bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of a 4-week Multicomponent Exercise (Vivifrail) on Predicted Maximum Oxygen Consumption and Fatigue Levels in the Elderly with Frailty Syndrome: A Randomized Controlled Trial
Authors: Hartantri Wico , Andriana R. A. Meisy , Andriati  , Satyawati Rwahita , Mikami Yukio , Melaniani Soenarnatalina 
Published: December 2023

Introduction:
Frailty syndrome (FS) impairs cardiorespiratory fitness, physical capacity, and disability in the elderly population. Vivifrail, a multicomponent exercise, has shown significant benefits for FS management, but research in the Asian population is still limited. This study aims to see how 4-week Vivifrail program affects predicted maximum oxygen consumption (VO2max) and fatigue levels in the elderly with FS.

Methods:
This randomized controlled trial included 47 participants with FS living in a nursing home in Surabaya, Indonesia. The participants were randomly assigned to either the Vivifrail group (VG) and the control group (CG). The VG followed the 5 days a week Vivifrail program combined with 15 min daily group-based conventional exercise for 4 weeks. The CG was only given the conventional exercise. Six-minute walking test and the Indonesian version of the Fatigue Severity Scale (FSS-I) were measured to assess VO2max dan and fatigue levels before and after the 4-week intervention.

Results:
After 4 weeks of intervention, a significant increase in VO2max and decrease in FSS-I were found in the VG (P = 0.021 and P = 0.002, respectively), whereas no significant changes in VO2max or FSS-I were found in the CG (P = 0.170 and P = 0.052). However, there was no statistically significant difference in VO2max between groups (P = 0.716), but the decline of FSS-I between groups was statistically significant (P = 0.001).

Conclusions:
The addition of Vivifrail exercise for 4 weeks can improve cardiorespiratory fitness and decrease fatigue levels. This supports the routine use of Vivifrail for Indonesian elderly with FS who live in nursing homes.
Outcome of Kidney Trauma Management: Experiences from a Tertiary Referral Hospital in East Indonesia
Authors: Azmi Yufi Aulia , Irsayanto Danang , Soetanto Kevin Muliawan , Renaldo Johan , Wirjopranoto Soetojo 
Published: December 2023

Introduction:
Due to the high mortality and morbidity, kidney trauma ranks third among causes of abdominal solid organ injury, accounting for 24% of cases. In terms of trauma patient profiles, including trauma kinds, diagnoses, and management techniques, middle-income nations like Indonesia have distinctive characteristics. In order to improve the kidney trauma database in Indonesia, particularly in Surabaya, this study examines the 7-year treatment results for renal trauma at a tertiary referral hospital.

Methods:
The Department of Urology at Dr. Soetomo General-Academic Hospital handled 116 renal trauma patients over the course of 7 years (2013–2020), and secondary data from these cases were analyzed in this retrospective single-institution analysis. Age, gender, hemodynamic status, injury site, kidney damage score from the American Association for the Surgery of Trauma (AAST), related organ injury, treatment, and treatment outcomes are among the variables.

Results:
Total 116 patients with kidney trauma recorded. 89% of patients in hospitals are male, with male adolescents 20 years of age or under making up about 42% of this group. The majority of cases (94.8%) were caused by motor vehicle accidents (MVAs). Grade I trauma was encountered by nearly half of all patients (43.1%). Abdominal injuries made up the majority of cases (47.9%). Both low- and high-grade AAST injury groups showed stable hemodynamic status (71.3%, P = 0.36), low mortality (71.4%, P = 1.00), and conservative therapy (74.2%, P = 0.40).

Conclusion:
The majority of kidney trauma cases were discovered in men, were MVA-related, and involved severe damage in addition to preexisting injuries. Adult trauma centers should employ nonoperative treatment for low-grade and high-grade renal trauma.
Effect of Light-Intensity Cycle Ergometer Aerobic Exercise on 2-Min Walking Test Distance and Maximum Oxygen Uptake in Myasthenia Gravis Patients: A Randomized Controlled Trial
Authors: Anggarini Yunita Dwi , Poerwandari Dewi , Narasinta Inggar , Sugianto Paulus , Mazlan Mazlina , Melaniani Soenarnatalina , Kartika Lisa , Bin Satri Muhammad Suhail 
Published: December 2023

Introduction:
Fatigue and impaired functional capacity are more likely to be observed with myasthenia gravis (MG). MG prevalence in the Indonesian population is still limited. MG can benefit from participating in aerobic exercise without causing a decline in function, but relatively few exercise training studies have been conducted in this group of patients. This study analyzed how light-intensity cycle ergometer aerobic exercise influences functional and aerobic capacity in MG.

Methods:
An 8-week randomized controlled trial using a light-intensity cycle ergometer for aerobic exercise three times a week was carried out on adult patients with MG Foundation of America Class I-IIa, and adult patients. Eighteen MG patients were randomly assigned to the intervention or control group (standard exercise training). Two-min walking tests (2MWTs) distance and maximum oxygen uptake (VO2Max) were measured before and after the 8-week intervention. VO2Max was calculated from the 2MWT formula. A t-test was used to compare 2MWT distance and VO2Max within and between groups with a significance level of P < 0.05.

Results:
Light intensity cycle ergometer aerobic exercise significantly improved the functional and aerobic capacity in the intervention group at 8 weeks (2MWT distance P = 0.001 and VO2Max
P = 0.001) but not in the control group (P = 0.523 and P = 0.575, respectively). Substantial changes were also found between groups in both 2MWT distances (P = 0.002; effect size = 1.75) and VO2Max (P = 0.001; effect size = 1.81) pre- and post-test.

Conclusion:
Eight weeks of light-intensity cycle ergometer aerobic exercise improves the functional and aerobic capacity of adult MG patients.
The Influence of Noise Exposure at Different Loudness Levels on EEG Index and Types of Attention
Authors: Mohammadi Zahra , Jafari Mohammad Javad , Khavanin Ali , Jafarpisheh Amir Salar , Ameri Ali , Pouyakian Mostafa 
Published: December 2023

Abstract

Bachground:
Noise is one of the most important harmful factors in the environment. There are limited studies on the effect of noise loudness on brain signals and attention. The main objective of this study was to investigate the relationship between exposure to different loudness levels with brain index, types of attention, and subjective evaluation.

Methods:
Four noises with different loudness levels were generated. Sixty-four male students participated in this study. Each subject performed the integrated visual and auditory continuous performance test (IVA-2) test before and during exposure to noise loudness signals while their electroencephalography was recorded. Finally, the alpha-to-gamma ratio (AGR), five types of attention, and the subjective evaluation results were examined.

Results:
During exposure to loudness levels, the AGR and types of attention decreased while the NASA-Tax Load Index (NASA-TLX) scores increased. The noise exposure at lower loudness levels (65 and 75 phon) leads to greater attention dysfunction than at higher loudness. The AGR was significantly changed during exposure to 65 and 75 phon and audio stimuli. This significant change was observed in exposure at all loudness levels except 85 phon and visual stimuli. The divided and sustained attention changed significantly during exposure to all loudness levels and visual stimuli. The AGR had a significant inverse correlation with the total score of NASA-TLX during noise exposure.

Conclusions:
These results can lead to the design of methods to control the psychological effects of noise at specific frequencies (250 and 4000 Hz) and can prevent non-auditory damage to human cognitive performance in industrial and urban environments.
Epidemiology and changing trends of sexually transmitted diseases over the past 17 years in a tertiary care center
Authors: Mendiratta Vibhu , Meena Amit Kumar , Verma Damini 
Published: December 2023

Introduction:
Sexually transmitted diseases (STDs) continue to be a major public health problem with significant burden on the society. Some of this can be attributed to our lack of knowledge about the change of disease spectrum from time to time.

Aims:
The aim of the study was to understand the changing pattern of STDs over the past 17 years (2003–2019).

Materials and Methods:
It was a retrospective study where data of patients who attended our Suraksha Clinic from 2003 to 2019 were collected. All the cases were subjected to detailed history, examination, and investigations done to rule out STDs.

Results:
A total of 2436 patients were included in the study. The majority of the patients were in the age group of 18–30 years. The most frequent diagnosis was vulvovaginal candidiasis, followed by herpes genitalis. 3.3% of patients had human immunodeficiency virus. 4.8% of patients were men sex men (MSM). Overall, viral STDs were most common, followed by fungal and bacterial. To understand the changing trends, data were divided into different phases according to the time period. During Phase 1 (2003–2007), viral STDs were most common, followed by bacterial and fungal. However, this trend changed in Phase 4 (2016–2019) and fungal STDs became most common.

Conclusions:
Despite numerous health initiatives, the number of STD cases is rising day by day. The increasing number of MSM over the study period necessitates dedicated efforts to address the health needs of this population. The National AIDS Control Organization should take necessary measures and steps to address the overall increase in STDs considering recent trends showing a drop in bacterial STDs and an increase in fungal and viral STDs.
Sexually transmitted infections with Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis in pregnant women as detected by molecular testing
Authors: Filho Antônio Chambô , Assis Marcos Cinthia Rafaela Santos , Colnago Jéssica Maria , Miranda Angélica Espinosa Barbosa , Duarte Júlia Nascimento , Peruchi Luiza Spinassé 
Published: December 2023

Context:
During pregnancy, sexually transmitted infections can be transmitted vertically to the fetus, leading to an increase in morbidity and mortality for both mother and child.

Aims:
This study aimed to determine the profile of cervical and vaginal infections in pregnant women receiving prenatal care in a single institute.

Settings and Design:
The study was conducted in a tertiary hospital. Molecular testing was used to detect Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis.

Materials and Methods:
Samples of vaginal secretions were collected from pregnant women using the Aptima® Multitest Swab Specimen Collection kit to test for the pathogens. The inclusion criteria consisted of pregnant women of 15–45 years of age receiving prenatal care at the institute, irrespective of gestational age, who agreed to provide vaginal swab. The exclusion criterion was the use of antibiotics in the preceding 3 months.

Statistical Analysis:
Frequencies and percentages were calculated for the pathogens detected in the samples evaluated.

Results:
Overall, 200 samples were tested. Of the pathogens detected, there was a predominance of T. vaginalis (15.5% of the samples) and C. trachomatis (14.5%), followed by M. genitalium (10.0%) and N. gonorrhoeae (0.5%).

Conclusion:
Identifying the microorganisms present in the microbiota of pregnant women is of the utmost importance in assuring the appropriate treatment for each pathogen, thus avoiding complications both for the woman and for her fetus. These results should serve to stimulate the debate on implementing these tests as routine during prenatal care.
Trends in genital ulcer disease
Authors: Patel Zalak R. , Makwana Vaishali S. , Bhadja Sejal G. , Tundiya Hiral J. , Vyas Aniruddha P. 
Published: December 2023

Introduction:
Genital ulcer disease (GUD) often creates diagnostic difficulty in developing countries like India, with limited resources available in the health-care system. The changing etiology in GUDs over the years makes it imperative that a correct diagnosis is made to establish appropriate treatment and formulate awareness programs.

Aims:
This study was done to determine the recent trends in the demographic parameters, clinical presentations, etiology of GUDs, and their association with human immunodeficiency virus (HIV).

Materials and Methods:
An observational cross-sectional study was conducted from October 2021 to August 2022 at the Dermatology Outpatient Department in our hospital. All the patients who presented with GUDs were included after written informed consent. The diagnosis of GUD was confirmed by thorough clinical examination and appropriate laboratory test. Data were entered and analyzed using IBM SPSS software.

Results:
Out of 135 cases of GUDs, the majority were males (79%). The most common age group was 21–30 years, with a mean age of 35.23 ± 14.98 years. Most of the patients were heterosexual (90%). Multiple sexual partners were found in 40% of cases. Herpes genitalis was the most common GUD (59%), followed by syphilis (15%). HIV infection was found in 6.6% of cases.

Conclusion:
This study represents the increasing burden of viral GUDs compared to the last three decades. The ulcerative sexually transmitted infection facilitates the transmission of HIV. In this HIV era, there is a need for increased efforts toward acknowledgment, safe sexual practices, periodic screening, and sexual health awareness programs in the high-risk population.
Overcoming Problems Caused by Offset Distance of Multiple Targets in Single-isocenter Volumetric Modulated Arc Therapy Planning for Stereotactic Radiosurgery
Authors: Ito Takaaki , Kubo Kazuki , Monzen Hajime , Yanagi Yuya , Nakamura Kenji , Sakai Yusuke , Nishimura Yasumasa 
Published: December 2023

Purpose:
The purpose of the study is to investigate the impact of large target offset distances on the dose distribution and gamma passing rate (GPR) in single-isocenter multiple-target stereotactic radiosurgery (SIMT SRS) using volumetric modulated arc therapy (VMAT) with a flattening filter-free (FFF) beam from a linear accelerator.

Methods:
Two targets with a diameter of 1 cm were offset by ”±2, ±4, and ±6 cm from the isocenter in a verification phantom for head SRS (20 Gy/fr). The VMAT plans were created using collimator angles that ensured the two targets did not share a leaf pair from the multi-leaf collimator. To evaluate the low-dose spread intermediate dose spill (R50%), GPRs were measured with a criterion of 3%/2 mm using an electronic portal imaging device and evaluated using monitor unit (MU), modulation complexity score for VMAT (MCSv), and leaf travel (LT) parameters.

Results:
For offsets of 2, 4, and 6 cm, the respective parameters were: R50%, 4.75 ± 0.36, 5.13 ± 0.36, and 5.11 ± 0.33; GPR, 95.01%, 93.82%, and 90.67%; MU, 5893 ± 186, 5825 ± 286, and 5810 ± 396; MCSv, 0.24, 0.16, and 0.13; and LT, 189.21 ± 36.04, 327.69 ± 67.01, and 430.39 ± 114.34 mm. There was a spread in the low-dose region from offsets of ≥4 cm and the GPR negatively correlated with LT (r = −0.762). There was minimal correlation between GPR and MU or MCSv.

Conclusions:
In SIMT SRS VMAT plans with an FFF beam from a linear accelerator, target offsets of <4 cm from the isocenter can minimize the volume of the low-dose region receiving 10 Gy or more. During treatment planning, it is important to choose gantry, couch, and collimator angles that minimize LT and thereby improve the GPR.
The role of serum lipid profile, fasting blood sugar, and body mass index on recurrence and metastasis in patients with estrogen receptor-positive breast cancer: A case–control study
Authors: Mohammadbeigy Iman , Khalilian Mohammad Sadegh , Najafizadeh Nadia , Moazam Elham , Hemati Simin , Zeinalian Mehrdad 
Published: December 2023

Background:
Breast cancer (BC) is the leading cause of cancer death in women. The current study is designed to evaluate the association of lipid profiles, FBS, and body mass index (BMI) with BC recurrence and metastasis.

Materials and Methods:
This is a case–control study on estrogen receptor-positive BC patients in Isfahan Province, Central Iran, between 2008 and 2020. The control group was patients who had no evidence of recurrence or metastasis at least 1 year after the end of chemotherapy and hormone therapy. The case group was patients with evidence of metastasis or recurrence within 1 year after the end of chemotherapy and hormone therapy. Fasting blood sugar (FBS), total cholesterol (Chol), triglyceride (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were measured before treatment, after chemotherapy, and after hormone therapy as well as BMI in the case and control groups.

Results:
There were 108 patients in the case and 119 patients in the control group with a mean age of 50.72 ± 13.26 and 51.91 ± 11.79, respectively. There were no meaningful differences between the case and control groups regarding serum FBS, Chol, TG, HDL, LDL, and BMI.

Conclusion:
We found no association between serum FBS, lipid profile, and BMI at initial diagnosis and BC recurrence or metastasis.
Moving from specialist-led to generalist-led hospital care: propensity-matched analyses of clinical outcomes and survey of patient care experiences
Authors: Lim Yee Wei , Neo Sin Hui , Teo Ee Lin Kimberly , Tan Cherylanne , Chong Lin Siew , Bundele Anjali , Sumner Jennifer 
Published: December 2023

Abstract

Introduction:
In this study, we aimed to compare the clinical outcomes of patients who received care under a new generalist-led hospital care model — the Integrated General Hospital (IGH) — with those receiving care under the usual specialist-led hospital model, and to examine patients’ care experiences of the IGH model.

Methods:
A retrospective propensity-matched analysis comparing attendees of IGH (n = 2,127) and usual care attendees at a different hospital (n = 2,127) was conducted between 1 January 2019 and 31 August 2019. Clinical outcomes included length of stay, 30-day readmission, inpatient mortality and mortality within 30 days of discharge. In addition, a patient survey on IGH care experiences (n = 270) was conducted between 7 October 2019 and 12 April 2021. A two-sample t-test or chi-square test was used to compare the matched samples. For time-to-event variables, a Cox proportional hazards model was used to estimate the hazard ratio with 95% confidence intervals.

Results:
After propensity-matching, statistically significant differences were found between the IGH and usual care groups for length of stay (P = 0.003), inpatient mortality (P = 0.007) and mortality within 30 days of discharge (P = 0.014), but not for 30 day readmission (P = 0.456). The hazard ratio for 30-day readmission was 0.94 (P = 0.46) and for mortality within 30 days of discharge was 0.51 (P = 0.01). Survey responses on IGH care found the care experiences were generally positive, particularly in terms of provider–patient communication and perceived staff teamwork.

Conclusion:
Initial analysis of the IGH model was associated with better clinical outcomes in some respects compared with the usual care model. Patient care experiences of IGH were also favourable. An ongoing prospective study will explore the longer-term clinical impact of the IGH care model, including the effect on postdischarge care and care continuity.
Cycles in graphs with geometric property (T)
Authors: Winkel Jeroen 
Published: December 2023

We show that a sequence of graphs with uniformly bounded vertex degrees, number of vertices going to infinity, and with geometric property (T) has many small cycles. We also show that when a small part of such a sequence of graphs with geometric property (T) is changed, it still has geometric property (T), provided that it is still an expander. We use this to give an example of a sequence of graphs with geometric property (T) that has large cycle-free balls.
Can Outreach Training and Supportive Supervision Improve Competency in Malaria Service Delivery? An Evaluation in Cameroon, Ghana, Niger, and Zambia
Authors: Ashton Ruth A. , Worges Matt , Zeh Meka Albert , Yikpotey Paul , Domkam Kammogne Irenee , Chanda-Kapata Pascalina , Vanderick Caroline , Streat Elizabeth , Yukich Joshua 
Published: December 2023

ABSTRACT.
Outreach Training and Supportive Supervision (OTSS) of malaria services at health facilities has been adopted by numerous malaria-endemic countries. The OTSS model is characterized by a hands-on method to enhance national guidelines and supervision tools, train supervisors, and perform supervision visits. An independent evaluation was conducted to evaluate the effectiveness of OTSS on health worker competence in the clinical management of malaria, parasitological diagnosis, and prevention of malaria in pregnancy. From 2018 to 2021, health facilities in Cameroon, Ghana, Niger, and Zambia received OTSS visits during which health workers were observed directly during patient consultations, and supervisors completed standardized checklists to assess their performance. Mixed-effects logistic regression models were developed to assess the impact of increasing OTSS visit number on a set of eight program-generated outcome indicators, including overall competency and requesting a confirmatory malaria test appropriately. Seven of eight outcome indicators showed evidence of beneficial effects of increased OTSS visits. Odds of health workers reaching competency thresholds for the malaria-in-pregnancy checklist increased by more than four times for each additional OTSS visit (odds ratio [OR], 4.62; 95% CI, 3.62–5.88). Each additional OTSS visit was associated with almost four times the odds of the health worker foregoing antimalarial prescriptions for patients who tested negative for malaria (OR, 3.80; 95% CI, 2.35–6.16). This evaluation provides evidence that successive OTSS visits result in meaningful improvements in indicators linked to quality case management of patients attending facilities for malaria diagnosis and treatment, as well as quality malaria prevention services received by women attending antenatal services.