bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Profile of Acute Methotrexate Toxicity in Rheumatic Diseases: A Series of 15 Cases
Authors: Mruthyunjaya Prakashini , Maikap Debashis , Bhuyan Biswajit , Ahmed Sakir , Misra Ramnath , Tripathy Ratikanta , Padhan Prasanta 
Published: March 2024

Background: Methotrexate (MTX) at a dose of ≤25 mg/week is one of the most prescribed disease-modifying anti-rheumatic drugs (DMARDs) in a variety of rheumatic diseases. It can potentially cause life-threatening neutropenic sepsis, and acute renal and hepatotoxicity when taken inadvertently at high doses. We aim to analyse the clinical profile and risk factors of patients who presented with acute MTX toxicity. Methods: All patients presenting to the Rheumatology department with a history of inadvertent consumption of higher doses of MTX (>25 mg/week), from July 2021 to May 2023 were included. Additional data was extracted from hospital electronic medical health records. The clinical profile, risk factors, and outcome of patients with MTX toxicity were analysed. Results: The median age of the patients in our cohort was 52 IQR (40–62.5) years, with 80% females. The median cumulative dose of MTX was 120 mg (IQR 95–150). The reason for overdose in our cohort was medication error in comprehending once-weekly dosing. The most common major adverse event was neutropenia (80%). All our patients had stomatitis, with half of them having oral bleeding. Gastrointestinal adverse events like vomiting and diarrhoea were seen in 60% and 13% of the patients, respectively. Our cohort had two patients who succumbed to the complications due to neutropenic sepsis. The dose of MTX did not correlate with the severity of the disease or duration of hospital stay; however, the latter was significantly influenced by lower absolute neutrophil count (ANC). Conclusion: Acute MTX toxicity is one of the severe rheumatological emergencies and the toxicity profile includes haematological, gastrointestinal, hepatic, and renal adverse events. Severe neutropenia leading to sepsis can be fatal if not intervened early.
Prevention of Atherosclerotic Cardiovascular Disease in Rheumatoid Arthritis: Persistent Low-grade In-flammation May be an Impediment Needing Attention
Authors: Malaviya Anand N. , Bondge Babita , Prasad Shiv 
Published: March 2024

Objective: To determine the status of ‘residual inflammatory risk’ (RIR) and ‘residual cholesterol risk’ (RCR) in patients with Rheumatoid Arthritis (RA) in remission with the aim of estimating their atheroscle-rotic cardiovascular disease (ASCVD) risk. Methods: The study included patients with RA in remission during their last two clinic visits on treatment with disease- mod-ifying anti-rheumatic drugs (DMARDs). Using the QRISK-3 calculator, participants were stratified into four risk categories for ASCVD: ‘Very high’, ‘High’, ‘Moderate’, and ‘Low’. Patients were prescribed lipid-lowering drugs targeting low-density lipoprotein cholesterol (LDL-C) levels to <50 mg/dl, <70 mg/dl, <100 mg/dl or <130 mg/dl, respectively. Those with a history of ASCVD before or during the follow-up period was excluded from the study. Multimorbidity were also recorded in all the patients. Results: The study included 130 patients with RA in remission. The results showed that despite being in remission and taking treatment for lipid control, 81 (62%) and 91 (70%) patients still had ‘RIR’ and ‘RCR’, respectively. Hypertension, hypothyroidism, type-2 diabetes mellitus and obesity were the common multimorbidity. Conclusions: Persistent RIR in 62% of patients despite being in remission, could possibly be due to the current ‘liberal’ definition of RA permitting hs-CRP level up to <10 mg/l, which is five-fold higher than the recommended <2 mg/l for ASCVD prevention. Hence it may be necessary to revise the definition of ‘remission’ in RA factoring in the suggested lower level of hs-CRP. Additionally, rheumatologists might need to be more vigilant in lipid management with appropriate patient education regarding RCR.
Translation and Validation of Tamil Version of Fatigue Severity Scale (FSS) in Individuals with Rheumatoid Arthritis
Authors: Dhanish J , Kanthanathan Subbiah , Rajeswari S. , Aseer P. Antony Leo 
Published: March 2024

Background: Fatigue has a significant negative impact on individuals with Rheumatoid Arthritis (RA). Fatigue Severity Scale (FSS) is the most widely used tool to assess fatigue severity which is a common problem in RA. Availability of FSS in local vernacular language could add more value and the study aims to construct the Tamil version of the FSS and validate it among patients with RA. Methodology: The study was conducted in 2 phases. In phase I, the English version of FSS was translated into Tamil by following the Linguistic Guidelines by mapi eprovide. In Phase II – Validation of Tamil version of FSS was carried out in 50 patients of RA by establishing; Test-retest reliability, Internal consistency, Content validity; and Convergent validity in comparison with HAQ-DI and SF-12 Results: The initial testing between Tamil FSS with English version revealed an intraclass correlation coefficient (ICC) (0.821) and α(0.902). The content validity was established by Cohen’ kappa agreement k which is >80% with a significance <0.004, which shows Good substantial agreement between raters. FSS showed strong positive correlation with HAQ-DI (>0.0005) and negative correlation with SF-12 (>0.0005). The scale demonstrated excellent internal consistency ( α = 0.972) and test-retest reliability (ICC = 0.93). Conclusions: The validated Tamil version demonstrated excellent content validity as well as good internal consistency and test-retest reliability, would be a useful instrument for clinical practice and research. It can be recommended for the assessment of Fatigue severity among Tamil-speaking population with RA.
The acceptability, practicality, implementation and efficacy of a physical and social activity intervention ‘BreatheHappy’ for people with long-term respiratory conditions: A feasibility study
Authors: Lewis A , Turner LA , Fryer S , Smith R , Dillarstone H , Patrick YW , Bevan-Smith E 
Published: March 2024

Objectives This study aimed to determine the feasibility of a group-based pilot programme of low-to-moderate physical activity training, education and social activities, by investigating acceptability, practicality, implementation and efficacy testing. We offer suggestions on programme adaptions for future study. Methods People with a range of chronic respiratory diseases were invited to participate in a pilot 12 week group activity programme. Activities included outdoor walking, tai-chi, education and a range of social activities. Acceptability was determined by participant experiences determined during interviews. Practicality was determined by programme and outcome measure completion, cost and adverse events. Implementation was determined according to whether the programme ran as planned. Efficacy was determined by statistical analyses of outcomes including hand grip strength, timed up and go test, COPD Helplessness Index, COPD Assessment Test, and measures of physical activity via accelerometry. Results Thematic analysis indicated that the “BreatheHappy” programme was acceptable. Seven of nine participants completed eight out of 10 sessions and the majority completed all outcome measures. “BreatheHappy” was therefore considered practical. The programme was not implemented as planned, with only 10 sessions running rather than the 12 intended. There was a significant increase in daily step counts (MD: 1284 95% CI: 240-2329 p: 0.024 effect size: 0.988), stepping time (MD: 16 min 95% CI: 5-27 min p: 0.011 effect size: 1.36) and daily minutes completing light physical activity (MD: 23 95% CI: 6-38 p: 0.006 effect size: 1.6). However, time spent sitting for ≥30 min but ≤60 min significantly increased (MD: 26 95% CI: 0.2-52 min p: 0.049 effect size: 0.931), showing signs of efficacy and changing physical activity behaviour patterns. Discussion A 10-week programme of low-moderate physical activity training, education and social activities shows signs of feasibility for future research. Suggested adaptions for future study include using physical activity measures such as daily step count or light physical activity for a primary outcome, and mental health and social health related outcome measures relatable to participant's beneficial experiences of the programme. Recruitment in future studies will try and reach both those less socially active and possibly those who have completed pulmonary rehabilitation (PR). Venues should be close to efficient transport links whilst different frequencies and durations of programme delivery should be trialled. Adequate funding should be provided for both staff running the programme and blinded research staff for outcome measurement.
Outcomes of standard EVAR for juxtarenal abdominal aortic aneurysm in patients unsuitable for fenestrated EVAR and open repair
Authors: Wang Mingshan , Liu Zhen , Cai Huoying , Wang Jinsong , Zhou Yu , Hu Zuojun 
Published: March 2024

Objective To evaluate the long-term outcomes of standard endovascular aneurysm repair (S-EVAR) of juxtarenal abdominal aortic aneurysms (JAAAs). Methods Data of patients with JAAAs who were unsuitable for fenestrated endovascular aneurysm repair (F-EVAR) and open repair (OR) and underwent treatment from January 2015 to December 2021 were retrospectively reviewed. Computed tomography angiography and ultrasonography of the aorta were performed before discharge, at 6 and 12 months postoperatively, and annually thereafter. The main outcome measures were mortality, type Ia endoleaks, and reintervention. Results A total of 62 patients (mean age, 72.1 ± 7.3 years) underwent S-EVAR. The mean aneurysm length and diameter and the proximal neck length and diameter were 110.4 ± 30.9 mm, 57.2 ± 15.9 mm, 8.09 ± 0.97 mm, and 26.05 ± 0.49 mm, respectively. The mean suprarenal and infrarenal aortic angles were 162.9 ± 26° and 144.1 ± 31°, respectively. The mean follow-up duration was 40.6 ± 23.4 months and the 5-year survival rate was 62.2%. Six (9.8%) patients experienced type Ia endoleaks, of whom three underwent endovascular repair at 12, 18, and 24 months, one underwent conversion to OR for AAA rupture at 7 days and died, two had minor endoleaks and were kept under observation, and one declined reintervention at 36 months. The 5-year freedom from reintervention rate was 84.4%. The aneurysm diameter shrank in 50 cases (81%), remained stable in 5 cases (8%), and increased in 7 cases (11.3%). A suprarenal aortic angle <114° was associated with type Ia endoleak ( p = .005). Conclusions In patients unsuitable for F-EVAR and OR and with a suprarenal aortic angle >114°, the use of S-EVAR for JAAAs can be considered safe and effective. In this study, early and long-term postoperative outcomes demonstrated that S-EVAR achieved satisfactory results in the prevention of aneurysm rupture and associated mortality.
Maternal mortality and COVID-19: A nationwide ecological analysis from Ecuador
Authors: Ortiz-Prado Esteban , Izquierdo-Condoy Juan S , Fernández-Naranjo Raúl , Vásconez-González Jorge , Izquierdo-Condoy Nathaly , Checa-Jaramillo Diana , Yanchapaxi-Silva Pablo , Asmal-Iturralde Tatiana , Dávila Rosero María Gabriela , Carrington Sarah J , Sanchez-SanMiguel Hugo 
Published: March 2024

Background: During the COVID-19 pandemic, distinct population subsets, including pregnant women, have been differentially affected. While over 90% of COVID-19-infected pregnant women experience a benign course, a subset demonstrates marked clinical exacerbation. Symptomatic pregnant individuals, in particular, present a heightened risk of severe disease in comparison to their non-pregnant counterparts. Objective: The objective of this study is to systematically evaluate the epidemiological characteristics of COVID-19 in pregnant women, assess related maternal mortalities, ascertain the case fatality rate, and delineate associated risk factors. Design: This is a comprehensive population-based ecological study. Methodology: A population-based study was conducted to investigate the epidemiological patterns of COVID-19-associated morbidity and mortality in pregnant women in Ecuador from 27 February 2020 to 14 May 2021. Results: A total of 3274 positive COVID-19 cases were identified among pregnant women, with 22 official fatalities, yielding a case fatality rate of 0.67%. The majority of cases were of Mestizo ethnicity (92.66%); however, the highest case fatality rate was noted among indigenous pregnant women (case fatality rate = 1.25%), those aged between 40 and 44 years (case fatality rate = 2.68%), and those with a history of comorbidities (2.08%). Pregnant women residing at lower altitudes (<2500 m) exhibited a higher incidence rate (0.20/100,000) compared to those at higher altitudes (>2500 m), which stood at 0.17/100,000. Conclusion: The COVID-19 pandemic has profoundly impacted pregnant women in Ecuador during the first 14 months, particularly those with comorbidities, older age, and of indigenous ethnicity. These factors have heightened their vulnerability and susceptibility to severe COVID-19 infection and subsequent mortality. This underscores the urgency for comprehensive protective measures, including prioritization for vaccination. Further studies are needed to inform tailored prevention strategies and therapeutic interventions for these high-risk groups.
“For men, by men”: Menstrual victimization and the weaponization of period products in carceral settings
Authors: Tapp Kathryn , Henson Abigail 
Published: March 2024

Background: The literature on menstruation defines period poverty as the inability to access sufficient period products, education, and sanitary facilities needed to manage menstruation healthily and effectively. While research has identified shortcomings of healthcare in the carceral setting, period poverty behind bars has remained largely absent from criminal legal discourse. Objectives: The current study examines the interplay of period poverty and carceral control to introduce the novel concept of menstrual victimization, defined as the physical, emotional, and financial victimization that results from period poverty perpetuated through carceral control. Methods: The study uses qualitative content analysis to systematically gather and code journalistic accounts pertaining to the menstrual experiences of incarcerated and previously incarcerated females, criminal justice practitioners, and journalists. The analysis uses literary pieces ( n = 99), which were coded deductively and guided by concepts related to structural violence and radical feminist criminology. Results: The findings shed light on the unique structural harms incarcerated menstruators face and reveal the dearth of needed empirical research on period poverty in carceral spaces. The narratives in the sample revealed how manufactured scarcity of period products within carceral spaces is used as a means of oppression by institutional agents. The emergent themes highlight how the intersection of period poverty and carceral control led to menstrual victimization characterized through shame, humiliation, control, and coercion. Conclusion: Potential outcomes associated with understanding menstrual victimization in the carceral setting are discussed, including reducing menstrual stigma, disseminating health education, minimizing health disparities, and ultimately, shifting modes of holding accountability away from oppressive, retributive, and controlling tactics.
Annexin A2 antibodies in post-treatment Lyme disease
Authors: Miller John B. , Rebman Alison W. , de Flores Marcia Daniela Villegas , Wang Hong , Darrah Erika , Aucott John N. 
Published: March 2024

Background: Anti-annexin A2 (AA2) antibodies have been described in Lyme arthritis and erythema migrans, although they have not been described in post-treatment Lyme disease (PTLD). Objectives: Determine whether anti-AA2 antibodies are present among patients with PTLD and determine the clinical relevance of these antibodies. Design and methods: Anti-AA2 levels were tested serially in a longitudinal cohort of 44 patients with acute Lyme disease, 22 with a return to health (EM RTH), and 22 with PTLD. Anti-AA2 antibodies were also assessed in a cross-sectional group of 281 patients with PTLD. Results: Anti-AA2 antibodies were highest after antimicrobial therapy in both the EM RTH and PTLD cohorts. By 6 months, there was no difference between EM RTH and healthy controls. Anti-AA2 antibodies were higher in the cross-sectional PTLD group (79.69 versus 48.22 units, p < 0.0001), though with no difference in total symptom burden. Conclusion: Anti-AA2 persists in PTLD, though did not identify a clinical phenotype.
Integrated Care Model by the Village Health Volunteers to Prevent and Slow down Progression of Chronic Kidney Disease in a Rural Community, Thailand
Authors: Theeranut Ampornpan , Methakanjanasak Nonglak , Lertsinudom Sunee , Surit Pattama , Panyaek Nichanun , Leeladapattarakul Saisamon , Nilpetch Peangtikumporn , Kessomboon Pattapong , Chalermwat Chalongchai , Rintara Watcharapong , Khongtong Wudipong , Paktipat Pawich , Banchonhattakit Pannee , Chunlertrith Darunee , Sharma Amod , Cha’on Ubon , Anutrakulchai Sirirat 
Published: March 2024

Introduction: Chronic kidney disease (CKD) is a major health problem in Thailand and health behaviors are central to its risk and progression. Because of the shortage of healthcare personnel, village health volunteers (VHVs) have been collaborating in the primary health care system. However, the contribution of VHVs to CKD reduction has not been evaluated yet. This study aimed to evaluate the efficacy of the VHV-integrated model in preventing and slowing down CKD and its risk factors. Methods: The population-based cohort study was conducted in a rural community of Thailand between 2017 and 2019. Baseline clinical and behavioral characteristics including CKD, diabetes, hypertension, and other high-risk factors of the participants were collected. The integrated care model was initiated by the multidisciplinary care team that facilitated, empowered, and trained VHVs targeting risk factors of CKD, health literacy, and health promotion. Then the participants were educated and trained for lifestyle modification and were monitored continuously for 18 months by VHVs. Changes in the CKD risk factors, and kidney functions before and after the application of integrated care model were compared. Results: A total of 831 subjects participated in the study with an average age of 57.5 years, and 69.5% were female. Among them, 222 participants (26.7%) were diagnosed as having CKD, the vast majority (95%) of which were in the early stages (G1-G3 and A1-A2). CKD risk factors such as high salt intake, smoking, alcohol consumption, self-NSAID (non-steroidal anti-inflammatory drugs) use were significantly decreased after application of the care model. Also, hemoglobin A1c was significantly reduced in diabetic patients, and blood pressure was controlled better than before in the hypertensive patients. Most importantly, a decline of estimated glomerular filtration rate of the CKD group was improved and lower than the non-CKD group. Conclusion: The integrated care model through VHV significantly attenuated the risk factors associated with CKD in the general and high-risk population and effectively slowed down the progression of CKD.
Analysis of the Moderating Roles of Human and Physical Capital on the Impact of Foreign Aid on Economic Growth in Nigeria
Authors: Ehigiamusoe Kizito Uyi , Ramakrishnan Suresh , Babalola Sikiru Jimoh , Samsurijan Mohamad Shaharudin , Rahmat Siti Rahyla 
Published: March 2024

Though the impact of foreign aid on economic growth has been examined in several studies, the roles of human and physical capital in aid-growth nexus has not been investigated. This is important because the effectiveness of foreign aid could be contingent upon the absorption capacity of the recipient country. We fill this research gap by examining the moderating roles of human and physical capital on aid-growth nexus in Nigeria during 1980 to 2020. Our study deploys the Autoregressive Distributed Lag approach on the interaction models. It shows that the variables are cointegrated. Though aid has a positive impact on growth, human and physical capital have significant moderating roles on the impact of aid on growth. Precisely, the marginal effect of aid on growth varies with the levels of human and physical capital. However, if human and physical capital surpass the threshold levels of 55% and 65%, respectively, an increase in aid cannot accelerate growth. These findings are robust to alternative proxies, structural breaks as well as diagnostic tests. This research implies that, given the requisite levels of human and physical capital, foreign aid can complement domestic capital to enhance growth. Hence, for nations to obtain the long-term benefits of aid, they should create the enabling environment by adequately investing in human and physical capital to attain sustainable economic development. JEL Classification: O47; F35; E22; J24
Posterior Ankle Impingement: It’s Not Only About the Os Trigonum
Authors: Mansur Nacime Salomao Barbachan , Femino John E. , Chinnakkannu Karthikeyan , Fayed Aly , Glass Natalie , Phisitkul Phinit , Amendola Annunziato 
Published: March 2024

Background: Os trigonum and Stieda process are common etiologies for posterior ankle impingement syndrome (PAIS), and diagnosis is typically made by radiographs, computed tomographic, or magnetic resonance imaging. However, these static tests may not detect associated soft tissue and bony pathologies. Posterior ankle and hindfoot arthroscopy (PAHA) is dynamic, providing at least ×8 magnification with full anatomical visualization. The primary aim of this study was to report the prevalence of associated conditions seen with trigonal impingement treated with PAHA. Methods: In this retrospective comparative study, patients who underwent PAHA for PAIS due to trigonal impingement, from January 2011 to September 2016, were reviewed. Concomitant open posterior procedures and other indications for PAHA were excluded. Demographic data were collected with pre- and postoperative diagnosis, arthroscopic findings, type of impingement, location, associated procedures, and anatomical etiologies. Trigonal impingements were divided in os trigonal or Stieda and subgrouped as isolated, with flexor hallucis longus (FHL) disorders, with FHL plus other impingement, and with other impingement lesions. Results: A total of 111 ankles were studied—74 os trigonum and 37 Stieda. Isolated trigonal disorders accounted for 15.3% of PAIS (n = 17). Cases having associated conditions had a mode of 3 additional pathologies. FHL disorders were found in 69.4%, subtalar impingement in 32.4%, posteromedial ankle synovitis in 25.2%, posterolateral ankle synovitis in 22.5%, and posterior inferior tibiofibular ligament impingement in 19.8% of cases. Associated pathologies were observed in 58.6% of cases when FHL was not considered. Significant differences were noted comparing os and Stieda (isolated: 20.3% to 5.4%, P = .040; FHL plus others: 35.1% to 59.5%, P = .015). Conclusion: Trigonal bone (os trigonum or Stieda) was found to cause impingement in isolation in a small proportion of cases even when the FHL was considered part of the same disease spectrum. This should alert surgeons when considering removing trigonal impingement. Open approaches may limit the visualization and assessment of associated posterior ankle and subtalar pathoanatomy, thus possibly overlooking concomitant causes of PAIS. Level of Evidence: Level III, retrospective comparative study.