bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sub-lethal concentration of a colloidal nanosilver formulation (Silversol®) triggers dysregulation of iron homeostasis and nitrogen metabolism in multidrug resistant Pseudomonas aeruginosa
Authors: Gajera Gemini , Thakkar Nidhi , Godse Chhaya , DeSouza Anselm , Mehta Dilip , Kothari Vijay 
Published: October 2023

Abstract
Background
Pseudomonas aeruginosa is a notorious pathogen. Its multidrug resistant strains are listed among priority pathogens against whom discovery of novel antibacterial agents and, elucidation of new anti-pathogenicity mechanisms are urgently warranted. This study describes multiple antibacterial effects of a colloidal nano-silver formulation- Silversol® against a multi-drug resistant strain of P. aeruginosa.

Results
Minimum inhibitory concentration (MIC) of Silversol® against P. aeruginosa was found to be 1.5 ppm; and at sub-MIC of 1 ppm, it was able to alter quorum-sensing regulated pigmentation (pyocanin 82%↓; pyoverdine 48%↑), exopolysaccharide synthesis (76%↑) and biofilm formation, susceptibility to antibiotics (streptomycin and augmentin), protein synthesis and export (65%↑), nitrogen metabolism (37%↑ nitrite accumulation), and siderophore production in this pathogen. Network analysis of the differentially expressed genes in the transcriptome of the silversol-treated bacterium identified ten genes as the potential molecular targets: norB, norD, nirS, nirF, nirM, nirQ, nosZ, nosY, narK1, and norE (all associated with nitrogen metabolism or denitrification). Three of them (norB, narK1, and norE) were also validated through RT-PCR.

Conclusions
Generation of nitrosative stress and disturbance of iron homeostasis were found to be the major mechanisms associated with anti-Pseudomonas activity of Silversol®.
What is important to the GP in recognizing acute appendicitis in children: a delphi study
Authors: Blok Guus C.G.H. , Berger Marjolein Y. , Ahmeti Arjan B. , Holtman Gea A. 
Published: October 2023

Abstract
Background
For diagnostic research on appendicitis in registration data, insight is needed in the way GPs generate medical records. We aimed to reach a consensus on the features that GPs consider important in the consultation and medical records when evaluating a child with suspected appendicitis.

Methods
We performed a three-round Delphi study among Dutch GPs selected by purposive sampling. An initial feature list was created based on a literature search and features in the relevant Dutch guideline. Finally, using a vignette describing a child who needed later reassessment, we asked participants to complete an online questionnaire about which consultation features should be addressed and recorded.

Results
A literature review and Dutch guideline yielded 95 consultation features. All three rounds were completed by 22 GPs, with the final consensus list containing 26 symptoms, 29 physical assessments and signs, 2 additional tests, and 8 further actions (including safety-netting, i.e., informing the patient about when to contact the GP again). Of these, participants reached consensus that 37 should be actively addressed and that 20 need to be recorded if findings are negative.

Conclusions
GPs agreed that negative findings do not need to be recorded for most features and that records should include the prognostic and safety-netting advice given. The results have implications in three main domains: for research, that negative findings are likely to be missing; for medicolegal purposes, that documentation cannot be expected to be complete; and for clinical practice, that safety-netting advice should be given and documented.
Computer-assisted evaluation of small airway disease in CT scans of Iran-Iraq war victims of chemical warfare by a locally developed software: comparison between different quantitative methods
Authors: Baradaran Mahdavi Mohammad Mehdi , Rafati Mehravar , Ghanei Mostafa , Arabfard Masoud 
Published: October 2023

Abstract
Objective
Diagnosis of small airway disease on computed tomography (CT) scans is challenging in patients with a history of chemical warfare exposure. We developed a software package based on different methodologies to identify and quantify small airway disease in CT images. The primary aim was to identify the best automatic methodology for detecting small airway disease in CT scans of Iran-Iraq War victims of chemical warfare.

Methods
This retrospective case–control study enrolled 46 patients with a history of chemical warfare exposure and 27 controls with inspiratory/expiratory (I/E) CT scans and spirometry tests. Image data were automatically segmented, and inspiratory images were registered into the expiratory images' frame using the locally developed software. Parametric response mapping (PRM) and air trapping index (ATI) mapping were performed on the CT images. Conventional QCT methods, including expiratory/inspiratory mean lung attenuation (E/I MLA) ratio, normal density E/I (ND E/I) MLA ratio, attenuation volume Index (AVI), %low attenuation areas (LAA) < -856 in exhale scans, and %LAA < -950 in inhale scans were also computed. QCT measurements were correlated with spirometry results and compared across the two study groups.

Results
The correlation analysis showed a significant negative relationship between three air trapping (AT) measurements (PRM, ATI, and %LAAExp < -856) and spirometry parameters (Fev1, Fvc, Fev1/Fvc, and MMEF). Moreover, %LAAExp < -856 had the highest significant negative correlation with Fev1/Fvc (r = -0.643, P-value < 0.001). Three AT measurements demonstrated a significant difference between the study groups. The E/I ratio was also significantly different between the two groups (P-value < 0.001). Binary logistic regression models showed PRMFsad, %LAAExp < -856, and ATI as significant and strong predictors of the study outcome. Optimal cut-points for PRMFsad = 19%, %LAAExp < -856 = 23%, and ATI = 27% were identified to classify the participants into two groups with high accuracy.

Conclusion
QCT methods, including PRM, ATI, and %LAAExp < -856 can greatly advance the identification and quantification of SAD in chemical warfare victims. The results should be verified in well-designed prospective studies involving a large population.
Spatial distribution and determinants of tetanus toxoid immunization among pregnant women in Ethiopia using data from Ethiopian demographic and health survey 2016
Authors: Fentie Beletech , Alemu Tewodros Getaneh , Techane Masresha Asmare , Wubneh Chalachew Adugna , Assimamaw Nega Tezera , Belay Getaneh Mulualem , Tamir Tadesse Tarik , Muhye Addis Bilal , Kassie Destaye Guadie , Wondim Amare , Terefe Bewuketu , Tarekegn Bethelihem Tigabu , Ali Mohammed Seid , Gonete Almaz Tefera , Tekeba Berhan , Kassa Selam Fisiha , Desta Bogale Kassahun , Ayele Amare Demsie , Dessie Melkamu Tilahun , Atalell Kendalem Asmare 
Published: October 2023

Abstract
Introduction
Tetanus is a major public health problem caused by clostridium tetani. Although it is vaccine-preventable, the case fatality rate among neonates in areas with poor immunization coverage and limited access to clean deliveries reaches 80-100%. Vaccination of pregnant mothers with the tetanus toxoid (TT) vaccine is the most effective way to protect against neonatal tetanus. This study aimed to examine the spatial distribution and determinants of tetanus toxoid immunization among pregnant mothers using the 2016 EDHS data.

Method
Secondary analysis of the Ethiopia Demographic and Health Survey 2016 was done to assess the spatial distribution and determinants of tetanus toxoid vaccine among pregnant women in Ethiopia. Spatial autocorrelation analysis and hot spot analysis were used to detect spatial dependency and spatial clustering of the tetanus toxoid vaccine in Ethiopia. Spatial interpolation was used to predict the tetanus toxoid vaccine coverage in unsampled areas. The multilevel binary logistic regression model was fitted to identify factors associated with tetanus toxoid vaccination. An adjusted odds ratio with 95% CI was calculated and used as the measure of association and a p-value less than 0.05 were considered statistically significant.

Result
From the total of 7043 pregnant women, 42.4% of them have taken at least two doses of tetanus toxoid immunization. Spatial clustering of TT immunization was observed in the Northern, Southwestern and Southwestern parts of Ethiopia. Whereas, low TT coverage was observed in the Eastern and Western parts of the country. Increased ANC visits and the richest economic status favored TT immunization, whereas living in Addis Ababa and Dire Dewa cities decreased the TT immunization coverage.

Conclusion
The finding of this study reveals that TT immunization had spatial dependency, with the highest immunization coverage observed in the Northern, Southwestern and Southeastern parts of the Country. Thus, geographically targeted interventions should be implemented particularly in the eastern and western parts of the country.
Corneal topographic indices of scheimpflug camera in type 2 diabetic and non-diabetic elderly populations
Authors: Hashemi Alireza , Khabazkhoob Mehdi , Narooei Foroozan , Mortazavi Abolghasem , Hashemi Hassan 
Published: October 2023

Abstract
Purpose
The present study was conducted to determine the corneal topographic indices of Scheimpflug camera in type 2 diabetes patients without diabetic retinopathy (DR), DR and non-diabetic elderly populations.

Methods
A total of 1105 participants were selected using random cluster sampling from Tehran, Iran and categorized into three groups including type 2 diabetes patients without diabetic retinopathy (DR), DR and non-diabetic. The diabetic group had HbA1c levels ≥ 6.4% with no other systemic problems. The non-diabetic participants had normal eye findings and no systemic diseases. The pachymetric progression index (PPI) values were measured using the Pentacam AXL.

Results
A total of 1105 participants including 429 diabetes patients (38.46% male) and 676 non-diabetic (38.76% male) subjects entered the study. Only PPIavg and PPImax were higher in the diabetics versus non-diabetics (P = 0.019 and 0.010, respectively). There was a significant difference in PPImax between the three groups (P = 0.036). There were significant differences only in index of vertical asymmetry (IVA), central keratoconus index (CKI), PPI average, and PPI max between different stages of diabetic retinopathy (DR) (P = 0.045, 0.005, 0.002, and 0.004, respectively). There was a significant difference in index of Surface Variance (ISV), index of vertical asymmetry (IVA), PPIavg, and PPImax between diabetes patients with and without DR (P = 0.016, 0.022, < 0.001, and < 0.001, respectively).

Conclusion
According to the results, diabetes and DR change several topographic indices. In addition, the HbA1c level may affect pachymetric progression index max. Therefore, special attention should be paid to these patients for different treatment strategies.
Patient, clinician, and performance-based measures provide different information about clinical symptoms in patients with severe knee osteoarthritis presenting with depressive symptoms: a cross-sectional study
Authors: Pérez-Maletzki José , Domínguez-Navarro Fernando , Roig-Casasús Sergio , Díaz-Díaz Beatriz , Querol-Giner Felipe , García-Gomáriz Carmen , Blasco José-María 
Published: October 2023

Abstract
Background and purpose
Clinical status of subjects with knee osteoarthritis (KOA) is influenced by a complex interaction of several biopsychosocial factors. The use of patient-reported measures (PROM) is considered the gold standard for their evaluation. However, considering that 1 in 5 subjects with KOA present with depressive symptoms, it is necessary to analyse how this psychological domain may influence the subjective perception of PROM. The objective was to study the impact that depressive symptoms have on functional outcome assessments, according to the degree of objectivity of diverse outcome measures.

Methods
Cross-sectional study. Subjects with severe KOA, verified with clinical and radiological symptoms, were assessed with patient-reported (Oxford Knee Score), clinician-reported (knee range of motion), and performance-based (Timed up and go test) measures. The existence of depressive symptoms was assessed with the Yesavage scale, and participants were classified for having no-, mild- or severe-symptoms. Linear correlations (r) and one-way analysis of variance compared groups (95% CI).

Results
244 participants were analysed, of which 75 (30.7%) had depressive symptoms. These symptoms had an inverse moderate association with Oxford Knee Score (r = -0.387). However, the correlation with the Timed up and go test was low (r = 0.176), while there was no correlation with knee ROM (r = -0.087).

Conclusions
This study supports that patient-reported questionnaires may offer biased information on the clinical status of patients with severe knee osteoarthritis who present with depressive symptoms. Consideration of such symptoms may be critical to ensure data collected to accurately reflect patients’ capacities and perceptions.
The relationship between spiritual intelligence and self-management in patients with diabetes type 1
Authors: Rafiei Sima , Souri Saber , Nejatifar Zahra , Amerzadeh Mohammad 
Published: October 2023

Abstract
Background
Diabetes is widely recognized as one of the most pressing public health concerns globally. To manage blood glucose levels and reduce subsequent complications and mortality rates, self-management mechanisms have been found to be effective in controlling diabetes. This study aimed to investigate the association between spiritual intelligence and diabetes self-management in patients with type 1 diabetes in Qazvin, Iran.

Methods
This cross-sectional study included 220 adults with type 1 diabetes aged 18–35 years who referred to an outpatient diabetes clinic of a tertiary hospital in Qazvin province, and were selected through a convenience sampling method in 2022. Two valid and reliable questionnaires were used for data collection, including the 24-item questionnaire of spiritual intelligence and self-management of type 1 diabetes for adolescents (SMOD-A). To analyze the data, correlation coefficients and multiple linear regression analysis were used.

Results
The total score of spiritual intelligence was 57.24 ± 10.77, and self-management was 77.14 ± 8.92. Among different subscales of spiritual intelligence, critical thinking obtained the highest score. In self-management, the highest score was achieved for communication.Findings also revealed that spiritual intelligence could predict 7.2% of changes in self-management among diabetes patients, and its relationship with diabetes self-management was estimated at 0.27.

Conclusion
The growing prevalence of diabetes worldwide underscores the significance of self-management of the disease in the well-being of patients. This study demonstrated that spiritual intelligence played a crucial role among young adults with diabetes and assisted them in coping with stressful situations. As such, placing greater emphasis on the spiritual aspects of care is necessary, especially in the healthcare of young adults who are dealing with diabetes and its complex conditions.
The roles of health literacy in parents’ honey use and the use of complementary alternative medicine in a Turkish population
Authors: Tek Ayaz Suzan 
Published: October 2023

Abstract
Background
As a biologically based therapy, honey is used by parents in many parts of the world as a home remedy for their children. While information exists regarding the traditional use of honey for health issues in children, data regarding its relationship with health literacy is lacking. The aims of this study were to determine the use of honey to address children’s health issues among parents of children aged 0–72 months and to explore the relationship between the use of complementary and alternative medicine (CAM) and health literacy.

Methods
The data for this descriptive, cross-sectional study were collected between October and November 2022 via an online survey of 907 parents of children aged 0–72 months. A sociodemographic data collection form, the Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ), and the Turkey Health Literacy Scale-32 (THLS-32) were used to collect the data. A t-test, one-way analysis of variance, and Pearson correlation analysis were used to analyze the data.

Results
The majority (86.5%) of the parents used honey for their children’s health problems. Among the parents, 83.1% utilized honey as a remedy for alleviating cough symptoms, 10.4% employed it as a treatment for diarrhea, and 14% administered it for the management of oral mucositis. The mean THLS-32 and HCAMQ scores of the parents were 29.39 and 21.31, respectively, and there was a moderate correlation between the parents’ THLS-32 and HCAMQ mean scores (r = 0.662, p < 0.001).

Conclusion
This study revealed that a significant proportion of parents who used honey to alleviate their children’s health issues displayed positive attitudes toward complementary and alternative medicine (CAM) while concurrently exhibiting insufficient or limited health literacy levels. Therefore, it is advisable to enhance health literacy regarding the proper and safe utilization of honey, which functions as a biologically based CAM therapy.
Development of novel composite data quality scores to evaluate facility-level data quality in electronic data in Kenya: a nationwide retrospective cohort study
Authors: Odeny Beryne M. , Njoroge Anne , Gloyd Steve , Hughes James P. , Wagenaar Bradley H. , Odhiambo Jacob , Nyagah Lilly M. , Manya Ayub , Oghera Ooga Wesley , Puttkammer Nancy 
Published: October 2023

Abstract
Background
In this evaluation, we aim to strengthen Routine Health Information Systems (RHIS) through the digitization of data quality assessment (DQA) processes. We leverage electronic data from the Kenya Health Information System (KHIS) which is based on the District Health Information System version 2 (DHIS2) to perform DQAs at scale. We provide a systematic guide to developing composite data quality scores and use these scores to assess data quality in Kenya.

Methods
We evaluated 187 HIV care facilities with electronic medical records across Kenya. Using quarterly, longitudinal KHIS data from January 2011 to June 2018 (total N = 30 quarters), we extracted indicators encompassing general HIV services including services to prevent mother-to-child transmission (PMTCT). We assessed the accuracy (the extent to which data were correct and free of error) of these data using three data-driven composite scores: 1) completeness score; 2) consistency score; and 3) discrepancy score. Completeness refers to the presence of the appropriate amount of data. Consistency refers to uniformity of data across multiple indicators. Discrepancy (measured on a Z-scale) refers to the degree of alignment (or lack thereof) of data with rules that defined the possible valid values for the data.

Results
A total of 5,610 unique facility-quarters were extracted from KHIS. The mean completeness score was 61.1% [standard deviation (SD) = 27%]. The mean consistency score was 80% (SD = 16.4%). The mean discrepancy score was 0.07 (SD = 0.22). A strong and positive correlation was identified between the consistency score and discrepancy score (correlation coefficient = 0.77), whereas the correlation of either score with the completeness score was low with a correlation coefficient of -0.12 (with consistency score) and -0.36 (with discrepancy score). General HIV indicators were more complete, but less consistent, and less plausible than PMTCT indicators.

Conclusion
We observed a lack of correlation between the completeness score and the other two scores. As such, for a holistic DQA, completeness assessment should be paired with the measurement of either consistency or discrepancy to reflect distinct dimensions of data quality. Given the complexity of the discrepancy score, we recommend the simpler consistency score, since they were highly correlated. Routine use of composite scores on KHIS data could enhance efficiencies in DQA at scale as digitization of health information expands and could be applied to other health sectors beyondHIV clinics.
Association between fibrosis-related gene polymorphism and long-term allograft outcome in renal transplant recipients
Authors: Yin Yu , Zhang Han , Sun Li , Han Qianguang , Zheng Ming , Chen Hao , Fei Shuang , Tan Ruoyun , Ju Xiaobing , Wang Zijie , Gu Min 
Published: October 2023

Abstract
Background
Renal allograft fibrosis is one of characteristic causes of long-term renal function loss. The purpose of our study is to investigate the association between fibrosis-related genes single nucleotide polymorphism (SNPs) and kidney function in 5 years after kidney transplantation.

Methods
A total of 143 recipients were eligible for screening with 5-year follow-up information and SNP sequencing information from blood samples were included in this study. Minor Allele Frequency (MAF) and Hardy–Weinberg Equilibrium (HWE) analysis was conducted to identify tagger single-nucleotide polymorphisms (SNPs) and haplotypes. SNPs associated with the fifth year chronic kidney disease (CKD) staging were screened by SPSS and the “SNPassoc” package in RStudio and used for subsequent prediction model construction.

Results
A total of 275 renal transplant-related SNPs identified after target sequencing analysis. 64 Tagger SNPs were selected, and two SNPs (rs13969 and rs243849) were statistically significant for stage of CKD in 5 years. Finally, a model based on Gender, Age, rs1396, and rs243849 was constructed by multivariate linear regression analysis. Additionally, this model has a good performance in predicting uremia five years after kidney transplantation.

Conclusion
Two SNPs (rs13969 and rs243849) were identified to be significantly associated with long-term renal allograft function. Based on this, a prediction model for long-term allograft function was established containing Gender, Age, rs1396, and rs243849. However, an independent cohort should be enrolled to validate the predicting performance.