bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of blood enterovirus and parechovirus polymerase chain reaction testing in young febrile infants: a prospective multicentre observational study
Authors: Alonso-Cadenas Jose Antonio , Velasco Roberto , Clerigué Arrieta Nuria , Amasorrain Urrutia Jone , Suarez-Bustamante Huélamo Maria , Mintegi Santiago , Gomez Borja 
Published: August 2024

ObjectivesTo analyse the performance of blood enterovirus and parechovirus PCR testing (ev-PCR) for invasive bacterial infection (IBI) (isolation of a single bacterial pathogen in a blood or cerebrospinal fluid culture) when evaluating well-appearing infants ≤90 days of age with fever without a source (FWS).MethodsWe describe the well-appearing infants ≤90 days of age with FWS and normal urine dipstick. We performed a prospective, observational multicentre study at five paediatric emergency departments between October 2020 and September 2023.ResultsA total of 656 infants were included, 22 (3.4%) of whom were diagnosed with an IBI (bacteraemia in all of them and associated with meningitis in four). The blood ev-PCR test was positive in 145 (22.1%) infants. One patient with positive blood ev-PCR was diagnosed with an IBI, accounting for 0.7% (95% CI 0.02 to 3.8) compared with 4.1% (95% CI 2.6 to 6.2) in those with a negative test (p=0.04). All four patients with bacterial meningitis had a negative blood ev-PCR result. Infants with a positive blood ev-PCR had a shorter hospital stay (median 3 days, IQR 2–4) compared with 4 days (IQR 2–6) for those with negative blood ev-PCR (p=0.02), as well as shorter duration of antibiotic treatment (median 2 days, IQR 0–4 vs 2.5 days, IQR 0–7, p=0.01).ConclusionsYoung febrile infants with a positive blood ev-PCR are at a low risk of having an IBI. Incorporating the blood ev-PCR test into clinical decision-making may help to reduce the duration of antibiotic treatments and length of hospital stay.
Early screening for foot problems in people with diabetes is the need of the hour: ‘Save the Feet and Keep Walking Campaign’ in India
Authors: Viswanathan Vijay , Gupta Amit , Devarajan Arutselvi , Kumpatla Satyavani , Shukla Sharvari , Agarwal Sanjay , Makkar Brij Mohan , Saboo Banshi , Kumar Vasanth , Sahay Rakesh Kumar 
Published: August 2024

IntroductionEvidence on the prevalence of foot problems among people with diabetes in India at a national level is lacking. Hence, this study was aimed to assess the burden of high-risk (HR) feet in people with diabetes across India.Research design and methodsA cross-sectional national-level project ‘Save the Feet and Keep Walking’ campaign was conducted by the Research Society for the Study of Diabetes in India (RSSDI) from July 10, 2022 to August 10, 2022. A modified version of 3 min foot examination was used to assess the foot problems. Around 10 000 doctors with RSSDI membership were trained online to conduct foot screening and provided a standardised monofilament for detection of loss of protective sensation. People with diabetes aged >18 years who visited the clinics during the study period were examined for foot problems. Data were collected online using the semi-structured questionnaire. A total of 33 259 participants with complete information were included for the final analysis. The foot at risk was categorised based on International Working Group on the Diabetic Foot guidelines 2023.ResultsNearly 75% of the participants were aged above 45 years. Around 49% had diabetes duration >5 years and uncontrolled diabetes (hemoglobin A1c >8%). Presence of history of foot ulcer (20%), lower limb amputation (15.3%), foot deformities (24.5%) and absence of diminished dorsal pedis and posterior tibial pulses (26.4%) was noted in the study participants. Around 25.2% of them had HR feet and highly prevalent among males. Diabetic kidney and retinal complications were present in 70% and 75.5% of people with HR feet. Presence of heel fissures (OR (95% CI) 4.6 (4.2 to 5.1)) and callus or corns (OR (95% CI) 3.6 (3.3 to 4.0)) were significantly associated with HR feet.ConclusionsOne-fourth of people with diabetes were found to have HR feet in India. The findings are suggestive of regular screening of people with diabetes for foot problems and strengthening of primary healthcare.
Cardioembolic stroke in an HIV endemic region: underdiagnosed and severe
Authors: Sadiq Eitzaz , Woodiwiss Angela , Norton Gavin , Modi Girish 
Published: August 2024

Background and objectivesCardioembolic stroke (CES) appears to be a rare cause of stroke (4%–9%) in people living with HIV (PLWH) in sub-Saharan Africa (SSA). However, due to limited access to diagnostic resources, this may be an underestimate. It is also unclear which cardiac pathologies are the major contributors to CES in this region. We sought to determine the prevalence and aetiology of CES in PLWH and to determine whether there are any differences compared with HIV negative stroke patients.MethodsThis cross-sectional study recruited PLWH with new-onset stroke at a quaternary-level hospital in Johannesburg, South Africa, from 2014 to 2017, and compared them to age-matched and sex-matched HIV negative stroke patients. Comprehensive investigations were performed to determine the underlying stroke aetiology, including electrocardiography, echocardiography, CT angiography and cerebrospinal fluid examination.Results85 PLWH with ischaemic stroke were recruited and compared with 109 HIV negative controls. CES was identified in 17/85 (20.0%) of PLWH. These patients had more severe strokes than PLWH with non-CES (National Institutes of Health Stroke Scale score 14.9±6.7 vs 11.7±5.4, p=0.04). Cardiomyopathy was the predominant cardiac pathology in PLWH (76.4% vs 45.5% in HIV negative, p=0.04) while valvulopathy was more common in HIV negative patients (42.4% vs 11.8% in PLWH, p=0.03). Arrhythmia (n=1) and ischaemic heart disease (n=1) were uncommon in PLWH.ConclusionCES is underdiagnosed in SSA and is more severe than non-CES. The identification of cardiomyopathy as the predominant underlying cardiac pathology may assist to target resources towards its detection using accessible cost-effective biomarkers.
Dietary variety score and risk of metabolic syndrome incidence: Tehran Lipid and Glucose Study
Authors: Hosseini-Esfahani Firoozeh , Koochakpoor Glareh , Mirmiran Parvin , Hosseinpour-Niazi Somayeh , Azizi Fereidoun 
Published: August 2024

PurposeThere are contradictions in the association between dietary variety and metabolic syndrome (MetS). The concept of dietary variety should be merged with other dietary recommendations including diet quality and proportion. We aimed to investigate the association of the healthy food diversity index with MetS and its components in Iranian adults.Design/methodology/approachIn this prospective study, 4654 subjects (62.0%women) were chosen from participants of the Tehran Lipid and Glucose Study. Diet was assessed based on a valid and reliable semi-quantitative Food Frequency Questionnaire. The healthy food diversity index was based on 26 food groups extracted from the 2020 dietary guideline. MetS was defined based on the Iranian-modified National Cholesterol Education Programme and Adult Treatment Panel III.FindingsThe mean±SD ages of men and women were, respectively, 39.3±14.7and 36.1±12.1 years. The incident cases of MetS were 1129 during a median follow-up of 3.31 years. Participants in the top quartiles of diversity score had higher educational levels, also they were likely to be older, female and were less likely to be current smokers in comparison to those in the lower quartiles (p<0.05). After adjustment of potential confounders, participants in the top quartile of the healthy food diversity score had lower risk of hypertriglyceridaemia (HR 0.14; 95% CI 0.05 to 0.25) and high fasting blood glucose (FBG) (HR 0.11; 95%CI 0.02 to 0.21, P trend=0.004) in comparison to those in the lowest quartile. There was no significant association between the healthy food diversity score and risk of MetS and the other components of MetS after adjustment of confounding factors.OriginalityIncreasing diversity score may be sufficient to reduce the risk of hypertriglyceridaemia and high FBG, but the healthy food diversity score is not associated with the risk of MetS incidence in the Tehranian population.
Postoperative chronic operation-related symptoms after minimally invasive lung surgery: a prospective observational protocol
Authors: Huang Yizhou , Chen Maohui , Wu Zhihui , Liu Peichang , Zhang Shuliang , Chen Chun , Zheng Bin 
Published: August 2024

IntroductionSignificant numbers of patients undergoing minimally invasive lung surgery develop chronic symptoms such as chronic pain and chronic cough after surgery, which may lead to a reduced quality of life (QoL). Despite this, there remains a dearth of high-quality prospective studies on this topic. Therefore, our study aims to systematically investigate the incidence and progression of long-term chronic symptoms following minimally invasive lung surgery, as well as changes in patient’s psychological status and long-term QoL.MethodsThis is a single-centre, observational, prospective study that included patients with stage I non-small cell lung cancer or benign lesions. Prior to surgery, patients’ baseline levels of chronic pain, chronic cough and sleep will be documented. Anxiety, depression and QoL assessments will be conducted using the Hospital Anxiety and Depression Scale (HADS) and the European Organisation for Research and Treatment of Cancer (EORTC) 30-item QoL Questionnaire (QLQ-C30). Following surgery, pain and cough will be evaluated during the initial 3 days using the Numeric Pain Rating Scale and Visual Analogue Scale score, with assessments performed thrice daily. Additionally, sleep status will be recorded daily during this period. Subsequently, postoperative chronic symptoms and QoL will be assessed at weeks 1, 2, 4, 12, 26 and 52. Chronic cough will be evaluated using the Leicester Cough Questionnaire, chronic pain will be assessed via the Brief Pain Inventory and McGill Pain Questionnaire while the EORTC QLQ-C30 questionnaire and HADS will provide continuous monitoring of QoL, anxiety and depression statuses. Data will also include the timing of chronic symptom onset, predisposing factors, as well as aggravating and relieving factors.Ethics and disseminationEthical approval was obtained from the Ethics Committees of Fujian Medical University Union Hospital. The findings will be disseminated in peer-reviewed publications.Trial registration numberNCT06016881.
Implementation of time-limited parenteral hydromorphone in people with treatment-resistant injecting opioid use disorder: a protocol for a single-site, uncontrolled, open-label study to assess feasibility, safety and cost
Authors: Rodgers Craig , Siefried Krista J , Ritter Alison , Belackova Vendula , Treloar Carla , Jauncey Marianne , Ezard Nadine , Roberts Darren , Steele Maureen , van den Brink Willem , Strang John , Oviedo-Joekes Eugenia , Lintzeris Nicholas , Dunlop Adrian John , Bell James 
Published: August 2024

IntroductionSupervised injectable opioid treatment (SIOT) is an evidence-based intervention targeting opioid-dependent people for whom existing treatments have been ineffective. This project will primarily assess the feasibility and the acceptability of time-limited SIOT using injectable hydromorphone delivered in an existing Australian public opioid treatment programme, with secondary outcomes of safety, cost, changes in drug use and other health outcomes. If feasible, the goal is to scale up the intervention to be more widely available in Australia.Methods and analysisBetween 20 and 30 participants will be offered two times per day hydromorphone to inject under direct observation, in addition to their current opioid agonist treatment (OAT), for up to 2 years. At the end of 2 years of supervised hydromorphone treatment, participants will be continued on standard OAT only. Informed consent will be obtained from all participants included in the study. This is a single-site, uncontrolled, open-label study where quantitative and qualitative interview data will be collected at baseline, 12 months and lastly at 3 months following their final hydromorphone dose. The main outcome measures are feasibility, as assessed by recruitment, retention and participation in treatment, and acceptability to participants, clinic staff and other stakeholders assessed by qualitative interviews. Secondary outcome measures of safety, as assessed by adverse events, and cost will also be assessed, as well as a range of other drug and health outcomes.Ethics and disseminationThis study received ethical approval from the St Vincent’s Hospital Human Research Ethics Committee (2019/ETH00418). This will be the first study of time-limited SIOT in the Australian setting. All results will be submitted to peer-reviewed journals, scientific conferences and local practice meetings. A preliminary report on outcomes will also be presented to local health policy makers. A consumer and community forum will also be held to feedback results to a broader audience.Trial registration numberACTRN12621001729819.
Strategies to foster community engagement for epidemic and pandemic preparedness and response in sub-Saharan Africa: a scoping review protocol
Authors: Issahaku Gyesi Razak , Fischer Hanna-Tina , Appiah-Brempong Emmanuel , Opoku Daniel , Hanefeld Johanna 
Published: August 2024

Introduction
The surge of public health emergencies over the past decade has disproportionately affected sub-Saharan Africa. These include outbreaks of infectious diseases such as Ebola, Monkeypox and COVID-19. Experience has shown that community participation is key to the successful implementation of infection control activities. Despite the pivotal role community engagement plays in epidemic and pandemic preparedness and response activities, strategies to engage communities have been underexplored to date, particularly in sub-Sahara Africa. Furthermore, reviews conducted have not included evidence from the latest pandemic, COVID-19. This scoping review aims to address these gaps by documenting through available literature, the strategies for community engagement for epidemic and pandemic preparedness and response in sub-Sahara Africa.

Methods and analysis
We will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and the methodological framework for scoping reviews from Arksey and O�Malley to guide the review. Two reviewers will develop a systematic search strategy to identify articles published from January 2014 to date. We will retrieve peer-reviewed research published in the English language from databases including Embase, EBSCO-host, PubMed, Global Health, CINAHL, Google Scholar and Web of Science. Additionally, we will search for relevant grey literature from the websites of specific international organisations, public health institutes and Government Ministries of Health in African countries. After the removal of duplicates, the two reviewers will independently screen all titles, abstracts and full articles to establish the relevance of each study for inclusion in the review. We will extract data from the included articles using a data extraction tool and present the findings in tabular form with an accompanying narrative to aid comprehension.

Ethics and dissemination
Ethical approval is not required for the conduct of scoping reviews. We plan to disseminate the findings from this review through publications in a peer-reviewed journal, presentations at conferences and meetings with policy-makers.
Assessment of economic burden due to COVID-19 pandemic during institutional childbirth in Nepal: before-and-after design
Authors: Basnet Omkar , Bhattarai Pratiksha , Malla Honey , Gurung Rejina , Paudel Prajwal , Sunny Avinash K , Målqvist Mats , KC Ashish 
Published: August 2024

IntroductionThe COVID-19 pandemic caused disruptions in global health and economic stability. In Nepal, before the pandemic, more than 50% of healthcare costs were out-of-pocket expenditure (OOPE). This study aimed to assess the OOPE for maternity care during before and during the COVID-19 pandemic in nine hospitals in Nepal.MethodWe conducted a before-and-after study between March 2019 and December 2020 with 13 months of prepandemic period and 9 months of pandemic period. OOPE was assessed using a semistructured interview with 53 864 women. Bivariate (unadjusted) and multivariate (adjusted) linear regression modelling was conducted to assess the change in OOPE in US dollar between the periods. Adjustment in linear regression model was done for population characteristics different between the periods.ResultThe OOPE for childbirth increased by 28.1% during pandemic, with an increase of OOPE from US$19.2 to S$23.9 (adjusted-β coefficient 5.4; 95% CI 4.5 to 5.7; p<0.0001). The OOPE of laboratory diagnosis increased by 15.3% for spontaneous birth during the pandemic (adjusted-β coefficient, 1.6; 95% CI 1.4 to 1.8; p<0.0001). OOPE increased by 29.8%, 40.0% and 10.3% for spontaneous vaginal birth, instrumental birth and caesarean section, respectively. The OOPE among the poorest family increased by 12.9%, and OOPE for richer family increased by 57.6% during the pandemic period.ConclusionOOPE for maternity care increased by more than 28% during the COVID-19 pandemic in Nepal. OOPE increased in all wealth quintile with marked rise in richer wealth quintile group. Mitigation efforts to secure affordable maternal healthcare services are required during pandemic.
Lived experiences and perspectives of women who had undergone perinatal loss in Nairobi county, Kenya: a qualitative study
Authors: Kaburu Emily Wanja , Aimakhu Christopher O , Kamau Thomas Matenjwa , Owor Michael Omondi 
Published: August 2024

BackgroundThis study explored the lived experiences and perspectives of women who had suffered a perinatal loss in Nairobi county, Kenya. Existing research works have established that perinatal loss often comes with a significant psychosocial burden, which has been made worse by negative cultural beliefs and practices. Despite this, perinatal loss grieving is rarely recognised or socially legitimated in many countries. This study aimed to shed light on the experiences of bereaved women to come up with effective interventions and combat the stigma associated with perinatal loss.MethodsThe study used a qualitative research design employing a descriptive phenomenological approach targeting women of reproductive age who had experienced perinatal loss within the previous 3 years. The study was conducted in three subcounties of Nairobi. Purposive sampling was used to identify and recruit 22 women to participate in focus group discussions. After the discussions, the audio recordings were transcribed, translated and analysed thematically. Triangulation was then done per thematic area to allow for a deeper understanding of the experiences and perceptions of the study participants.ResultsThe research identified 3 themes and 7 subthemes: (1) ‘Psychosocial challenges of perinatal loss’ with five subthemes;—‘Emotional trauma and grief’, ‘Multiple losses and reproductive pressure’, ‘Broken relationships,’ ‘Violence and abuse’ and ‘Familial stigmatization’. (2) ‘Healthcare experiences.’ (3) ‘Stigma and cultural influences’ with 2 subthemes ‘Societal stigmatisation’, and ‘Cultural perceptions and norms surrounding perinatal loss’.ConclusionWomen who have experienced perinatal loss often suffer psychological torture, discrimination, abuse, stigma and trauma. The findings from this study highlight the urgent need to set-up robust support systems to assist individuals coping with perinatal loss. This will require a range of interventions, including implementing trauma management programmes, training of healthcare workers, advocacy, sensitisation and establishing support networks to address discrimination and stigma faced by those affected.
Should patients with minor strokes be given thrombolytics?
Authors: Wang Xun , Dong Yi , Dong Qiang , Wang David 
Published: August 2024

Mild stroke symptoms are cited as the reason for not using tissue-type plasminogen activator in 29–43% of time-eligible patients. Previous studies suggested that not all of these patients had a good recovery or even survival to hospital discharge. Since then, stroke guidelines worldwide recommended thrombolysis in minor but disabling strokes.Dual antiplatelet treatment with aspirin and clopidogrel was more effective than aspirin alone for reducing subsequent events in patients with minor stroke if started within 24 hours of onset in both CHANCE (Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events) and POINT (Platelet-Oriented Inhibition in New TIA and Minor Ischaemic Stroke) trials. Recently, both PRISMS (The Potential of rtPA for Ischemic Strokes With Mild Symptoms) trial and TEMPO-2 (Tenecteplase Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion) trial showed that treatment with thrombolysis versus antiplatelet did not increase the likelihood of favourable functional outcome at 90 days among patients with minor non-disabling acute ischaemic strokes. Therefore, a narrative review on thrombolysis for patients with minor strokes from published studies may help practicing clinicians.
Efficacy of robot-assisted thoracoscopic surgery in the treatment of pulmonary sequestration in children
Authors: Liang Liang , Tan Zheng , Huang Ting , Gao Yue , Zhang Jian , Yu Jiangen , Xia Jie , Shu Qiang 
Published: August 2024

ObjectiveThis study was performed to evaluate the efficacy of robot-assisted thoracoscopic surgery (RATS) in the treatment of pulmonary sequestration (PS) in children.MethodsAll video-assisted thoracoscopic surgery (VATS) and RAST performed on patients with PS at a single center from May 2019 to July 2023 were identified. Theχ2and Wilcoxon tests were used to compare the perioperative outcomes between VATS and RATS groups.ResultsNinety-three patients underwent RATS while 77 patients underwent VATS. In both two groups, one patient converted to thoracotomy and no surgical mortality case. The median operation time was longer for the RATS group compared with the VATS group (75 minvs.60 min,p<0.001). A lower ratio of chest tube indwelling (61.3%vs.90.9%,p<0.001), fewer drainage days (1.0 dayvs.2.0 days,p<0.001), and a shorter postoperative length of stay (5.0 daysvs.6.0 days,p<0.001) were found in the RATS group than that in the VATS group. No significant difference was found in the incidence of short-term postoperative complications (hydrothorax and pneumothorax) between two groups.ConclusionsRATS was safe and effective in children with PS over 6 months old and more than 7 kg. Furthermore, RATS led to better short-time postoperative outcome than VATS. Multi-institutional studies are warranted to compare differences in long-term outcomes between RATS and VATS.