bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identificación de trabajadores especialmente sensibles en el ámbito sanitario mediante un cuestionario de salud laboral
Authors: Sol Vidiella Josep , Pelechano-Valcarcel Sonia , Lapeira-Figueres Carme , Verdera-Benedicto Susana 
Published: February 2025

Objetivo: Facilitar la identificación de trabajadores/as especialmente sensibles (TES) frente a riesgos laborales y la priorización de los exámenes de salud iniciales y periódicos de trabajadores de centros sanitarios.
Método: Estudio transversal realizado en profesionales sanitarios/as de once equipos de atención primaria y un centro hospitalario de la Gerència de Terres de l’Ebre del Institut Català de la Salut. Se utilizó un cuestionario de salud laboral que incluía variables que definían las vulnerabilidades de los/as TES, junto con una analítica básica con serologías adaptadas a los riesgos del ámbito sanitario. En una primera fase dicha metodología se aplicó a trabajadores de nueva incorporación durante el periodo pandémico 2020-2022, y posteriormente, en una segunda fase se amplió a la totalidad de los/as TES registrados en el periodo 2013-2023.
Resultados: Se identificaron 10 TES en la primera fase y 598 TES en la segunda. El grupo de vulnerabilidad asociada más frecuente fue el embarazo/lactancia materna (n=271; 45,3%), seguido de osteomuscular (n=145; 24,3%), las alergias (n=55; 9,2%), salud mental (n=38; 6,4%), inmunológicas (n=33; 5,5%), otras vulnerabilidades (n=32; 5,4%) y discapacidades sensoriales (n=24; 4,0%). En las dos fases de nuestro estudio el 100% de las variables definitorias de TES podían identificarse a través de este método.
Conclusiones: La implementación de un cuestionario de salud laboral, complementado con una analítica y serologías es una herramienta útil para facilitar la identificación inicial de TES, priorizar los exámenes de salud de los TES de nueva incorporación y mejorar el seguimiento laboral del resto de trabajadores.
The role of a caregiver of a patient with venous leg ulcers in recurrence prevention: a case study
Authors: Karafová Anna , Siemieniecka Agnieszka , Karafa Marian 
Published: February 2025

Objective: Venous leg ulcer (VLU) is a common complication which significantly reduces the patient's quality of life. Despite many effective treatment methods, such as compression therapy, which allow the wound to heal in a short time, it is important to maintain the long-term effects of the therapy. We present the case of a 67-year-old male patient with a trophic ulcer of his left leg. Method: The patient was treated with inelastic multicomponent compression bandages applied every day under Kikuhime pressure-measuring device (HPM-KH-01; TT Meditrade, Denmark) control and advised to wear a compression stocking. Results: The patient's wound closed within eight weeks. After five months, the patient returned to our clinic with a one-month-old wound due to non-adherence with medical recommendations. Conclusion: Key roles in recurrence prevention seem to be played not only by the patient's motivation and perseverance, but, more importantly, by the approach of the therapist. Health professionals should focus not only on one-time closure of the patient's wound, but on cooperation with the patient's family and caregivers, and instructing them on how to look after the patient on a daily basis, including with help to put on compression garments and with motivation to move and exercise. In many cases, with unaccompanied patients, rapid VLU recurrence is observed.
The efficacy and safety of acids as topical antimicrobial agents: a review
Authors: Nagoba Basavraj S , Rayate Abhijit S , Gavkare Ajay M , Rao Arunkumar 
Published: February 2025

Objective: Infected wounds, refractory to conventional therapy, are a major burden on the healthcare system. Available data show that many commonly used antiseptic agents may be toxic to the cells involved in the healing process and may affect the normal tissue repair. The topical use of different acids to control wound infections effectively and promote healing is well known. The present review aims to summarise the safety and efficacy of various acids as topical agents for treating wound infections. Method: A literature search was performed in PubMed and manually from other sources (cross references and journal sites). Results: We reviewed 116 articles, from which data from 86 relevant articles were analysed. The studies showed that various organic acids were clinically effective in treating wound infections. Conclusion: This study found that various organic acids can act as a substitute for antiseptics to control wound infections refractory to conventional antibiotic therapy and local wound care. Various organic acids differ in efficacy, safety and limitations as topical agents to control wound infections and promote healing. Some acids deliver better results than others, particularly in those cases in which antibiotics and routine antiseptic agents yield little lasting success, especially in controlling hospital strains with multiple antibiotic resistance. Among topically used acids, citric acid and acetic acid are associated with better results.
Relationship of opioid tolerance to patient and wound factors, and wound micro-environment in patients with open wounds
Authors: Bae Jaewon , Campbell Amy , Hein Maria , Hillis Stephen L , Grice Elizabeth , Rakel Barbara A , Gardner Sue E 
Published: February 2025

Objective: Opioid tolerance is a criterion for opioid use disorder, which is currently an epidemic in the US. Individuals with open wounds are frequently administered opioids; however, the phenomenon of opioid tolerance has not been examined in the context of wounds. The purpose of this exploratory study was to compare patient/wound factors, wound microbiome and inflammatory mediators between individuals who were opioid-tolerant versus those who were not opioid-tolerant. Method: Patients with acute open wounds were enrolled in this cross-sectional study. All study data were collected before and during a one-time study dressing change. Results: The study included a total of 385 participants. Opioid-tolerant participants were significantly younger (p<0.0001); had higher levels of depression (p=0.0055) and anxiety (p=0.0118); had higher pain catastrophising scores (p=0.0035); reported higher resting wound pain (p<0.0001); had a higher number of wounds of <30 days' duration (p=0.0486); and had wounds with lower bacterial richness (p=0.0152) than participants who were not opioid-tolerant. A backward elimination logistic regression model showed that four predictors—resting wound pain, age, bacterial richness and depression—were the most important variables in predicting opioid-tolerance status. Conclusion: These findings provide the first insights into the phenomenon of opioid tolerance in the context of open wounds. This study provides findings from which to guide hypothesis-driven research in the future.
Pressure injury detection using alternate light: a proof-of-concept study
Authors: Scafide Katherine N , Arundel Linda , Assas Ghadeer , King Erica L 
Published: February 2025

Objective: Identification of early-stage pressure injuries (PIs) during visual skin assessment may be subjective and unreliable. An alternate light source (ALS) has been shown to increase the probability of detecting evidence of bruises on individuals with darker skin tones. Bruises and early-stage PIs are often difficult to identify, especially in those with darker skin tones, where melanin concentration is high. Given the effect skin pigmentation has on detecting both types of cutaneous injuries, this proof-of-concept study aimed to describe the characteristics of Stage 1 PIs and deep tissue PIs as viewed under an ALS. Method: Eligible participants were first examined by a certified wound ostomy continence nurse using environmentally available white light. A blinded second examiner then evaluated the size of the potential tissue impairment using violet (406nm) and blue (448nm) ALS viewed through yellow and orange goggles, respectively. Portable ultrasound was used to confirm tissue involvement. Data were summarised using descriptive statistics. Results: The study included 10 participants (40% of whom were from minority racial/ethnic groups) with a mean Braden Scale score of 11.1. The majority of PIs (80%) involved deep tissue and were located on lower extremities (60%). The median PI size was larger by 17.5cm2 and 13.7cm2, respectively, using ALS compared with white light when viewed under violet and blue wavelengths. Ultrasound data were limited to non-extremity regions (n=3 participants) with hypoechoic areas noted as being 10–13mm in thickness and up to 16.7mm deep. Conclusion: Evidence of tissue damage that extended beyond that visualised under white light was noted with ALS. Usefulness of ultrasound was limited over bony prominences where there was too little subcutaneous tissue. Further research is warranted to investigate the potential application of ALS for the early detection of PIs.
LONG-TERM CONSEQUENCES OF TOTAL ANKLE ARTHROPLASTY VERSUS ANKLE FUSION: A 25-YEAR NATIONAL POPULATION STUDY OF 41,000 PATIENTS
Authors: Hennessy Conor , Abram Simon , Loizou Con , Brown Rick , Sharp Bob , Kendal Adrian 
Published: February 2025

IntroductionDefinitive treatment for ankle arthritis is either Total Ankle Replacement (TAR) or Ankle Fusion (AF). AF may pre-dispose to hindfoot fusion resulting in a debilitatingly rigid ankle-hindfoot complex. In comparison, TAR may protect against adjacent joint disease but is associated with high revision rates. We do not know the life-time risks of further surgery, adjacent joint disease progression and rare but serious complications of TAR versus AF.MethodsAn England population cohort study was performed using the ONS mortality linked Hospital Episode Statistics database (1998–2023). The primary outcome was Kaplan-Meier curve analysis of revision surgery free survival of TAR versus AF. Secondary outcome measures were the rates of any re-operation to the ankle/hindfoot, including hindfoot fusion rate, 90-day complications, and peri-operative mortality.Results10,335 TAR and 30,704 AF were analysed. The revision rate of TAR was significantly higher than AF at all time points, including 5 years (6.7% vs 2.1%), 10 years (11.1% vs 2.9%) and 20 years (13.1% vs 3.1%).There was no significant difference in 20-year risk of hindfoot fusion following AF (5.94%, 95% CI 5.15 to 6.8%) versus TAR (4.80%, 95% CI 3.4% to 6.6%).TAR was associated with higher risks of intra-operative fracture (0.42% vs 0.10%, RR = 4.35) and re-operation for wound infection (0.26% vs 0.15%, RR 1.74) but fewer pulmonary emboli (0.23% vs 0.58%, RR = 0.40).28.9% of TAR resulted in a further operation; 60% of which were for exploration/debridement, infection, aspiration and/or revision.ConclusionsBoth TAR and AF are safe definitive treatments of ankle arthritis with low peri-operative risk. The risk of subsequent hindfoot fusion after AF is very low and not significantly higher than after TAR. England TAR revision rates are lower than reported globally with many smaller operations performed before the more complex revision surgery.
SUPRAMALLEOLAR OSTEOTOMY FOR ANKLE ARTHRITIS: SINGLE TERTIARY REFERRAL CENTRE. A 12-YEAR OVERVIEW COMPARING STANDARD AND CUSTOM IMPLANTS
Authors: Ali Seyed Ashgar , Mubark Islam , Weerasinghe Konara 
Published: February 2025

The aim was to demonstrate that Supramalleolar osteotomy is a valuable treatment method in eccentric ankle arthritis in young and middle aged since it is an under-utilised procedure. We retrospectively analysed the outcome of it performed over 12 year period. We also compared the results of recently introduced computer-assisted PSI Integrated custom-made implants with standard implants.Data was analysed from 48 patients over a period of 12 years of which 40 were by standard implant and 8 by computer assisted custom implant. 31 varus, 18 valgus deformity. The mean age was 57 (26–79 y/o), male:female ratio was 27:19. Mean follow-up was 15.25 months for standard implants; For the computer-assisted procedures the follow up range is 24 to 2 months. TAS, TTS and TT angels were measured pre and post-operatively. Fixation using a plate with/without bone graft or custom-made implant was performed by a single surgeon. MOXFQ and AOFAS questionnaires were completed pre and post-operatively. All followed similar rehabilitation programme.Average radiological healing time was 24.3 weeks. MOXFQ score improved from 55.17 to 25.11 and AOFAS from 20.16 to 56.21. Complications were 2 non-unions, 1 delayed union, 1 stress fracture. 8 patients require fusion/replacement between 3–5 years.The PSI Integrated computer-assisted technique gave improved accuracy than standard freehand method with better scores and a smoother approach for the surgeon. Early results with this technique are encouraging as we were able achieve 3 dimentional correction compared to the 2 dimentional correction achieved by the freehand method.Our results are comparable to similar studies. Being a joint preserving technique, Supra Malleolar Osteotomy should be considered either as an interim or definitive procedure especially with the development of computer assisted technologies which makes the technique easier to reproduce.
A NATIONAL SURVEY OF BOFAS MEMBERS ON THE TREATMENT OF PRIMARY OSTEOCHONDRAL DEFECTS OF THE TALUS
Authors: Khan Murtaza , Ankers Thomas , Mangwani Jitendra , Makwana Nilesh 
Published: February 2025

IntroductionOsteochondral defects (OCDs) of the talus were identified as a “TOP 10” research priority in foot and ankle surgery by the James Lund Alliance in partnership with BOFAS, BOA and NIHR. To develop a research strategy, the views of BOFAS members regarding OCDs of the talus were surveyed. The results are reported here.MethodsA questionnaire concerning the presentation, investigation and management of OCDs was formulated with input from the BOFAS National Clinical Study Group and ratified by the Scientific Committee. It concerned primary OCDs of the talus that had failed non-surgical management. It was distributed to BOFAS members via email using _Microsoft Forms_.ResultsThere were 90 responses. Data on presenting symptoms, investigations, initial management and decision making was collected. Surgical treatment was grouped according to defect size: small or large and shallow or deep. This gave 4 categories. For the purposes of the study a large defect had a width >15mm and a deep defect had a depth >5mm. For small, shallow lesions 85 respondents chose microfracture as the first line surgical treatment. For large shallow lesions 59 respondents chose microfracture, 18 chose bone marrow stimulation plus scaffold e.g. AMIC or ACIC and 6 chose bone marrow stimulation plus a biological agent e.g. cBMA or PRP. For small deep lesions microfracture was again most popular (69 respondents). For large deep lesions microfracture was chosen by 43 respondents, AMIC/ACIC by 23 and OATs by 7. Further data was collected on post op rehabilitation.DiscussionThe study demonstrates that microfracture is the most popular first line treatment for primary OCDs of the talus of any size. That said, a wide range of treatments are in practice. This information will facilitate the development of high-quality studies to identify the most appropriate evidence-based treatment for OCDs of the talus.
A pragmatic pipeline for drug resistance and lineage identification in Mycobacterium tuberculosis using whole genome sequencing
Authors: Elton Linzy , Aydin Alp , Stoker Neil , Rofael Sylvia , Wildner Letícia Muraro , Abdul Jabar Babatunde Pacome Agbo Achimi , Tembo John , Hamid Muzamil Abdel , Claujens Chastel Mfoutou Mapanguy , Canseco Julio Ortiz , Doyle Ronan , Satta Giovanni , O’Grady Justin , Witney Adam , Ntoumi Francine , Zumla Alimuddin , McHugh Timothy D. 
Published: February 2025

Delays in accurate diagnosis of drug resistant tuberculosis (DR-TB) can hinder treatment. Whole genome sequencing (WGS) provides more information than standard molecular and phenotypic testing, but commonly used platforms are expensive to implement, and data interpretation requires significant expertise. We aimed to optimise a TB WGS diagnostic pipeline balancing user-friendliness, cost-effectiveness and time to results, whilst ensuring accuracy. Growth conditions, DNA extraction protocols and Oxford Nanopore Technologies (ONT) library preparation kits were compared. ONT was compared with Illumina protocols. Software for basecalling and analysis were evaluated to find the most accurate resistance SNP and lineage predictor. Optimally, a spin-column CTAB DNA extraction method was combined with the RBK110.96 library preparation kit, high accuracy (HAC) basecalling and data analysis using TB-Profiler. Compared with Illumina, the pipeline was concordant for 16/17 (94%) isolates (lineage) and for 17/17 (100%) isolates (resistance SNPs). Our pipeline was 71% (12/17) concordant with phenotypic drug susceptibility test (DST) results. Time-to-diagnosis was around four weeks. This optimised TB sequencing pipeline requires less time and expertise to run and analyse than Illumina, takes less time than phenotypic DSTs and the results are comparable with Illumina. The cost per sample is comparable with other methods. These features make it an important tool for incorporating into routine DR-TB diagnostic pipelines and larger scale drug resistance surveillance in all settings.
Peripheral extremity surgery performed during the Syrian conflict – A scoping review
Authors: Khan Anas , Ammar Usman , Abbara Aula , Hariri Mahmoud , Darwish Ammar , Alawa Jude 
Published: February 2025

The protracted Syrian conflict has devastated healthcare infrastructure across Syria with impacts on both the conflict and non-conflict related surgical needs of patients. This review summarises the literature related to peripheral limb surgery performed in Syria between March 2011 to January 2024 to determine the influence of the conflict on surgical capacity and provision. A systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines was performed using six academic and one grey literature database. Studies that included clinical-epidemiological descriptions of procedures in orthopaedic, vascular and plastic surgery were included for quantitative and narrative analysis. The search resulted in 3951 papers, of which 7 met inclusion criteria. Studies varied widely in sample size (range: 25–3835; total: 7749), design, and outcomes. Procedures spanned orthopaedic (1285, 31%), vascular (741, 18%), and plastic surgery (2145, 51%), totalling 4171 cases. Common procedures included wound management (51%), external fixation (26%), and lower limb amputation (15%). There was prevalence of emergency over elective surgery, performed in rudimentary, secret field hospitals by practitioners lacking formal specialist training or aid-workers. Inadequate documentation and incomplete data capture, due to the conflict, hindered the availability of high-quality, comprehensive surgical datasets within Syria. The focus on emergency surgery is a natural consequence of the prioritisation required with conflict-related pathology, however poor resource availability resulted in challenges in providing basic surgical care. Further research is needed to address gaps in evidence regarding the current state of surgery, training needs, and the quality of care provided.
Investigating the impact of Premolis semirufa caterpillar bristle toxins on human chondrocyte activation and inflammation
Authors: de Lima Cinthya Lais , Pohl Paula C. , Villas-Boas Isadora M. , Pidde Giselle , Tambourgi Denise V. 
Published: February 2025

Background
The caterpillar of Premolis semirufa, known as Pararama, is found in the Brazilian Amazon, primarily on rubber trees of the genus Hevea. Pararamosis is an inflammatory disease resulting from accidental contact with the caterpillar’s bristles, leading to acute and chronic symptoms. Chronic exposure can cause significant osteoarticular deformities, similar to those seen in osteoarthritis and rheumatoid arthritis, due to cartilage degradation and synovial inflammation. Currently, there are no specific treatments for Pararamosis, and research on the molecular mechanisms of the caterpillar’s venom and its role in disease pathogenesis is limited. The chronic changes in Pararamosis are thought to be linked to chondrocyte activation and the NF-κB signaling pathway, influenced by the toxic components in the bristles. Understanding these interactions is crucial for developing preventive measures and therapeutic strategies, especially for rubber tappers at risk in the Amazon region.

Methodology/principal findings
This study investigated the effects of P. semirufa bristle extracts on human chondrocytes, focusing on the activation mechanism of the NF-κB transcription factor and the expression of osteoarthritis markers. Cell viability tests indicated that the extracts did not significantly affect chondrocyte survival. However, supernatant analysis revealed a time- and dose-dependent increase in IL-6 and IL-8 levels. Additionally, the expression of NF-κB and its inhibitor, IκB, was assessed, showing higher levels of phosphorylated IκB, which induces its proteosomal degradation, compared to the negative control, while native IκB expression was greater in the control group. Furthermore, the gene expression profile of treated chondrocytes demonstrated modulation in matrix metalloproteinases (MMPs), aggrecan (ACAN), collagen type II (COL2A1), interleukins (IL6 and IL8), and complement system molecules.

Conclusions/significance
These findings highlight the significant impact of P. semirufa bristle extracts on human chondrocyte activation and the inflammatory processes associated with pararamosis.