bluuebunny/crossref_metadata_2025_split huggingface dataset:
Magnitude of diabetic retinopathy and its associated factors among patients with type 2 diabetes on follow up at diabetes clinic of Asella Referral and Teaching Hospital, Asella, Ethiopia: a cross-sectional study
Authors: Bedada Kidist Tadesse , Tolla Koricho Simie , Regesu Ashenafi Habtamu , Abore Kibruyisfaw Weldeab , Chinkey Fraol Daba , Tekle Natnael Fikadu , Gebre Rekik Teshale , Tilahun Robel Bayou , Tilahun Rediet Atnafu , Sinshaw Sofonyas Silesh , Lechebo Tsion Andrias , Alemneh Zekarias Tadele 
Published: April 2024

Abstract

Background
Diabetic retinopathy is a microvascular complication of diabetes mellitus that is among the leading causes of irreversible blindness worldwide. There is a growing concern about diabetic retinopathy in Ethiopia associated with the increasing prevalence of diabetes. Limited studies have been conducted in Ethiopia that evaluated the magnitude of diabetic retinopathy and its associated factors among patients with type 2 diabetes. Thus, we aimed to assess the magnitude of diabetic retinopathy and its associated factors among patients with type 2 diabetes on follow-up at the diabetic clinic of Asella Referral and Teaching Hospital.
Methodology:
An institution-based cross-sectional study involving 428 patients with type 2 diabetes was conducted at the diabetic clinic of Asella Referral and Teaching Hospital. Participants were selected using a systematic random sampling technique. A descriptive analysis was performed to determine the prevalence of diabetic retinopathy. Bivariate binary logistic regression and multivariable logistic regression were conducted to determine factors associated with diabetic retinopathy, at α = 0.05 using adjusted odds ratio with 95% confidence interval.
Result
Of the 428 participants, 53 (12.4%) had diabetic retinopathy (95% CI: 9.4, 15.9). Dyslipidemia (AOR = 2.538, 95% CI: 1.190, 5.412), poor medication adherence (AOR = 3.706, 95% CI: 1.730, 7.940), presence of other complications of diabetes (AOR = 2.537, 95% CI: 1.10, 5.850) were factors associated with diabetic retinopathy. Furthermore, those who exercise regularly (AOR = 0.048, 95% CI: 0.004, 0.565) had lower odds of having retinopathy than their counterpart.
Conclusion
The prevalence of diabetic retinopathy in this study is lower than previous studies. Dyslipidemia, regular exercise, medication adherence, and the presence of other diabetic complications were factors significantly associated with diabetic retinopathy. Health education is recommended to promote exercise self-care and diabetes medication adherence. Early screening for other comorbidities and diabetes complications is also recommended.
Unveiling the Diagnostic and Prognostic potential of BMP Pathway and Hypoxia-inducible Factors in Glioblastoma Multiforme
Authors: Yazdani Behnaz , Sichani Adel Rezvani 
Published: April 2024

Abstract
Objective
Glioblastoma Multiforme (GBM) is a devastating neoplastic growth affecting the brain, with a dismal prognosis. The underlying diagnostic and prognostic potential hypoxia-inducible-factors and BMP pathway in this devastating malignancy remains poorly understood, lacking compelling preventive strategies.
Methods and materials:
A bioinformatic study was conducted using integrative bioinformatics techniques for the analysis of GBM count data, which were obtained from the Cancer Genome Atlas (TCGA) database and underwent normalization and differential expression analysis (DEG). Gene Set Enrichment Analysis (GSEA), Differential gene expression analysis, and correlation analysis using Pearson method were conducted for the genes involved in the BMP pathway. Gene Ontology and Protein-protein interaction analyses were employed. Survival analysis and Receiver Operating test (ROC) were also performed to identify potential prognostic and diagnostic biomarkers.
Results
The results revealed that the expression levels of EPAS1, HIF3A, CHRDL1, NOG, BMP6, and AHSG genes did not exhibit a statistically significant difference between GBM cancer samples and normal tissue samples. Further DEG analysis indicated that the majority of genes from the BMP pathogenesis were significantly downregulated in GBM cancer samples and a positive correlation was observed between the expression levels of EPAS1, BMPR2, and MAPK1 genes. the Top DEGs were correlated with specific pathways, such as the TGF-beta signaling pathway, pathways in cancer, and the cell cycle. By ROC test we identified the best diagnostic biomarkers for GBM and SMURF1 gene is predicted to have significant prognostic capability.
Conclusion
These findings highlight the possible utility of these genes as promising diagnostic and prognostic biomarkers for the early detection of GBM.
Sustained effect of prasinezumab on Parkinson’s disease motor progression in the open-label extension of the PASADENA trial
Authors: Pagano Gennaro , Monnet Annabelle , Reyes Adriana , Ribba Benjamin , Svoboda Hanno , Kustermann Thomas , Simuni Tanya , Postuma Ronald , Pavese Nicola , Stocchi Fabrizio , Brockmann Kathrin , Smigorski Krzysztof , Gerbaldo Valentina , Fontoura Paulo , Doody Rachelle , Kerchner Geoffrey , Brundin Patrik , Marek Kenneth , Bonni Azad , Nikolcheva Tania 
Published: April 2024

Abstract

The PASADENA study is an ongoing Phase II, multicenter, randomized, double-blind, placebo-controlled trial evaluating the safety and efficacy of intravenous prasinezumab, administered every 4 weeks, in early-stage Parkinson’s disease (PD). During the double-blind study period, prasinezumab-treated individuals showed less progression of motor signs (Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale [MDS-UPDRS] Part III). We evaluated here whether the effect of prasinezumab on motor progression, assessed as change in MDS-UPDRS Part III in OFF- and ON-state, and MDS-UPDRS Part II scores was sustained over 4 years from the start of the trial. We compared participants enrolled in the PASADENA open-label extension (OLE) to an external comparator arm derived from the Parkinson's Progression Markers Initiative (PPMI) observational study. Both PASADENA delayed- (n = 94) and early-start (n = 177) groups showed a slower decline (less increase in score) on MDS-UPDRS Part III in OFF- (-51% for the delayed-start group and − 65% for the early-start group) and ON-state (-94% for the delayed-start group and − 118% for the early-start group), and on MDS-UPDRS Part II (-48% for the delayed-start group and − 40% for the early-start group), compared with the PPMI external comparator (n = 303). This exploratory analysis, which requires confirmation in future studies, suggests that the effect of prasinezumab in slowing motor progression in PD may be sustained long-term.
Recommendations for topical antimicrobial therapy of inflammatory diseases of the middle ear based on the results of evidence-based clinical study
Authors: Ovchinnikov A. Yu. , Miroshnichenko N. A. , Nikolaeva Yu. O. 
Published: April 2024

Introduction. In conditions of widespread resistance of pathogens to traditional antimicrobial drugs, active attention is paid to the development of topical antimicrobial drugs for the effective treatment of inflammatory pathology of the middle ear.Aim. To study the efficacy and safety of a new dosage form of the drug Dioxydin® (2.5 mg/ml ear drops) in the treatment of patients with acute purulent otitis media and exacerbation of chronic purulent otitis media in comparison with ear drops containing 0.3% ciprofloxacin solution.Materials and methods. A multicenter randomized comparative clinical trial included adults with acute purulent otitis media or exacerbation of chronic purulent otitis media and during 6 face-to-face visits (days 1st, 3rd, 6th, 9th, as well as a therapy completion visit and a follow-up visit), the effect of drugs was evaluated according to examination, otoscopy, microbiological and audiometric examinations. Safety was assessed by the frequency of adverse events and the results of blood, urine tests and vital signs.Results. The achievement of the primary criteria was evaluated among 164 participants randomized into 2 groups: the proportion of patients with no indications for systemic antibacterial therapy at Visit 2 and with no ear pain at Visit 4, Dioxydin® ear drops had no less effectiveness than the comparison drug (64.6 and 89.9% versus 68.3 and 87.3%, respectively). In terms of the frequency of elimination of the pathogen and improvement of air conduction, the compared drugs also had no statistically significant differences, and according to some secondary criteria, Dioxydin® significantly exceeded 0.3% ciprofloxacin solution (the proportion of patients with a pronounced decrease in pain and congestion in the ear, as well as hyperemia of the eardrum). According to the safety criteria, the compared drugs had no significant differences.Conclusions. The results of the study confirmed the high efficacy and safety of Dioxydin® ear drops in the treatment of otitis media in adults.
Generalized Anxiety Disorder among Paediatricians During the COVID-19 Pandemic
Authors: Aziz Shaffaq , Shabir Sadia , Noor Misbah , Samaa Asvar , Aslam Samia , Hamid Muhammad Haroon 
Published: April 2024

Background: COVID-19 pandemic has put healthcare professionals at risk of developing mental health issues. Primarily, because of their increased chances of being affected and fulfilling their job commitments despite insufficient knowledge about the new disease and its management. Hence, it is essential to assess the burden of such mental health issues amongst healthcare providers.
Objective: To determine the frequency and severity of generalized anxiety disorder among paediatricians during the COVID-19 pandemic.
Methods: Cross-sectional observational study conducted in Department of Paediatrics (unit 1), King Edward Medical University/ Mayo Hospital Lahore, duration of 03 months. After IRB approval, an online survey form was developed based on GAD-7 Scale as an assessment tool for assessing anxiety among paediatricians. A survey form was dispersed using social media to pediatricians of different ages and working statuses. The responses were recorded and assessed using SPPSS. Quantitative variables (age, GAD-score) were summarised as mean and standard deviation. Qualitative variables (gender, place of work, individual GAD- component score) were summarised as frequency and percentages.
Results: A total of 147 responses were received, out of which 13 were excluded. The remaining 134 were analysed through SPSS 26. Out of these, 106 (79.1%) turned out to be suffering from new-onset anxiety. Amongst these 106 paediatricians, 69 (65.1%) were females, and 37(35.9%) were males (p-value 0.013). The severity of anxiety was mild, moderate and severe in 62 (46.3%), 37 (27.6%) and 7 (5.2%) of paediatricians, respectively.
Conclusion: More than three-fourths of paediatricians had higher GAD 7 scores during the COVID-19 pandemic suggesting generalized anxiety disorder.
Remote Exercise Training Intervention During the COVID-19 Pandemic: Randomized Controlled Trial
Authors: Philippi Keito F A , Zeier Peter , Brahmer Alexandra , Neuberger Elmo W I , Sandner Magdalena , Hagenah Matthias , Porten Thilo , Lenz Regina , Ochmann David T , Wedekink Florian , Wischhusen Jörg , Lutz Beat , Lieb Klaus , Wessa Michèle , Simon Perikles 
Published: April 2024

Background
Societal measures to contain the spread of COVID-19 (eg, lockdown and contact restrictions) have been associated with decreased health and well-being. A multitude of prepandemic studies identified the beneficial effects of physical exercise on both physical and mental health.

Objective
We report on the feasibility of a remote physical exercise intervention and its stress-buffering potential in 2 untrained cohorts: a pre–COVID-19 cohort that completed the intervention in 2019 and a lockdown cohort that started the intervention shortly before pandemic-related restrictions were implemented.

Methods
In a randomized controlled trial, participants were assigned to either an intervention group (IG; pre–COVID-19 cohort: n=7 and lockdown cohort: n=9) or a control group (CG; pre–COVID-19 cohort: n=6 and lockdown cohort: n=6). IG participants received weekly individualized training recommendations delivered via web-based support. The intervention period was initially planned for 8 weeks, which was adhered to in the pre–COVID-19 cohort (mean 8.3, SD 0.5 weeks) but was extended to an average of 17.7 (SD 2.0) weeks in the lockdown cohort. Participants’ health parameters were assessed before and after the intervention: aerobic capacity was measured as peak oxygen uptake (VO2peak) via cardiopulmonary exercise testing. Depressive symptoms were scored via the depression subscale of the Brief Symptom Inventory-18.

Results
Dropout rates were low in both cohorts in the IG (pre–COVID-19 cohort: n=0, 0% and lockdown cohort: n=2, 16.7%) and the CG (pre–COVID-19 cohort: n=0, 0% and lockdown cohort: n=2, 20%). The mean adherence to the training sessions of the IG for both cohorts was 84% (pre–COVID-19 cohort: SD 5.5% and lockdown cohort: SD 11.6%). Aligned rank transform ANOVAs in the lockdown cohort indicated deterioration of VO2peak and depressive symptoms from before to after the intervention in the CG but no longitudinal changes in the IG. Analyses in the pre–COVID-19 cohort revealed significant increases in VO2peak for the IG compared to the CG (P=.04) but no intervention effects on depressive symptoms.

Conclusions
With low dropout rates and high adherence, the remote intervention was feasible for healthy adults under regular conditions and in the face of pandemic-related stressors. Moreover, our results hint at a stress-buffering effect as well as a buffering of a lockdown-induced deconditioning of remote physical exercise interventions in the pandemic scenario, which can be used in future studies to overcome equally stressful periods of life. However, due to limited statistical power, these findings should be replicated in similar scenarios.

Trial Registration
German Clinical Trials Register DRKS00018078; https://drks.de/search/en/trial/DRKS00018078
An Empirical Evaluation of Prompting Strategies for Large Language Models in Zero-Shot Clinical Natural Language Processing: Algorithm Development and Validation Study
Authors: Sivarajkumar Sonish , Kelley Mark , Samolyk-Mazzanti Alyssa , Visweswaran Shyam , Wang Yanshan 
Published: April 2024

Background
Large language models (LLMs) have shown remarkable capabilities in natural language processing (NLP), especially in domains where labeled data are scarce or expensive, such as the clinical domain. However, to unlock the clinical knowledge hidden in these LLMs, we need to design effective prompts that can guide them to perform specific clinical NLP tasks without any task-specific training data. This is known as in-context learning, which is an art and science that requires understanding the strengths and weaknesses of different LLMs and prompt engineering approaches.

Objective
The objective of this study is to assess the effectiveness of various prompt engineering techniques, including 2 newly introduced types—heuristic and ensemble prompts, for zero-shot and few-shot clinical information extraction using pretrained language models.

Methods
This comprehensive experimental study evaluated different prompt types (simple prefix, simple cloze, chain of thought, anticipatory, heuristic, and ensemble) across 5 clinical NLP tasks: clinical sense disambiguation, biomedical evidence extraction, coreference resolution, medication status extraction, and medication attribute extraction. The performance of these prompts was assessed using 3 state-of-the-art language models: GPT-3.5 (OpenAI), Gemini (Google), and LLaMA-2 (Meta). The study contrasted zero-shot with few-shot prompting and explored the effectiveness of ensemble approaches.

Results
The study revealed that task-specific prompt tailoring is vital for the high performance of LLMs for zero-shot clinical NLP. In clinical sense disambiguation, GPT-3.5 achieved an accuracy of 0.96 with heuristic prompts and 0.94 in biomedical evidence extraction. Heuristic prompts, alongside chain of thought prompts, were highly effective across tasks. Few-shot prompting improved performance in complex scenarios, and ensemble approaches capitalized on multiple prompt strengths. GPT-3.5 consistently outperformed Gemini and LLaMA-2 across tasks and prompt types.

Conclusions
This study provides a rigorous evaluation of prompt engineering methodologies and introduces innovative techniques for clinical information extraction, demonstrating the potential of in-context learning in the clinical domain. These findings offer clear guidelines for future prompt-based clinical NLP research, facilitating engagement by non-NLP experts in clinical NLP advancements. To the best of our knowledge, this is one of the first works on the empirical evaluation of different prompt engineering approaches for clinical NLP in this era of generative artificial intelligence, and we hope that it will inspire and inform future research in this area.
Alarm Management in Intensive Care: Qualitative Triangulation Study
Authors: Mosch Lina , Sümer Meltem , Flint Anne Rike , Feufel Markus , Balzer Felix , Mörike Frauke , Poncette Akira-Sebastian 
Published: April 2024

Background
The high number of unnecessary alarms in intensive care settings leads to alarm fatigue among staff and threatens patient safety. To develop and implement effective and sustainable solutions for alarm management in intensive care units (ICUs), an understanding of staff interactions with the patient monitoring system and alarm management practices is essential.

Objective
This study investigated the interaction of nurses and physicians with the patient monitoring system, their perceptions of alarm management, and smart alarm management solutions.

Methods
This explorative qualitative study with an ethnographic, multimethods approach was conducted in an ICU of a German university hospital. Using triangulation in data collection, 102 hours of field observations, 12 semistructured interviews with ICU staff members, and the results of a participatory task were analyzed. The data analysis followed an inductive, grounded theory approach.

Results
Nurses and physicians reported interacting with the continuous vital sign monitoring system for most of their work time and tasks. There were no established standards for alarm management; instead, nurses and physicians stated that alarms were addressed through ad hoc reactions, a practice they viewed as problematic. Staff members’ perceptions of intelligent alarm management varied, but they highlighted the importance of understandable and traceable suggestions to increase trust and cognitive ease.

Conclusions
Staff members’ interactions with the omnipresent patient monitoring system and its alarms are essential parts of ICU workflows and clinical decision-making. Alarm management standards and workflows have been shown to be deficient. Our observations, as well as staff feedback, suggest that changes are warranted. Solutions for alarm management should be designed and implemented with users, workflows, and real-world data at the core.
The role of endoscopic ultrasound in assessment of physiological cardia insufficiency during diagnosis of hiatal hernia
Authors: Shevchenko B.F. , Babii O.M. , Prolom N.V. , Titova M.V. , Tarabarov S.O. , Ushchina S.V. 
Published: April 2024

Background. The aim of the study: to determine the role of endoscopic ultrasound (EUS) in assessing the failure of the physiological cardia in the diagnosis of hiatal hernias (HH). Materials and methods. At the Department of Digestive Surgery of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” in 2023, we have performed surgical treatment of 33 patients with HH: axial HH were diagnosed in 21 (63.6 %) cases (I type), paraesophageal HH — in 12 (36.4 %) patients (II type) (ICD-10 code is K44). Control group included 20 practically healthy people. Results. All patients underwent an X-ray and endoscopic examination of the esophagus, stomach, duodenum, and EUS. All 33 (100.0 %) patients underwent an X-ray to confirm the diagnosis and an endoscopic examination to detect changes in the esophageal mucosa. EUS was performed in 31 (93.9 %) patients. The thickness of the esophageal wall was assessed using EUS, which made it possible to determine the state of the structures of the phy­siological cardia in HH: the displacement of part of the stomach above the diaphragm, location of the gastroesophageal junction relative to the legs of the diaphragm and relative to each other; the distance between the legs of the diaphragm (area of the HH) and their length; the cross-sectional area of the HH (hernial sac). The data obtained during EUS influenced the choice of the method for surgical correction of the physiological cardia with HH. Conclusions. Thus, with HH, EUS makes it possible to evaluate pathological changes of the main structures in the failure of the physiological cardia, to improve diagnosis for the types of HH, the location of the gastroesophageal junction, with determination of dimensions of the esophageal hiatus, the distance between the legs of the physiological cardia, localization and cross-section of the hernial sac, which influenced the choice of the surgery for physiological cardia in HH.
MENKES DISEASE: A LITERATURE REVIEW AND CLINICAL CASE
Authors: Tokarchuk N. , Chekotun T. , Starynets L. , Antonets V. , Stanislavchuk L. 
Published: April 2024

Menkes Kinky Hair Disease (MKHD) is characterized by an abnormality in copper metabolism caused by a mutation in the ATP7A gene, which is located on Xq13.3 and has 23 exons. In addition, this gene encodes 1500 amino acids and is expressed in large quantities in various organs. It’s worth mentioning that about 357 diff erent mutations have been identifi ed in the ATP7A gene. It is a relatively rare disease with an incidence of 1 case per 100,000 to 250,000 live births. MKHD is an X-linked recessive trait that almost exclusively aff ects boys.The diagnosis of this rare disease is based on the genetic- molecular study of a metabolic disease panel, including the ATP7A gene and the biochemical phenotype (a decrease in serum copper and ceruloplasmin levels).In developing therapeutic strategies for individuals with Menkes disease, three fundamental problems are being addressed: 1) unlocking the absorption of copper in the intestine; 2) making copper available to enzymes in cells that require it as a cofactor; and 3) identifying infants with Menkes disease and initiating treatment at a very early stage of life, before irreversible neurodegeneration occurs. This article presents a clinical case of Menkes disease in a 7-month-old boy. The diagnosis was confi rmed by molecular genetic testing (NGS) of the Neurometabolic Disorders Panel, which included the ATP7A gene and biochemical phenotype. The described case illustrates the complexity of diagnosing Menkes disease in the neonatal period due to the non-specifi city of disease symptoms (lethargy, weak sucking, weight loss, etc.) and the importance of biochemical and molecular genetic methods of fetal investigation in subsequent pregnancies or in a newborn sibling for early diagnosis and treatment. This case will be published with the consent of the mother in accordance with bioethical principles.