health, psychological health, level of independence, social relationship, environment, and spirituality/religion/personal beliefs), there was evidence the distribution of values was significantly lower in the comorbid PLWHA compared to the non-comorbid PLWHA (p<0.001), with the largest difference seen for physical health. The mean physical health (interquartile range) was 9 (7-10) and 17 (15-19) for comorbid and non-comorbid PLWHA respectively. The most prevalent comorbidities among the PLWHA were hypertension 97 (54.49%) and diabetes 36 (20.22%). Conclusion Non-comorbid PLWHA had better QoL than comorbid PLWHA in all the QoL domains and the greatest difference was observed in physical health. Special efforts should be made to improve the QoL of comorbid PLWHA.
Spirometry in clinical use: practical issues
Authors: Agnew M. 
Published: October 2024

Educational aimsTo identify practical problems when carrying out spirometry.To provide a short ‘pathway’ to assess spirometry results.To provide a standard operational procedure to carry out spirometry from current guidelines.Summary‘Spirometry is a simple test of lung function’. How often have we heard that statement? Does this come to mind when trying to get an 80-yr-old, ill, somewhat confused patient to follow instructions and perform an acceptable, reproducible test in our department? NO. Of course, there is more to spirometry than the patient being able to follow instructions, but that is another issue. Let's start with the basics. Three things impact on good test results: 1) the operator (be it a technician, scientist, nurse, physiotherapist or doctor); 2) the equipment (in this case a spirometer (desktop or handheld) or hospital department lung function equipment); and 3) the patient (who can be young, interested and co-operative, or elderly, ill and non-cooperative, or somewhere in between). All three can impact in a positive or negative way on your test results; therefore, it is important to optimise the working of each one to rule out problems.
Transdermal iontophoresis versus high power pain threshold ultrasound in Mechanical Neck Pain: a randomized controlled trial
Authors: Ibrahim Nouran A. , Hamdy Hend A. , Elbanna Rana Hesham Mohamed , Mohamed Dina M.A. , Ali Ebtesam A. 
Published: October 2024

Abstract
Background
The investigation aimed to assess the impacts of magnesium sulphate (MgSO4) iontophoresis and high-power pain-threshold ultrasound (HPPT-US) on pain, range of motion (ROM), and functional activity in physical therapy students suffering from mechanical cervical pain.

Methods
Typically, 75 males aged 19 to 30 years suffering from mechanical neck pain were enrolled in this investigation. Participants were divided at random into three groups. Group A received iontophoresis plus conventional physical therapy program, Group B received HPPTUS along with conventional therapy, and Group C received conventional therapy only. The outcomes were pain evaluated by visual analog scale (VAS) and Digital Electronic Pressure Algometer, cervical range of motion measured by Myrin gravity reference goniometer, and Arabic Neck disability index (ANDI) evaluate neck function.

Results
The differences within and between groups were detected utilizing a mixed-design multivariate analysis of variance (MANOVA). The within- and between-group analysis of all outcome measures revealed that there were statistically significant differences at post-intervention between high-power ultrasound and conventional group at all variables and also between iontophoresis and conventional group, but there was no statistically significant variation between high-power ultrasound and iontophoresis.

Conclusion
MgSO4 iontophoresis and HPPT-US are effective in decreasing pain, improving neck function, and improving neck ROM in subjects with mechanical neck pain who have active myofascial trigger points (MTrPs) on the upper fibers of the trapezius with no superiority of one over the other.

Trail registration
The study was registered in the Clinical Trials Registry (registration no: NCT05474898) 26/7/2022.
Morphometric measurements of intraoral anatomy in children with Beckwith-Wiedemann syndrome: a novel approach
Authors: Romeo Dominic J. , George Andrew M. , Sussman Jonathan H. , Banala Manisha , Wiemken Andrew , Wu Meagan , Ng Jinggang J. , Taylor Jesse A. , Schwab Richard J. , Cielo Christopher M. , Kalish Jennifer M. 
Published: October 2024

Abstract
Background
An easy-to-use tool to objectively measure intraoral anatomy with meaningful clinical correlations may improve care for patients with Beckwith-Wiedemann syndrome (BWS), who commonly have symptomatic macroglossia.

Methods
Children aged 2–17 years with BWS were enrolled between 12/2021 and 01/2024. Digital intraoral photographs with a laser ruler were taken, and morphometric measurements were made using ImageJ software. Relationships between morphometrics and outcomes including BWS clinical score, percentage mosaicism, and incidence of tongue reduction surgery were examined using t-tests and multivariate linear models.

Results
Pharyngeal morphometric measurements were obtained in 49 patients with BWS. Mouth area, width, and height differed significantly across BWS molecular subtypes. Right-to-left tongue width and mouth width were larger in those with loss of methylation at imprinting control region 2 (IC2 LOM) than other BWS variants. Patients with paternal uniparental isodisomy of chromosome 11p15 (pUPD11) had narrower mouths than others. Those with tongue reduction surgery had more tongue ridging than those without surgery. There were correlations between mouth area and BWS clinical score, tongue width and BWS clinical score, and tongue length and percentage mosaicism.

Conclusion
Intraoral morphometric measurements are associated with phenotypic burden in BWS. Tongue morphology varies across the BWS spectrum, with IC2 LOM having wider tongues and mouths, and pUPD11 having narrower mouths. Tongue ridging is more common in those selected for surgery. Intraoral morphometric measurements may be safely obtained at low costs across centers caring for children with BWS or others at risk of upper airway obstruction.
Mechanisms of glutamate receptors hypofunction dependent synaptic transmission impairment in the hippocampus of schizophrenia susceptibility gene Opcml-deficient mouse model
Authors: Sun Xiaoxuan , Meng Hu , Lu Tianlan , Yue Weihua , Zhang Dai , Wang Lifang , Li Jun 
Published: October 2024

AbstractSchizophrenia is a severe psychiatric disorder with high heritability, characterized by positive and negative symptoms as well as cognitive abnormalities. Dysfunction in glutamate synapse is strongly implicated in the pathophysiology of schizophrenia. However, the precise role of the perturbed glutamatergic system in contributing to the cognitive abnormalities of schizophrenia at the synaptic level remains largely unknown. Although our previous work found that Opcml promotes spine maturation and Opcml-deficient mice exhibit schizophrenia-related cognitive impairments, the synaptic mechanism remains unclear. By using whole-cell patch clamp recording, we found that decreased neuronal excitability and alterations in intrinsic membrane properties of CA1 PNs in Opcml-deficient mice. Furthermore, Opcml deficiency leads to impaired glutamatergic transmission in hippocampus, which is closely related to postsynaptic AMPA/NMDA receptors dysfunction, resulting in the disturbances of E/I balance. Additionally, we found that the aripiprazole which we used to ameliorate abnormal cognitive behaviors also rescued the impaired glutamatergic transmission in Opcml-deficient mice. These findings will help to understand the synaptic mechanism in schizophrenia pathogenesis, providing insights into schizophrenia therapeutics with glutamatergic disruption.
Remote monitoring of rheumatoid arthritis (REMORA): study protocol for a stepped wedge cluster randomized trial and process evaluation of an integrated symptom tracking intervention
Authors: van der Veer Sabine N. , Griffiths-Jones Deb , Parkes Matthew , Druce Katie L. , Amlani-Hatcher Paul , Armitage Christopher J. , Bansback Nicholas , Bower Peter , Dowding Dawn , Ellis Benjamin , Firth Jill , Gavan Sean , Mackey Elaine , Sanders Caroline , Sharp Charlotte A. , Staniland Karen , Dixon William G. ,   the REMORA team
Published: October 2024

Abstract
Background
Management of rheumatoid arthritis (RA) relies on symptoms reported by patients during infrequent outpatient clinic visits. These reports are often incomplete and inaccurate due to poor recall, leading to suboptimal treatment decisions and outcomes. Asking people to track symptoms in-between visits and integrating the data into clinical pathways may improve this. However, knowledge on how to implement this into practice and its impact on services and outcomes remains scarce in RA. Therefore, we evaluate the comparative effectiveness and cost-effectiveness of integrated symptom tracking in people with RA over and above usual care, while generating insights on factors for successful implementation.

Methods
In this superiority stepped wedge cluster-randomized controlled trial with continuous recruitment short exposure design, 16 rheumatology outpatient departments (clusters) recruit a total of 732 people with active RA. They initially offer clinic visits according to standard of care before switching in pairs to visits with integrated symptom tracking. Clusters switch in randomized order every 3 weeks. Integrated symptom tracking consists of (1) a mobile app for patients to track their symptoms daily and other RA aspects weekly/monthly, and (2) an interactive dashboard visualizing the app data, which healthcare professionals access from their electronic health record system. Clinic visits happen according to usual practice, with tracked symptom data only reviewed during visits. Our primary outcome is a difference in marginal mean disease activity score at 12 ± 3 months between standard of care and integrated symptom tracking, after accounting for baseline values, cluster, and other covariates. Secondary outcomes include patient-reported disease activity, quality of life and quality-adjusted life-years, medication/resource use, consultation and decision-making experience, self-management, and illness perception. We also conduct interviews and observations as part of a parallel process evaluation to gather information on implementation.

Discussion
Our trial will generate high-quality evidence of comparative and cost-effectiveness of integrated symptom tracking compared to standard of care in people with RA, with our process evaluation delivering knowledge on successful implementation. This optimizes the chances of integrated symptom tracking being adopted more widely if we find it is (cost-) effective.

Trial registration
Registered 4-Jun-2024 on https://www.isrctn.com/, ISRCTN51539448.

Trial open science framework repository
https://osf.io/sj9ha/.
Sex-specific phenotypical, functional and metabolic profiles of human term placenta macrophages
Authors: Paparini Daniel E. , Grasso Esteban , Aguilera Franco , Arslanian M. Agustina , Lella Victoria , Lara Brenda , Schafir Ana , Gori Soledad , Merech Fátima , Hauk Vanesa , Schuster Claudio , Martí Marcelo , Meller Cesar , Ramhorst Rosanna , Vota Daiana , Leirós Claudia Pérez 
Published: October 2024

Abstract
Background
Placental macrophages, Hofbauer cells (HBC) are the only fetal immune cell population within the stroma of healthy placenta along pregnancy. They are central players in maintaining immune tolerance during pregnancy. Immunometabolism emerged a few years ago as a new field that integrates cellular metabolism with immune responses, however, the immunometabolism of HBC has not been explored yet. Here we studied the sex-specific differences in the phenotypic, functional and immunometabolic profile of HBC.

Methods
HBC were isolated from human term placentas (N = 31, 16 from male and 15 female neonates). Ex vivo assays were carried out to assess active metabolic and endoplasmic reticulum stress pathways by flow cytometry, confocal microscopy, gene expression and in silico approaches.

Results
HBC from female placentas displayed a stronger M2 phenotype accompanied by high rates of efferocytosis majorly sustained on lipid metabolism. On the other hand, male HBC expressed a weaker M2 phenotype with higher glycolytic metabolism. LPS stimulation reinforced the glycolytic metabolism in male but not in female HBC. Physiological endoplasmic reticulum stress activates IRE-1 differently, since its pharmacological inhibition increased lipid mobilization, accumulation and efferocytosis only in female HBC. Moreover, differential sex-associated pathways accompanying the phenotypic and functional profiles of HBC appeared related to the placental villi environment.

Conclusions
These results support sex-associated effects on the immunometabolism of the HBC and adds another layer of complexity to the intricate maternal-fetal immune interaction.

Graphical abstract
HPV16 integration regulates ferroptosis resistance via the c-Myc/miR-142-5p/HOXA5/SLC7A11 axis during cervical carcinogenesis
Authors: Chen Xiao-Jing , Guo Chu-Hong , Yang Yang , Wang Zi-Ci , Liang Yun-Yi , Cai Yong-Qi , Cui Xiao-Feng , Fan Liang-Sheng , Wang Wei 
Published: October 2024

Abstract
Background
Ferroptosis, a newly identified form of regulated cell death triggered by small molecules or specific conditions, plays a significant role in virus-associated carcinogenesis. However, whether tumours arising after high-risk HPV integration are associated with ferroptosis is unexplored and remains enigmatic.

Methods
High-risk HPV16 integration was analysed by high­throughput viral integration detection (HIVID). Ferroptosis was induced by erastin, and the levels of ferroptosis were assessed through the measurement of lipid-reactive oxygen species (ROS), malondialdehyde (MDA), intracellular Fe2+ level and transmission electron microscopy (TEM). Additionally, clinical cervical specimens and an in vivo xenograft model were utilized for the study.

Results
Expression of HPV16 integration hot spot c-Myc negatively correlates with ferroptosis during the progression of cervical squamous cell carcinoma (CSCC). Further investigation revealed that the upregulated oncogene miR-142-5p in HPV16-integrated CSCC cells served as a critical downstream effector of c-Myc in its target network. Inhibiting miR-142-5p significantly decreased the ferroptosis-suppressing effect mediated by c-Myc. Through a combination of computational and experimental approaches, HOXA5 was identified as a key downstream target gene of miR-142-5p. Overexpression of miR-142-5p suppressed HOXA5 expression, leading to decreased accumulation of intracellular Fe2+ and lipid peroxides (ROS and MDA). HOXA5 increased the sensitivity of CSCC cells to erastin-induced ferroptosis via transcriptional downregulation of SLC7A11, a negative regulator of ferroptosis. Importantly, c-Myc knockdown increased the anti-tumour activity of erastin by promoting ferroptosis both in vitro and in vivo.

Conclusions
Collectively, these data indicate that HPV16 integration hot spot c-Myc plays a novel and indispensable role in ferroptosis resistance by regulating the miR-142-5p/HOXA5/SLC7A11 signalling axis and suggest a potential therapeutic approach for HPV16 integration-related CSCC.