bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Morphine in Critically Ill COVID-19 Patients: An Ethics Reflection
Authors: Idiculla Jyothi Mariam , Muralidharan Jananee , Kurpad Sunita Simon 
Published: November 2023

Abstract
The use of Morphine in terminal COVID is different from that in palliative care due to variable nature of the pandemic. In developing countries, the limitations in resources that can arise during a COVID wave, necessitates the availability of national guidelines for terminal care.
A case–control study to assess association of factors with treatment interruption of antiretroviral therapy (ART) among people living with HIV at ART center of tertiary care hospital in Himachal Pradesh, India
Authors: Kumar Dinesh , Raina Sunil K 
Published: November 2023

Abstract

Background:
Treatment interruption affects virologic suppression during antiretroviral therapy (ART) among people living with HIV (PLHIV). The present study was planned to explore factors associated with Loss to follow-up (LFU) among PLHIVs receiving ART from 2017 to 2021 at ART center of tertiary care hospital in Himachal Pradesh.

Materials and Methods:
A case–control study where selected PLHIVs registered with ART center of a tertiary care hospital from 2017 to 2021 were assessed with logistic regression for baseline characteristics and possible reasons for treatment interruption among 120 cases (regular) and 124 controls (missed and LFU).

Results:
Record-based analysis of a total of 703 PLHIV registered at ART center from 2017 to 2021 observed 18.3% LFU of which 70.5% died over 5 years. Adjusted association showed that mean duration of treatment interruption was significantly positively associated with missed (adjusted odds ratio [aOR]: 1.1; 95% confidence interval [CI]: 0.9–1.1), LFU (aOR: 1.1; 95% CI: 1.0–1.2), and combined (missed + LFU) (aOR: 1.1; 95% CI: 1.01–1.2) as compared to regular category. Effect of adverse effects showed a negative significant association with missed (aOR: 0.1; 95% CI: 0.0–0.2) and combined (missed and LFU) (aOR: 0.1; 95% CI: 0.0–0.1) in comparison to regular category.

Conclusions:
ART services need to be made available further down to health care delivery system and closer to place of residence of PLHIV.
Effect of Moringa oleifera Leaf Extract on Glycemic Parameters in Patients with Type 2 Diabetes Mellitus and Prediabetes: A Systematic Review and Meta-analysis
Authors: Kamrul-Hasan A. B. M. , Talukder Samir Kumar , Nagendra Lakshmi , Alam Muhammad Shah , Aalpona Fatema Tuz Zahura , Dutta Deep , Selim Shahjada 
Published: November 2023

Background:Moringa oleiferaleaf (MOL) extract has been used traditionally for treating several diseases, including diabetes mellitus (DM). This study aimed to holistically analyze and summarize the efficacy and safety of MOL extract on glycemic parameters in patients with type 2 DM (T2DM) and prediabetes.Materials and Methods:Electronic databases were searched for randomized controlled trials (RCTs) and nonrandomized trials involving patients with T2DM or prediabetes receiving MOL extract in the intervention arm and placebo (or no MOL extract) in the control arm. The primary outcome was the changes in glycemic parameters, for example, hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and 2-h postprandial plasma glucose (2-h PPG), from the baseline at the end of the trial.Results:From 86 initially screened articles, data from 5 studies (3 RCTs and 2 nonrandomized trials) involving 260 subjects were analyzed. Subjects in the MOL extract group had similar reductions in HbA1c (mean difference [MD] −0.11%, 95% confidence interval [CI] [ −0.37, 0.14],P= 0.39,I2= 24% [not important heterogeneity], very low certainty of evidence) and FPG (MD −0.63 mmol/L, 95% CI [−1.89, 0.64],P= 0.33,I2= 94% [high heterogeneity], very low certainty of evidence) than the control group although reductions in 2-h PPG were greater in the MOL extract group (MD −3.46 mmol/L, 95% CI [−4.96, −2.16],P< 0.00001,I2= 0% [not important heterogeneity], very low certainty of evidence). Subjects in the MOL extract group achieved greater systolic and diastolic blood pressure reductions than the control group. No hypoglycemic events were reported in either group.Conclusion:Current preliminary data do not support MOL extract’s glucose-lowering efficacy in patients with T2DM and prediabetes.
Transfusion Audit and Targeted Education as Tools to Improve Clinical Practice of Fresh Frozen Plasma Transfusions: An Interventional Study
Authors: Navin Nisha , Shahulhameed Shaiji Panthiyil , Dharmadas Meena 
Published: November 2023

Background and Objectives:
The transfusion of fresh frozen plasma (FFP) is an essential modality of treatment but carries a residual risk of transfusion-transmitted infections and other adverse events. Continuous education and promotion of evidence-based practice are essential among clinicians to follow good clinical practices with respect to transfusion. This study aims to assess the impact of transfusion audit and educational interventions on the appropriateness of FFP transfusions with respect to indications, by comparing the proportion of appropriate FFP requests before and after the intervention. The study was an interventional study done on all medical professionals who requested FFP for various reasons from the department of transfusion medicine, for 1 year from April 01, 2011, to March 31, 2012.

Methods:
The study was done in three phases, preintervention audit; intervention including continuous education, one-to-one interactions, and hospital transfusion committee-mediated regulations; and postintervention audit. Statistical analysis was done by SPSS version 16. A paired t-test was used to compare quantitative variables which were continuous. Chi-square test was used for associations in categorical data.

Results:
A total of 3281 units of FFP were transfused in the preintervention period, and 2480 units in the postintervention period. Out of a total of 823 appropriate indications 75.6% indications were definitely indicated in the preintervention period. This increased to 81.8% of total 1290 requests after the intervention. The increase in definite indications was found to be statistically significant.

Conclusion:
Transfusion audits and educational interventions can create an impact on the appropriateness of FFP Transfusions especially if targeted to particular specialties and continued to follow-up.
Analysis of semen parameters, and hormonal changes of FSH, LH, testosterone, and libido following bariatric surgery
Authors: Javani Siroos , Mosapour Esmaeil , Hoseine Seyedmokhtar , Ashrafi Amir , Farhadi Elham 
Published: November 2023

Introduction:
Although studies have shown that bariatric surgery can have a positive effect on the patient's sexual function, there are still disagreements and contradictions in this regard. The present study is aimed to evaluate semen parameters, hormonal changes of FSH, LH, testosterone, and libido following bariatric surgery.

Methods:
The present research as a prospective study was performed on 20 male candidates for bariatric surgery referred to Golestan and Aria hospitals in Ahvaz in 2021. Semen parameters (volume, count, motility, and the percentage of sperm with normal morphology), hormonal profile (including FSH, LH test hormones), and sexual function were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire before and 6 months after the surgery.

Results:
The results of this study indicated that semen parameters did not change significantly 6 months after surgery in comparison with before the surgery (P < 0.05). After the operation, just the total level of testosterone increased significantly (2.23 nmol/L vs. 2.74, P = 0.009). However, LH and FSH levels did not change significantly six months after surgery (P = 0.858 and P = 0.287). The results indicated significant improvement in IIEF score after the operation (P = 0.011).

Conclusion:
The findings of the present study indicated that the decrement of weight as a result of bariatric surgery had a favorable effect on the levels of serum testosterone and sexual performance, while semen parameters did not improve after surgery.
Anthropometric indexes for predicting high blood pressure in Turkish adults
Authors: Canyolu Burcu Aksoy , Şen Nilüfer , Sadıç Beste Özben 
Published: November 2023

Purpose:
It is controversial which anthropometric indexes are the best in predicting the risk of hypertension and how anthropometric measurements are related to blood pressure (BP). This study aimed to evaluate the relationship between BP and anthropometric indexes and to determine the best predictors for hypertension risk.

Methods:
This cross-sectional study was conducted with 415 consecutive participants (161 men, mean age: 33.4 years) aged 18–88 years in Istanbul, Turkey. Weight, height, waist circumference (WC), and neck circumference (NC) and BP were measured by well-trained personnel. Waist-to-height ratio (WHtR) and body mass index (BMI) were calculated. Pearson correlation, linear regression, and multivariate analyses were used to assess the relationship between anthropometric measurements and SBP, DBP, using the Statistical Package for the Social Sciences version 23.0.

Results:
The systolic BP (SBP) and diastolic BP (DBP) were related to weight, WC, NC, BMI, and WHtR (P < 0.05). Linear regression analyses showed BMI and WC as independent risk factors for SBP with an increase by 1.11 mmHg in men (P = 0.036) and 1.59 mmHg in women (P = 0.001) in SBP when BMI increased 1 unit, while SBP increases by 0.2 mmHg when WC increases by 1 unit regardless of gender (P = 0.013).

Conclusion:
Our results showed that BMI and WC are related to BP and important predictors of hypertension risk. Therefore, the uses of BMI and WC are recommended as screening tools for the prediction of hypertension risk among Turkish adults.
Elderly awareness and perception of neck femur fracture in Saudi Arabia
Authors: Shehata Shehata Farag , Altalhiyyah Khalid Siraj , Alqahtani Saad Haif , Asiri Abdullah Saad , Alqahtani Faris Saleh M. , Alfarwan Salem Msaoud 
Published: November 2023

Background:
Femoral neck fractures are prevalent and make up the highest per cent of proximal femur fractures. The femoral neck is the most common location for a hip fracture. This study aims to assess elderly awareness and perception of neck femur fracture in Saudi Arabia.

Methods:
A descriptive cross-sectional web-based study was conducted targeting all persons aged 60 years or above. An online questionnaire was developed by the study researchers based on literature review and after consultation of the field experts. The anonymous questionnaire was published using the social media platforms from October 2022 to January 2023 by the researchers and their families.

Results:
A total of 410 elderly completed the study questionnaire. Elderly age ranged from 60 to 89 years with mean age of 68.2 ± 10.9 years old. A total of 44 (10.7%) of the study elderly had an overall good awareness regarding NFF. The most reported sources were physician (61.7%), social media (41.2%), mass media (33.4%) and books and magazines reading (20.5%).

Conclusion:
In conclusion, elderly awareness regarding femur neck fracture was very low especially among male elderly and those with no history of trauma. Poor awareness for clinical presentation and complications of NFF was reported.
Use of Systemic Mycophenolate Mofetil Therapy in Ocular Surface Inflammatory Pathologies at the Initiative and Responsibility of the Ophthalmologist
Authors: Furundaoturan Onur , Akçay Pelin , Selver Ozlem B. 
Published: November 2023

Abstract:

PURPOSE:
The purpose of the study was to evaluate the efficacy and safety of systemic mycophenolate mofetil (MMF) treatment in ocular surface inflammatory diseases.

METHODS:
For this retrospective study, patients who were treated with systemic MMF for ocular surface inflammatory diseases between March 2020 and March 2022 were evaluated. Apart from demographic data, examination notes including MMF treatment indication and systemic side effect interrogation and routine laboratory examinations during drug treatment were extracted from the patient records. Detailed staging scores were performed according to the diagnosis including Foster and Mondino for ocular mucous membrane pemphigoid (MMP) and limbal stem cell deficiency scoring for limbal transplantation. For thorough evaluation, anterior segment pictures were used.

RESULTS:
Fourteen patients were enrolled to the study, with a mean age of 58 ± 12. MMP (6, 42.8%) and limbal allograft transplantation (6, 42.8%) constituted the main indications for the MMF treatment, followed by keratitis–ichthyosis–deafness (KID) syndrome (1, 7.2%) and Mooren’s ulcer (1, 7.2%). Five of six patients with MMP regressed according to both staging systems. Only one remained stable which was evaluated as Stage 3. Furthermore, while all limbal transplant groups (6) stabilized and showed regression according to the individualized limbal stem cell deficiency staging system with no rejection during follow-up. Furthermore, patients with Mooren’s ulcer and KID syndrome showed control of the inflammation and stabilization after MMF treatment. No significant systemic side effects apart from constipation and nausea (3) were observed in patients whose routine laboratory tests were stable throughout the follow-up.

CONCLUSION:
MMF has the potential to be a valuable and safe systemic agent of first choice in the control of ocular surface inflammatory disorders, especially when topical treatment is not effective. With such studies, it is predicted that MMF may reach wider usage areas with the increase in its effectiveness and safety in its use for ocular surface inflammatory pathologies.
Study the Association between Interleukin-4 Polymorphism and Specific Chlamydia Pneumoniae Immunoglobulin E in Asthmatic Children
Authors: Al-Hasnawy Huda Hadi , Abood Haidar Abdul Amir Najim , Hameed Raghdah Maytham 
Published: November 2023

Background:
Asthma is a chronic disorder caused by complex interactions between genetic and environmental influences.

Objective:
Investigate the possible correlation between interleukin-4 (IL-4) gene polymorphisms and development of specific Chlamydia
pneumoniae immunoglobulin (Ig) E levels.

Materials and Methods:
A total of 87 children, including 57 males and 30 females with asthma with ages between 1 and 16 years, attended the Respiratory Clinic at Karbala Pediatric Hospital, with a nonasthmatic children group which have the same age and gender. Restriction fragment length polymerase chain reaction was performed to determine IL-4 C-589T genetic polymorphisms. Total IgE level, C. pneumoniae IgG, and C. pneumoniae IgE antibodies were measured using the commercial quantitative enzyme-linked immunosorbent assay kits.

Results:

C. pneumoniae IgG and IgE antibodies were significantly increased in patients as compared with controls (P < 0.001 and P = 0.024, respectively). The CT genotype of IL-4 C-589T polymorphism was associated with asthmatic children (P < 0.01). A high C. pneumoniae IgE levels were found to be associated with CC genotypes (P = 0.01). On the other hand, there were no significant differences in serum C. pneumoniae IgG levels depending on different IL-4 C589T genotypes (P = 0.662).

Conclusion:
The development of C. pneumoniae IgE antibody in asthmatic children did not depend on IL-4 polymorphism.
Brain drain in medically challenged context: A study of the push, pull, and stick factors among a population of medical practitioners in Nigeria
Authors: Iloh Gabriel Uche , Ikwudinma Augustine Obiora , Obi Ikechukwu Vincent , Akodu Babatunde Abdulmajeed 
Published: November 2023

Background:
Globally, brain drain (BD) phenomenon has been an issue for decades in healthcare industry. However, the magnitude of BD syndrome and its impact on medical workforce crisis in a medically challenged environment has been the subject of great interest in the recent years, with apparently glaring effects on the medical workforce.

Aim:
The study was aimed at describing the push, pull, and stick factors, benefits, and preventive measures for BD among medical practitioners in Abia State, Nigeria.

Subjects and Methods:
This was a cross-sectional study carried out on 185 medical practitioners in Abia State, Southeastern Nigeria. Data collection was done using pretested, self-administered, and structured questionnaire that elicited information on push, pull, and stick factors, benefits, and preventive measures for BD. The plan to leave Nigeria and preferred foreign countries were also studied.

Results:
The age of the participants ranged from 26 to 72 (36 standard deviation 8.4) years. There were 159 (85.9%) males. One hundred and twenty-seven, 127/185 (68.6%) study participants had plans to leave the country with the most preferred countries of destination being Canada, United States, United Kingdom and Australia. The most common push factors from Nigeria and pull factors from abroad were similar and included poor income, wages, and salaries in all the participants 185/185 (100%). The most predominant stick factor was family-centric reasons, 126/185 (68.1%). Family and national family remittances were the main benefits, 185/185 (100%) for each while the most common pull factor was higher income, wages, and salaries abroad, 185/185 (100%). The most predominant stick factor was family-centric reasons, 126/185 (68.1%). The greatest benefits were family, 185/185 (100%), and national, 185/185 (100%), financial remittances. The most recommended preventive measures were enhanced income in Nigeria, 185/185 (100%). Young adult age (P< 0.001), male (P< 001), and duration of practice <10 years (P < 0.001) were significantly associated with the plan to leave the country. Conclusion: These findings demonstrates that about 70% of Nigerian medical practitioners plan to leave the country for abroad. The major underlying factors for brain drain include enhanced income in the destination country capacity for financial remittances to the family and nation.
The safety and efficacy of transluminal injection of foam sclerotherapy after endovenous thermal ablation in varicose veins with large trunk: A retrospective cohort study
Authors: Xu Jiatang , Cao Lin , Huang Minyi , Luo Xianghui , Chen Tianhong , Huang Kai , Yao Chen 
Published: November 2023

Abstract:

CONTEXT:
Closure rate of endovenous thermal ablation is limited by the trunk diameter of great saphenous vein.

AIMS:
This study aimed to investigate the safety and efficacy of transluminal injection of foam sclerotherapy (TLFS) after thermal ablation in improving the closure rate of primary varicose veins with large trunk.

SUBJECTS AND METHODS:
In this retrospective cohort study with 170 patients (189 legs), the outcomes of varicose veins patients treated with thermal ablation plus injection of sclerotherapy were compared with those treated with thermal ablation only. The primary outcome of this study was the rate of ablated segment closure after surgery and during patient follow-up. Propensity score matching model was used to eliminate the bias.

RESULTS:
After matching, 75 legs (65 patients) from the thermal ablation plus sclerotherapy group and 71 legs (66 patients) from the thermal ablation only group were further analyzed. The closure rate of the thermal ablation plus sclerotherapy group was 97.3%, which was significantly higher than that of the thermal ablation only group (87.3%, P = 0.048), and the closure rate of the thermal ablation plus sclerotherapy group remained higher during 1-year follow-up. No serious complications were observed in groups.

CONCLUSIONS:
TLFS can improve the efficacy of thermal ablation, increasing the closure rate of the ablation segment, and thus improving the symptoms.
Charity Colonoscopy Event and Fund in Singapore: A Novel Method to Raise Awareness of Colorectal Cancer Screening
Authors: Yee Francis Zheng Yi , Ng Yvonne Ying-Ru , Chok Aik Yong , Tan Emile Kwong-Wei , Seow-En Isaac 
Published: November 2023

Abstract

Background:
Despite the improvements in the incidence rate and mortality of colorectal cancer in Singapore, most cases are still diagnosed at later stages. This suggests limitations in the uptake of cancer screening, relating to suboptimal population awareness, unfamiliarity with tests, or cost concerns.

Objective:
We report our experience with a charity colonoscopy event to assist patients with endoscopy costs, raise public awareness of endoscopic cancer screening, and demonstrate the safety of colonoscopy.

Design and Settings:
The Singapore General Hospital (SGH) Preventing Rectal and Colon Cancer through Endoscopy (SPRUCE) fund was established in 2019. A charity endoscopic event was held to kickstart the official launch of the fund with corporate, individual, and industry support.

Patients and Methods:
The recruitment criteria were first-visit patients who required colonoscopic evaluation following specialist evaluation and those in possession of a Community Health Assist Scheme card, for which only Singapore citizens whose annual household per capita income was less than Singapore dollar (SGD) 24,000 (USD 17,500) were eligible. This enabled meaningful selection of patients who would most benefit from financial assistance.

Main Outcome Measures:
To determine the feasibility of a charity colonoscopy event while raising colorectal cancer public awareness.

Sample Size:
Forty-eight patients underwent colonoscopies by accredited endoscopists for the SPRUCE endoscopy event.

Results:
Of the 48 participants, 19 (39.5%) were men and 29 (60.4%) were women, with a median age of 64 years. Seven patients (14.6%) had a normal colonoscopy, while 42 (85.4%) had at least one abnormality documented. Forty-one benign polyps were detected and removed in 22 patients (45.8%), with an overall adenoma detection rate of 85.4%. One patient (2.1%) was diagnosed with colon cancer. No complications resulted from the procedures performed during the charity event.

Conclusion:
A charity colonoscopy event conducted in the form of a health fair for needy patients is feasible and may help raise colorectal cancer awareness. This framework may serve as a useful basis for similar future events held in Singapore or elsewhere.

Limitations:
Lack of longitudinal assessment of colorectal cancer awareness among the public, following the charity colonoscopy event.

Conflict of Interest:
The authors have no conflict of interest to declare.
Anal Pruritus: Diagnosis and Management
Authors: Slagle Daniel T. , Harb William J. 
Published: November 2023

Abstract
Pruritus ani is a condition that results in itching or burning in the perianal area. It can be due to primary or secondary causes and can be self-limiting or persistent. To date, there is limited quality evidence in the literature, and there are no published guidelines to aid the physician in its diagnosis and management. In this article, an overview of the current literature is discussed and a suggested treatment algorithm is provided. A thorough history and physical examination is essential to rule out secondary causes of pruritus. The underlying etiology of pruritus guides management. Education regarding anal hygiene is important for all cases. For any patient with refractory pruritus or an abnormal exam, biopsy should be strongly considered.
Case Report: Locally Acquired Leptospirosis in a Minnesota Boy and His Dog
Authors: Thielen Beth K. , Holzbauer Stacy , Templen Bethany , Schafer Ilana J. , Artus Aileen , Galloway Renee , Ireland Malia , Femrite Tanya , Schleiss Mark R. 
Published: November 2023

ABSTRACT.
Leptospirosis affects numerous animal species, including domestic dogs, but documented transmission to humans is rare. Here, we describe epidemiologically linked cases in a 12-year-old Minnesota boy and his pet dog. While human leptospirosis is often thought of as a disease of tropical locations, this case report describes a rare documented example of local transmission in the northern United States, a region historically not perceived to be at high risk of Leptospira species transmission to humans. This case highlights an unusual presentation, with facial nerve palsy, underappreciated epidemiological risks, and diagnostic challenges of this reemerging infection.