bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of recurrent stroke and dementia following acute stroke by changes in kidney function: results from the Perindopril Protection Against Recurrent Stroke Study
Authors: Maeda Toshiki , Woodward Mark , Jun Min , Sakamoto Yuki , Chen Xiaoying , Matsushita Kunihiro , Mancia Giuseppe , Arima Hisatomi , Anderson Craig S. , Chalmers John , Harris Katie 
Published: May 2024

Background:
Limited data exist on the relationship between declining kidney function and cardiovascular events, dementia, and mortality in patients with a history of stroke.
Thus the aims of the study were to investigate functional relationships between dynamic kidney function change and cardiovascular outcomes, and clarify whether adding kidney parameters to conventional cardiovascular risk factors improves model discrimination.

Methods:
Post hoc analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) clinical trial of blood pressure lowering for the secondary prevention of stroke. We examined the association between dynamic kidney function defined as percentage change (declines of >30%, and >0 to ≤30%, and increases of ≥0 to <30%, and ≥30%) in estimated glomerular filtration rate (eGFR) over 2 years and recurrent stroke, major cardiovascular events, dementia and all-cause death over the next 2 years using Cox proportional hazard models controlling for eGFR at registration and potential confounders. Restricted cubic splines were used to assess the functional relationships. C-statistics and Net Reclassification Improvement (NRI) at 2 years were used to assess model discrimination.

Results:
In 4591 patients followed for a mean of approximately 2 years, 254 (5.5%) developed recurrent stroke, 391 (8.5%) had a major cardiovascular event, 221 (4.8%) developed dementia, and 271 (5.9%) died. Reverse J-like or U-like relationships were observed for percent declines in eGFR and outcomes. Using declines in eGFR of >0 to ≤30% as a reference, increased risks were evident for a greater decline (>30%) in relation to recurrent stroke [adjusted hazard ratio 1.85, 95% confidence interval (CI) 1.20–2.85], major cardiovascular event (2.24, 1.62–3.10) and all-cause death (2.09, 1.39–3.15). A larger increase (≥30%) in eGFR was also associated with a greater risk of all-cause death (1.96, 1.14–3.37). Improvements in the C-statistic were found by adding baseline eGFR and percent change compared with a model with conventional cardiovascular risk factors alone, for major cardiovascular events, dementia, and all-cause mortality.

Conclusion:
Declining kidney function following an incident cerebrovascular event is associated with additional risk of a major cardiovascular events, dementia, and 2-year mortality. However, a large increase in kidney function was also found to be associated with a higher risk of mortality.
Characteristics associated with responsiveness to isometric handgrip training in medicated hypertensive patients: secondary data analysis
Authors: Farah Breno Q. , Forjaz Claudia L.M. , O’Driscoll Jamie M. , Millar Philip J. , Oliveira Marcelo S. , Fecchio Rafael , Kanegusuku Helcio , Sousa Julio C.S. , Correia Marilia A. , Ritti-Dias Raphael M. 
Published: May 2024

Objective:
Isometric handgrip training (IHT) has been shown to reduce blood pressure (BP) in hypertensive patients. However, factors that predict responsiveness to IHT are largely unknown. The aim of this study was to investigate the patient characteristics associated with the antihypertensive response to IHT using a recommended statistical approach for evaluating interindividual responses.

Methods:
Data from four randomized controlled trials were combined, totaling 81 patients undergoing IHT (48.8% women; 60 ± 11 years) and 90 control patients (45.6% women; 62 ± 12 years). IHT consisted of 4 × 2 min isometric contractions at 30% of maximal voluntary contraction, performed three times/week for 8–12 weeks. BP was measured at baseline and following IHT and control interventions. The interindividual variation was assessed by the standard deviation of the individual responses (SDir), and linear regression analyses were conducted to explore response predictors.

Results:
IHT significantly decreased both SBP (−5.4; 95% confidence interval (CI) −9.5 to −1.3 mmHg) and DBP (−2.8; 95% CI −5.1 to −0.6 mmHg). The interindividual variation of BP change was moderate for systolic (SDir = 5.2 mmHg, 0.30 standardized units) and low for diastolic (SDir = 1.7 mmHg, 0.15 standardized units). Sex, age, and BMI were not associated with the antihypertensive effect of IHT. However, a higher baseline SBP (b = −0.467, P < 0.001) and absence of dihydropyridine calcium channel blockers use (b = 0.340, P = 0.001) were associated with greater BP reductions.

Conclusion:
IHT reduced BP in medicated hypertensive patients regardless of age, sex, and BMI. Patients with a higher baseline SBP and those not prescribed dihydropyridine calcium channel blockers were more responsive to IHT.
Association Between Workaholism and Headaches Causing Presenteeism
Authors: Matsuyama Kazufumi , Nagata Tomohisa , Odagami Kiminori , Nagata Masako , Kajiki Shigeyuki , Sakai Kosuke , Mori Koji 
Published: May 2024

Objectives
This study investigates the association between workaholism and headaches causing presenteeism among Japanese employees.

Methods
Used data from self-reporting questionnaire and annual health checkups. Workaholism was assessed using the Dutch Workaholic Scale and headaches causing presenteeism were identified as the symptom hindering work. We performed a logistic regression analysis adjusted for covariates.

Results
Among 5802 respondents, 3.7% cited headaches as the symptom hindering work. We found an association between workaholism and such headaches (odds ratios [OR]: 1.05, 95% confidence intervals [CI]: 1.03–1.08). Both working excessively (OR: 1.08, 95% CI: 1.04–1.12) and working compulsively (OR: 1.10, 95% CI: 1.05–1.15) subscales were also related.

Conclusions
Workaholism may lead to productivity loss due to headaches, and addressing workaholism can prevent this loss. Combining health examination data with work hours data may enable the early detection of workaholism.
Disaster management – preparation and planning for acute care facilities
Authors: Gandra d’Almeida António , Coopersmith Craig M. 
Published: May 2024

Purpose of reviewBoth human-derived and naturally-occurring disasters stress the surge capacity of health systems and acute care facilities. In this article, we review recent literature related to having a disaster plan, facility planning principles, institutional and team preparedness, the concept of surge capacity, simulation exercises and advantages and disadvantages of each.Recent findingsEvidence suggests that every institution should have a disaster plan and a dedicated team responsible for updating this plan. The disaster plan must be people-oriented and incorporate different perspectives and opinions so that all stakeholders feel included and can contribute to a joint response. Simulation exercises are fundamental for preparation so that the team functions seamlessly in uncommon times when disaster management transitions from a theoretical plan to one that is executed in real time. Notably, however, there are significantly different realities related to disaster management between countries and even within the same country or region. Unfortunately, key stakeholders such as hospital administration, board of directors and investors often do not believe they have any responsibility related to disaster management planning or response. Additionally, while a disaster plan often exists within an institution, it is frequently not well known or understood by many stakeholders. Communication, simple plans and well defined roles are some of the most important characteristics of a successful response. In extreme circumstances, adapting civilian facilities to manage high-volume warfare-related injuries may be adopted, but the consequences of this approach for routine healthcare within a system can be devastating.SummaryDisaster management requires careful planning with input from multiple stakeholders and a plan that is frequently updated with repeated preparation to ensure the team is ready when a disaster occurs. Close communication as well as clearly defined roles are critical to success when transitioning from preparation to activation and execution of a disaster response.
Monitoring the venous circulation: novel techniques and applications
Authors: Longino August A. , Martin Katharine C. , Douglas Ivor S. 
Published: May 2024

Purpose of review
Venous pressure is an often-unrecognized cause of patient morbidity. However, bedside assessment of PV is challenging. We review the clinical significance of venous pressure measurement, existing techniques, and introduce the Venous Excess Ultrasound (VExUS) Score as a novel approach using doppler ultrasound to assess venous pressure.

Recent findings
Studies show clear associations between elevated venous pressure and adverse outcomes in critically ill patients. Current venous pressure measurement techniques include physical examination, right heart catheterization (RHC), two-dimensional ultrasound, and a variety of labor-intensive research-focused physiological maneuvers. Each of these techniques have specific shortcomings, limiting their clinical utility. To address these gaps, Beaubien-Souligny et al. introduced the VExUS Score, a novel doppler ultrasound-based method that integrates IVC diameter with doppler measurements of the hepatic, portal, and renal veins to generate a venous congestion assesment. Studies show strong correlations between VExUS score and RHC measurements, and well as an association between VExUS score and improvement in cardiorenal acute kidney injury, diuretic response, and fluid status shifts. However, studies in noncardiac populations have been small, heterogenous, and inconclus
ive.

Summary
Early studies evaluating the use of doppler ultrasound to assess venous congestion show promise, but further research is needed in diverse patient populations and clinical settings.
Monitoring CO2 kinetics as a marker of cardiopulmonary efficiency
Authors: Sipmann Fernando Suarez , Giralt Juan Antonio Sanchez , Tusman Gerardo 
Published: May 2024

Purpose of review
To describe current and near future developments and applications of CO2 kinetics in clinical respiratory and cardiovascular monitoring.

Recent findings
In the last years, we have witnessed a renewed interest in CO2 kinetics in relation with a better understanding of volumetric capnography and its derived parameters. This together with technological advances and improved measurement systems have expanded the monitoring potential of CO2 kinetics including breath by breath continuous end-expiratory lung volume and continuous noninvasive cardiac output. Dead space has slowly been gaining relevance in clinical monitoring and prognostic evaluation. Easy to measure dead space surrogates such as the ventilatory ratio have demonstrated a strong prognostic value in patients with acute respiratory failure.

Summary
The kinetics of carbon dioxide describe many relevant physiological processes. The clinical introduction of new ways of assessing respiratory and circulatory efficiency based on advanced analysis of CO2 kinetics are paving the road to a long-desired goal in clinical monitoring of critically ill patients: the integration of respiratory and circulatory monitoring during mechanical ventilation.
Comparison of mannitol and hypertonic saline solution for the treatment of suspected brain herniation during prehospital management of traumatic brain injury patients
Authors: Codorniu Anais , Charbit Emilie , Werner Marie , James Arthur , Hanouz Jean-Luc , Jost Daniel , Severin Armelle , Lang Elodie , Pottecher Julien , Favreau Malory , Weiss Emmanuel , Abback Paer Selim , Moyer Jean-Denis ,   TraumaBase Group
Published: May 2024

Background and importance
Occurrence of mydriasis during the prehospital management of traumatic brain injury (TBI) may suggest severe intracranial hypertension (ICH) subsequent to brain herniation. The initiation of hyperosmolar therapy to reduce ICH and brain herniation is recommended. Whether mannitol or hypertonic saline solution (HSS) should be preferred is unknown.

Objectives
The objective of this study is to assess whether HSS, compared with mannitol, is associated with improved survival in adult trauma patients with TBI and mydriasis.

Design/setting and participants
A retrospective observational cohort study using the French Traumabase national registry to compare the ICU mortality of patients receiving either HSS or mannitol. Patients aged 16 years or older with moderate to severe TBI who presented with mydriasis during prehospital management were included.

Outcome measures and analysis
We performed propensity score matching on a priori selected variables [i.e. age, sex and initial Coma Glasgow Scale (GCS)] with a ratio of 1 : 3 to ensure comparability between the two groups. The primary outcome was ICU mortality. The secondary outcomes were regression of pupillary abnormality during prehospital management, pulsatility index and diastolic velocity on transcranial Doppler within 24 h after TBI, early ICU mortality (within 48 h), ICU and hospital length of stay.

Results
Of 31 579 patients recorded in the registry between 2011 and 2021, 1417 presented with prehospital mydriasis and were included: 1172 (82.7%) received mannitol and 245 (17.3%) received HSS. After propensity score matching, 720 in the mannitol group matched 240 patients in the HSS group. Median age was 41 years [interquartile ranges (IQR) 26–60], 1058 were men (73%) and median GCS was 4 (IQR 3–6). No significant difference was observed in terms of characteristics and prehospital management between the two groups. ICU mortality was lower in the HSS group (45%) than in the mannitol group (54%) after matching [odds ratio (OR) 0.68 (0.5–0.9), P = 0.014]. No differences were identified between the groups in terms of secondary outcomes.

Conclusion
In this propensity-matched observational study, the prehospital osmotherapy with HSS in TBI patients with prehospital mydriasis was associated with a lower ICU mortality compared to osmotherapy with mannitol.
Effectiveness of Nirmatrelvir-Ritonavir for the Prevention of COVID-19–Related Hospitalization and Mortality: A Systematic Literature Review
Authors: Cha-Silva Ashley S. , Gavaghan Meghan B. , Bergroth Tobias , Alexander-Parrish Ronika , Yang Jingyan , Draica Florin , Patel Jaymin , Garner Denise A. , Stanford Richard H. , Meier Genevieve , McLaughlin John M. , Nguyen Jennifer L. 
Published: May 2024

Background:
Nirmatrelvir/ritonavir (NMV/r) is an oral antiviral drug used to treat mild-to-moderate coronavirus disease 2019 (COVID-19) in patients aged 12 years or older at high risk of progression to severe disease (eg, hospitalization and death). Despite being the preferred option for outpatient treatment in the majority of countries worldwide, NMV/r is currently underutilized in real-world clinical practice.

Areas of Uncertainty:
As numerous real-world studies have described patient outcomes following treatment with NMV/r, this systematic literature review provides a comprehensive summary of evidence on NMV/r effectiveness against hospitalization and mortality further organized by clinically meaningful categories, such as acute versus longer-term follow-up, age, underlying health conditions, and vaccination status, to help inform health care decision making.

Data Sources:
We searched Embase and PubMed (December 22, 2021–March 31, 2023) and congress abstracts (December 1, 2021–December 31, 2022) for reports describing NMV/r effectiveness.

Therapeutic Advances:
In total, 18 real-world studies met final selection criteria. The evidence showed that NMV/r significantly reduced postinfection risk of all-cause and COVID-19-related hospitalization and mortality in both acute (≤30 days) (21%–92%) and longer-term (>30 days) (1%–61%) follow-up. The reduction in postinfection risk was higher when treatment was received within 5 days of symptom onset. Real-world effectiveness of NMV/r treatment was observed regardless of age, underlying high-risk conditions, and vaccination status.

Conclusion:
The systematic literature review findings demonstrated the effectiveness of NMV/r against hospitalization and mortality during the Omicron period among individuals at high risk of progression to severe COVID-19 disease.
Sex Differences in Cardiovascular Management: A Call for Better Acknowledgment—Part 1 Pharmacological Differences in Women and Men; How Relevant Are They?
Authors: Ivanescu Andreea-Cristina , Dan Gheorghe-Andrei 
Published: May 2024

Background:
Sex differences (SDs) in pharmacology of cardiovascular (CV) drugs have been described previously; however, paradoxically, there are scarce recommendations in therapy based on these differences. It is of utmost importance to identify whether these SDs determine a modified clinical response and the potential practical implications for this, to provide a base for personalized medicine.

Area of uncertainty:
The aim of this article was to outline the most important pharmacological drivers of cardiovascular drugs that differ between women and men, along with their implications and challenges in clinical practice.

Data sources:
A detailed assessment of English-written resources reflecting SDs impact in CV drug pharmacology was performed using PubMed and Embase databases.

Results:
Despite large variations in CV drug pharmacokinetics and pharmacodynamics in individuals, correcting for height, weight, surface area, and body composition compensate for most “sex-dependent” differences. In addition, individual, cultural, and social factors significantly impact disease management in women versus men. Gender-biased prescribing patterns and gender-dependent adherence to therapy also influence outcomes. The development of sex-specific guidelines requires that they should reflect the SDs implications for the management of a disease and that the evidence should be carefully evaluated as to whether there is an adequate representation of both sexes and whether sex-disaggregated data are reported.

Conclusions:
Pharmacological drivers are under the influence of an impressive number of differences between women and men. However, to establish their significance in clinical practice, an adequate representation of women in studies and the reporting of distinct results is mandatory.
Contribution of Syphilis to Adverse Pregnancy Outcomes in People Living With and Without HIV in South Brazil: 2008 to 2018
Authors: Yang Lanbo Z. , Sundar Kavya G. , Cambou Mary Catherine , Swayze Emma J. , Segura Eddy R. , de Melo Marineide Gonçalves , Santos Breno Riegel , dos Santos Varella Ivana Rosângela , Nielsen-Saines Karin 
Published: May 2024

Background
Syphilis coinfection among pregnant people living with HIV (PLH) may worsen pregnancy outcomes. We evaluated the impact of syphilis coinfection on pregnancies in south Brazil.

Methods
Data were extracted from hospital records between January 1, 2008, and December 31, 2018. Preterm birth (PTB), low birth weight (LBW <2500 g), and a composite adverse infant outcome (AIO: HIV vertical transmission, loss to follow-up before HIV diagnosis, stillbirth, congenital syphilis) were evaluated among pregnancies without HIV and syphilis (PWOH + S), PLH monoinfection, syphilis monoinfection (PLS), and PLH with syphilis (PLH + S).

Results
Among 48,685 deliveries where patients were tested for HIV and syphilis, 1353 (2.8%) occurred in PLH; of these, 181 (13.4%) were HIV/syphilis coinfected (PLH + S). Among PLH, 2.4% of infants acquired HIV and 13.1% were lost to follow-up before HIV diagnosis. Among all PLS, 70.5% of infants acquired congenital syphilis. Across the cohort, 1.2% stillbirths/neonatal deaths occurred. Thirty-seven percent of PLH + S did not initiate antiretroviral therapy versus 15.4% of PLH monoinfection (P < 0.001). Less than half (37.6%) of PLH + S had VDRL titers ≥1:16 compared with 21.7% of PLS only (P < 0.001). Among PLH, syphilis coinfection and unknown/high VDRL titers (≥1:16) increased AIO risk more (adjusted relative risk [aRR], 3.96; 95% confidence interval [CI], 3.33–4.70) compared with low VDRL titers (≤1:8; aRR, 3.51; 95% CI, 2.90–4.25). Unsuppressed viremia (≥50 copies/mL) was associated with risk of PTB (aRR, 1.43; 95% CI, 1.07–1.92) and AIO (aRR, 1.38; 95% CI, 1.11–1.70) but not LBW. Lack of prenatal care was significant in predicting PTB and LBW in all PLH and PLS monoinfection.

Conclusions
Syphilis coinfection worsens AIOs in all women and compounds negative effects of HIV infection during pregnancy. Effective syphilis treatment and HIV viral load suppression are paramount for optimal obstetric care.
Undermining the Translational Potential of Clinical Research With Adolescents and Young Adults: Differential Enrollment in Randomized Clinical Trials During COVID-19
Authors: Perin Jamie , Anders Jennifer , Barfield Ashle , Gaydos Charlotte , Rothman Richard , Matson Pamela A. , Huettner Steven , Toppins Jacquelyn , Trent Maria 
Published: May 2024

Background
COVID-19 stay-at-home orders and research restrictions halted recruitment and follow-up of clinical research patients. Although clinical research has resumed, it is an open question whether research participation has returned to levels similar to those before COVID-19.

Methods
We used data from the TECH-PN (NCT No. NCT03828994) study, a single-center randomized controlled trial enrolling 13- to 25-year-olds with mild-moderate pelvic inflammatory disease (PID) receiving ambulatory care. We examined enrollment patterns before COVID-19 and during/after COVID-19 among those assessed for eligibility by estimating the average rate of recruitment visits for each period. We focused on this monthly rate by pandemic status, the length of stay (LOS) by pandemic status, as well as the relationship between the LOS and patient demographics. Descriptive analyses were conducted, including Student t test to compare rates between time periods and a χ
2 test to compare the proportion refusing enrollment.

Results
The monthly enrollment rate during/after the pandemic was significantly lower than before COVID-19 (4.8 per month compared with 7.4 per month, P < 0.001). However, eligible participants' age, race, and insurance type were similar before and during/after the pandemic. Among eligible patients, LOS for receiving PID care was slightly increased, from a median of 5.4 to 6.4 hours (P = 0.650), and the rate of refusal to participate among those eligible was similar (23% vs. 27%, P = 0.362). There were a similar number of ineligible patients because of inpatient admissions during both periods.

Conclusion
COVID-19 pandemic restrictions negatively impacted recruitment into this randomized controlled trial. Enrollment differences may reflect ongoing perceptions of restrictions in care access or a hesitancy to use health services. More research is needed to stabilize access to ambulatory sexually transmitted infection/PID care and access to clinical trials.