bluuebunny/crossref_metadata_2025_split huggingface dataset:
Centralisation of financial decision-making on public hospitals in the Eastern Cape province
Authors: Fana Thanduxolo , Mokhele Mosekama O. 
Published: January 2025

Background: The formal introduction of national health insurance in 2011 is making significant progress in South Africa. However, coronavirus disease 2019 (COVID-19) and the current financial situation pose a new challenge to South Africa’s ailing public health system, especially the centralisation of financial decision-making.Aim: This article examines the implementation of centralisation of financial decision-making and its impact on the functioning of public hospitals to deliver public healthcare services.Setting: The study’s research focussed on three public hospitals in the Eastern Cape province, South Africa.Methods: This article followed the qualitative research method using semi-structured interviews and focus groups.Results: Budget cuts, inadequate audit results, poor financial management and a lack of leadership support and management were the main reasons for centralising the financial decisions of public healthcare services to the Provincial Department of Health. The results further show that the chief executive offices in those hospitals do not have the power to make financial decisions, which affects hospital operations.Conclusion: This article concludes that the centralisation of financial decision-making leads to delays in decision-making and poor public hospital functionality in delivering public healthcare services.Contribution: It is crucial for public hospital leadership to understand which decision-making powers are centralised and which are decentralised. This understanding will assist public hospital leadership in assessing their respective hospitals’ specific needs and capabilities and strike a balance between the appropriate level of decentralisation, service performance, adequate staff availability and hospital functionality. Lastly, continuous monitoring and evaluation of the impact of centralised decision-making on public hospital operations could help public hospital leadership identify and promptly address any potential drawbacks.
Critical Issues in an Unmotivated Patient with Alcohol Dependence
Authors: Vadhavekar Nidhi , Chatwani Saloni , Desousa Avinash , Sheth Hardik , Dongerkery Kavitha V. , Deolekar Pradnya 
Published: January 2025

Abstract
Alcohol use disorder (AUD) is characterized by an impaired ability to stop alcohol consumption despite its adverse sociooccupational, health consequences and is associated with tolerance and withdrawal on sudden stoppage of alcohol. The patient had a history of AUD, alcoholic liver cirrhosis, HIV, and squamous-cell carcinoma of the vocal cords. The patient’s AUD was characterized by cluster B personality disorder traits, and treatment involved a multidisciplinary approach (acamprosate, sertraline, nicotine replacement therapy, psychotherapy, and admission into a rehabilitation center). However, all interventions failed, and the patient’s medical complications ultimately led to his demise. This case highlights the importance of considering a range of factors that contribute to poor treatment response in AUD, including motivation, personality factors, and medical comorbidities. This case also highlights the fact that there is an urgent need for stricter regulation of rehabilitation facilities in India, particularly those catering to patients with complex and comorbid conditions.
Investigating the Safety of Fampridine in Patients with Different Stages of Multiple Sclerosis
Authors: Vaheb Saeed , Farzan Mahour , Afshari-Safavi Alireza , Ebrahimi Narges , Shaygannejad Vahid , Mirmosayyeb Omid 
Published: January 2025

Abstract

Background:
Fampridine is the only drug approved by the US Food and Drug Administration (FDA) for people with multiple sclerosis (MS) to improve their movement and has exhibited a clinically significant improvement in gait function in a subset of MS patients with Expanded Disability Status Scale (ESDSS) from 4 to 7. Nevertheless, this drug has been reported to possess some adverse effects (AEs) like seizure because of its pharmacological features. The aim of this study was to evaluate the incidence rate of post-medication side effects (SEs) of fampridine in MS patients.

Methods:
This prospective cohort study includes MS patients aged between 18 and 65 years, referred to the neurology clinic of Kashani Hospital from April 2022 to October 2022, all with administration of fampridine (10 mg tablet twice daily according to the product specifications). Safety in these patients was monitored through monthly SEs checklist questions during 6 months of screening. SPSS version 18 was used to analyze the data of this study.

Results:
From 319 participants screened at baseline, 254 patients with MS, including 127 relapsing-remitting multiple sclerosis (RRMS), 101 secondary progressive multiple sclerosis (SPMS), and 26 primary progressive multiple sclerosis (PPMS), were included in the study. The most observed AEs in SPMS and RRMS patients were dry mouth (13.9% vs. 15%) and insomnia (12.9% vs. 11%), respectively. Urinary tract infection (UTI) (11.5%) and stomachache (11.5%) were the most common SEs in PPMS patients. The most severe complication of the patients was back pain, while digestive complications were less severe. Also, insomnia and UTI were the patients’ most persistent SEs.

Conclusions:
The drug seems to be safe and well tolerated, as the SEs were mild and transient and they were consistent with most of the previous studies focusing on this medication.
Diagnostic Value of Mean Platelet Volume, Neutrophil-to-Lymphocyte Ratio, and Platelet to Lymphocyte Ratio for Late-Onset Neonatal Sepsis
Authors: Barekatain Behzad , Mardani Elahe , Sadeghnia Alireza , Heidari Zahra 
Published: January 2025

Abstract

Background:
Neonatal sepsis (NS) is the most common cause of neonatal mortality, currently confirmed with blood culture as the diagnostic gold standard. However, being time-consuming, false-negative results, being affected by even a single dose of antibiotics, and expensiveness are negative aspects. Therefore, we aimed to investigate the diagnostic value of complete blood count (CBC) parameters: mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) which have been suggested in previous studies.

Methods:
A total of 100 term and preterm neonates (age ≥ 32 weeks) hospitalized in Alzahra and Shahid Beheshti hospitals in Isfahan, Iran, were studied. Fifty neonates with late neonatal sepsis were placed in the case group, and 50 neonates with other diagnoses were placed in the control group. Neonatal blood samples were sent to the laboratory, and MPV, NLR, and PLR were measured.

Results:
The mean (standard deviation) of MPV was 7.20 (4.39) in the case group and 9.55 (0.87) in the control group, and there was a significant difference between them (P value = 0.001). At the cutoff point of 8.25 in MPV, the area under the curve (AUC) was 0.594 with a sensitivity of 100% and specificity of 30%. The mean (standard deviation) of NLR was 1.79 (1.21) in the case group and 2.28 (1.25) in the control group, and there was no significant difference between them (P value = 0.692). The mean (standard deviation) of PLR was 62.58 (34.57) in the case group and 65.11 (28.55) in the control group, and there was no significant difference between them (P value = 0.836).

Conclusions:
MPV, unlike NLR and PLR, can be used as a sensitive and cost-effective primary screening index in late NS at the cutoff point of 8.25 due. However, low specificity suggests a poor diagnostic value.
Osteonecrosis of the Hip: A New Strategic Ultrasound-Guided Intra-Articular Approach using Platelet-Rich Plasma with Viscosupplementation
Authors: Kanchanamala B. , Das Gautam , Kara Krishna , Vaghasia Aarti 
Published: January 2025

Abstract
Osteonecrosis of the hip is a progressive degenerative condition which necessitates early detection and initiation of therapy. Medical management and surgical intervention are the widely used options available for these patients. Another nonsurgical interventional option available for these patients is ultrasound-guided intra-articular injection using platelet-rich plasma (PRP) with viscosupplementation. A patient with bilateral hip necrosis was treated with PRP with 3% hyaluronic acid intra-articular supplementation in Daradia Pain Hospital. The detailed history, procedure, and follow-up are discussed in this report. PRP with viscosupplementation in our patient provided pain relief Numerical Rating Scale (NRS) reduced from 6 to 1, functional capacity, measured by increase in degree of abduction and internal rotation increased 10 degrees and 20 degrees ½ hour post procedure. The effect persisted on review of patient after 1 month. PRP with viscosupplementation could be a cost-effective alternative to medical or surgical management of osteonecrosis of the hip. However, further studies are needed to validate the results.
Ultrasonic Percutaneous Tenotomy with Platelet-Rich Plasma in a Recurrent Lateral Epicondylosis, Can be a Failure?
Authors: Chilumula Ch Pavani , Das Gautam , Kara Krishna Ramesh 
Published: January 2025

Abstract
Tendinopathies like lateral epicondylitis are a difficult problem requiring lengthy management. Emerging regenerative therapy like autologous blood, PRP, Extracorporeal shock wave, tenotomy have a significant role in the management of recalcitrant lateral epicondylosis. The below mentioned case has been a failure even after promising management trials are done.
Exploring the Impact of Sleep Duration on Cryptogenic Steatotic Liver Disease: A Nigerian Case–control Study
Authors: Ibinaiye Philip Oluleke , Olarinoye-Akorede Sefiya Adebanke , Igashi Joseph Bako , Baduku Tokan Silas , Usman Bello O , Manko Muhammad , Ahmad Abdurrahman El-fulaty , Tabari Musa Abdulkadir , Mustapha Shettima Kagu , Balogun Muhammad Shakir , Saleh Mohammed Kabir 
Published: January 2025

Abstract

Background:
Cryptogenic steatotic liver disease (CSLD) is a growing public health concern in Nigeria, characterized by its unknown etiology and potential progression to severe liver complications such as cirrhosis and liver cancer, posing significant health risks. Despite its prevalence, limited research exists on CSLD in Nigerian populations, hindering effective prevention and management strategies. Despite the growing burden of CSLD, limited research explicitly addresses its prevalence, risk factors, and optimal diagnostic approaches in the Nigerian population. Understanding how lifestyle, like sleep duration, could influence the development of CSLD could lead to more effective prevention and management strategies tailored to local needs.

Aim:
The aim of the study was to determine the association between CSLD and daily sleep hours.

Materials and Methods:
This case–control study involved 181 healthy subjects with CSLD and an equal number of normal subjects without CSLD as controls. Case–control was performed on a total number of 362 subjects. They were recruited into the study consecutively as they emerged after clinical, laboratory, and imaging screenings. A liver ultrasound (US) scan was done using a 3.5 MHz frequency transducer to screen for fatty liver. A daily sleep duration based on our local pattern was evaluated using the information from the administered questionnaire. The data were analyzed with GraphPad Prism software version 6.

Results:
The median (interquartile range) age of CSLD and control groups were 44.0 (28.5–54.0) and 44.0 (30.0–55.0) years. Wilcoxon matched-pairs signed rank comparison test showed no significant difference in the ages of the two study groups (P = 0.5578), indicating age matching of the study participants. There was a significant association (χ
2 = 59.03, df = 18, P < 0.0001) between age and development of CSLD. One hundred and eighty-one study subjects with CSLD comprised 83 (45.8%) males and 98 (54.1%) females. They were categorized according to US severity into mild (n = 89), moderate (n = 78), and severe CSLD (n = 14). The Chi-square test for independence showed a significant association (χ
2 = 40.33, df = 9; P = 0.0001) between subjects’ sleep duration and the development of CSLD.

Conclusion:
The study shows that reduced hours of sleep are significantly associated with the development of CSLD among Nigerians in Zaria.
Advancements in Imaging Techniques for Foreign Body Localization in the Neck and Removal: A Case Report and Literature Review
Authors: Shofoluwe Nurudeen Adebola , Shuaibu Iliyasu Yunusa , Jimoh Abdullahi Onimisi , Omodele Abdulrahman , Hamza Manir Anka , Abdullahi Idris , Abdullahi Amina Muhammad , Sanni Rasheedat 
Published: January 2025

Abstract
Stereotactic surgery, utilizing precise targeting through a coordinate system, is employed for various interventions in the head and neck. This article introduces a method for localizing and extracting deep-seated radiopaque foreign bodies from the neck’s soft tissues and skeletal structure. By utilizing a stereotactic guide system, precise targeting is achieved externally, enabling minimal-pain surgical removal with moderate complication risks. Collaboration between neurosurgeons and otorhinolaryngologists is essential for successful procedures. A case study of a 55-year-old male patient with a lodged foreign body in the neck, resulting from a road traffic accident, illustrates the procedure’s efficacy, detailing the patient’s presentation, diagnosis, and successful removal of the foreign body.
NLRP3 inflammasome and gut microbiota–brain axis: a new perspective on white matter injury after intracerebral hemorrhage
Authors: Cai Xiaoxi , Cai Xinhong , Xie Quanhua , Xiao Xueqi , Li Tong , Zhou Tian , Sun Haitao 
Published: January 2025

Abstract
Intracerebral hemorrhage is the most dangerous subtype of stroke, characterized by high mortality and morbidity rates, and frequently leads to significant secondary white matter injury. In recent decades, studies have revealed that gut microbiota can communicate bidirectionally with the brain through the gut microbiota-brain axis. This axis indicates that gut microbiota is closely related to the development and prognosis of intracerebral hemorrhage and its associated secondary white matter injury. The NACHT, LRR, and pyrin domain-containing protein 3 (NLRP3) inflammasome plays a crucial role in this context. This review summarizes the dysbiosis of gut microbiota following intracerebral hemorrhage and explores the mechanisms by which this imbalance may promote the activation of the NLRP3 inflammasome. These mechanisms include metabolic pathways (involving short-chain fatty acids, lipopolysaccharides, lactic acid, bile acids, trimethylamine-N-oxide, and tryptophan), neural pathways (such as the vagus nerve and sympathetic nerve), and immune pathways (involving microglia and T cells). We then discuss the relationship between the activated NLRP3 inflammasome and secondary white matter injury after intracerebral hemorrhage. The activation of the NLRP3 inflammasome can exacerbate secondary white matter injury by disrupting the blood-brain barrier, inducing neuroinflammation, and interfering with nerve regeneration. Finally, we outline potential treatment strategies for intracerebral hemorrhage and its secondary white matter injury. Our review highlights the critical role of the gut microbiota-brain axis and the NLRP3 inflammasome in white matter injury following intracerebral hemorrhage, paving the way for exploring potential therapeutic approaches.
Bladder and bowel dysfunction in children: A physiotherapeutic, narrative review
Authors: Meena Prachi Raj , Tiwari Madhusudan , Meena Raj Kumar 
Published: January 2025

Abstract
Incontinence is a global health and social issue. It not only affects an individual’s physical, mental, and social health but also adds to the country’s economic burden. The relationship between wetting in childhood is related to urgency, voiding postponement, and hard stools in adolescence. The patterns of childhood incontinence often fail to resolve with age and are more difficult to treat. Hence an awareness regarding these simple measures to understand, identify, and address these symptoms is important in clinical practice as a preventive measure. Articles were searched through electronic databases, such as PubMed, Google Scholar. Keywords “Bladder and Bowel Dysfunction, Incontinence, Pelvic Floor Muscle Training, Breathing, Posture, Children” were used. Boolean operators such as AND, OR, and NOT. The study selection was done as per PRISMA flow diagram This narrative review covers the basic understanding of defecation function and urination function to educate the reader to develop an approach during early childhood to attain healthy bladder and bowel habits. The role of behavioral modification and nutrition has been emphasized in previous articles. An attempt to address the preventive and therapeutic role of physiotherapeutic management of symptoms of bladder and bowel dysfunction is made. The role of posture, respiratory rhythm, pelvic floor exercise, soft tissue manipulation and Interferential Therapy (IFT), Transcutaneous electrical stimulation (TENS) is emphasized upon from early childhood.
Management of open abdomen with enteroatmospheric fistulas: A retrospective analysis of 191 cases
Authors: Liu Bin , Zhang Jinpeng , Teng Yitan , Zhang Zherui , Wu Lei , Hong Zhiwu , Ren Huajian , Wang Gefei , Wu Xiuwen , Ren Jianan 
Published: January 2025

Background:
This study investigates the management of open abdomen, a significant advancement in abdominal damage control surgery essential for treating severe trauma, intra-abdominal infections, and abdominal compartment syndrome. However, challenges such as fluid loss, electrolyte imbalances, failures in primary fascial closure, and the development of enteroatmospheric fistulas remain prevalent.

Methods:
This observational research retrospectively analyzed clinical data from 191 patients with open abdominal cavities and enteroatmospheric fistulas admitted to the Department of General Surgery, Jinling Hospital, between January 2012 and January 2021. This study collected and analyzed baseline patient data, including age, gender, body mass index (BMI), primary disease. The study compared two groups based on temporary closure methods: Skin-implant and skin-suture-only.

Results:
This analysis revealed that 81.7% of the 191 patients included in the final analysis were male, with an average age of 46.5 years and a BMI of 21.7 kg/m2. The primary diseases were predominantly trauma, gastrointestinal tumors, gastrointestinal perforations, intestinal obstructions, and acute pancreatitis. Various methods for fistula closure and temporary abdominal closure techniques were employed, with abdominal wall defects repaired using the component separation technique or biological patches.

Conclusion:
These findings underscore the complexity of managing open abdomen cases with enteroatmospheric fistulas, highlight the importance of early intervention and appropriate temporary closure techniques for achieving optimal outcomes, and offer valuable insights into the diagnosis and treatment of enteroatmospheric fistulas.
The performance measures analysis of Erlang distribution in solving phase type distribution
Authors: Olanrewaju Agboola Sunday , Ayoade Abayomi A. , Fransis Sebastine , Dotia Ahmed K. 
Published: January 2025

The importance of phase type distribution in modeling activities cannot be under emphasized when both a distribution's initial and second moments are accessible or when the sequence of data points for computing moments is the information available. In continuous time process for an absorbing finite state Markov chain, the phase-type distribution can be thought of as the distribution of the time until absorption and it is widely used in queueing theories and other fields of applied probabilities with the used of generalized Erlang, Coxian, Hypo-exponential, and Hyper-exponential distributions. In this study, performance measures of phase type distribution using Erlang - r distribution, and mix Erlang –(r − 1) with Erlang - r distributions have been looked into, in order to provide meaningful study into the probability function, mean, kth moment, variance, Laplace Stieltjes transform and squared coefficient of variation of phase type distribution. We began from the tractability and memory less properties of exponential distribution, and since these properties are not enough, we examined the journey through a series of exponential phases to arrive at performance measures. Illustrative examples are demonstrated for various cases to arrive at various values for probability functions, Laplace Stieltjes transform, squared coefficient of variation, kth moment, mean and variance for the phase type distribution. The result of its variation and mean value, as well as the likelihood that the waiting period will exceed 12 time units are obtained on the waiting time until the fourth arrival with Poisson arrival process. And we demonstrate that, using the Erlang-r distribution, the squared coefficient of variation might have a variety of values. Also, by increasing the number of phases (r) and setting the parameter at each phase to be rμ. The variance goes to zero and the expectation stays at 1/μ in the limit as r→∞
GC-MS characterization and bioactivity studies of aerial part of <i>Hilleria latifolia</i> (lam) extract and fractions: Antioxidant and antibacterial potentials
Authors: Ajayi O. S. , Arowosegbe S.M. , Olawuni I.J. 
Published: January 2025

This study sets out on identifying active compounds within Hilleria latifolia (Lam) extracts and fractions, with a specific emphasis on their potential antibacterial and antioxidant activities. GC-MS analysis was employed to characterize the chemical constituents in the n-hexane (n-Hex) and dichloromethane (DCM) fractions. The nHex and DCM fractions of the aerial part of Hilleria latifolia (Lam) revealed the presence of 45 compounds (27 in n-Hex and 18 in DCM), many of which are known for their antioxidant, anticancer, anti-inflammatory, and antibacterial properties. Antioxidant activity was evaluated through iron-reducing power (FRAP), nitric oxide (NO) inhibition, metal chelating ability (MC), total antioxidant capacity (TAC) and 2,2-diphenyl-1- picrylhydrazyl (DPPH) assays. The EtOAc fraction showed the best activities in DPPH (IC 0.70±0.026 50 mg/mL), FRAP (478.503±8.607 mg AAE/g), MCA (0.199±0.085 mg/mL) and TAC (227.37±60.949 mg AAE/g). The sensitivity testing of the crude methanolic extract and fractions were carried out using the agarwell diffusion method against three gram-positive (Bacillus stearothermophillus, Staphylococcus aureus, and Micrococcus luteus) and five gram-negative (Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Proteus vulgaris, and Serratia marcescens) bacterial strains. The crude methanol extract and aqueous fraction did not show activity towards all the bacterial strains. However, the n-Hex fraction exhibited moderate antibacterial activity particularly against K. pneumoniae (12 mm), M. luteus (9 mm), P. aeruginosa (12 mm), B. stearothermophillus (10 mm), and S. aureus (12 mm), the DCM fraction also showed effective antibacterial activity against K. pneumoniae (16 mm), M. luteus (12 mm), P. vulgaris (11 mm), B. stearothermophillus (12 mm), E. coli (12 mm) and S. aureus (11 mm). The ethyl acetate (EtOAc) fractions have shown considerable antibacterial activity against K. pneumoniae (12 mm), M. luteus (12 mm), P. vulgaris (11 mm), B. stearothermophillus (12 mm) and S. aureus (8 mm). The present findings demonstrate the antioxidant and antibacterial properties of Hilleria latofolia fractions, underscoring the need for further research to confirm their medicinal potential and explore its pharmaceutical applications.