bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapeutic roles of thiazides and loop diuretics in blood pressure control and renal protection against chronic kidney disease
Authors: Jo Wonji , Koh Eun Sil , Chung Sungjin 
Published: May 2023

AbstractFluid overload secondary to loss of functional nephron mass can elevate blood pressure, which is characteristic of hypertension shown in chronic kidney disease (CKD). Therefore, it is logical to use diuretics at appropriate dose to lower blood pressure in patients with CKD and hypertension. Despite the theoretical background on the use of diuretics in CKD, there have been no definitive data on the effectiveness or safety of diuretics as first-line therapy for the management of hypertension in patients with CKD. Results from some clinical trials have demonstrated that diuretics would not lower blood pressure. They could even worsen electrolyte imbalance and kidney function when they are administered in patients with CKD. Major clinical practice guidelines on management of blood pressure or CKD have stated that evidence for benefits of thiazide diuretics is not conclusive yet in patients with advanced CKD, although loop diuretics are often effective for volume control at lower glomerular filtration rate. Recently, evidence for diuretics as effective blood pressure lowering agents in patients with advanced CKD is increasing. Renoprotective effect of thiazide or loop diuretics might represent a consequence of their influence on blood pressure or their ability to potentiate the effect of renin-angiotensin system blockade by making intraglomerular pressure more renin-angiotensin system-dependent, although their direct benefit on renal function remains controversial. This review summarizes recent data on the possible role of diuretics in lowering blood pressure, slowing the progression of kidney disease, and reducing cardiovascular risk in CKD patients.
International youth mental health case study of peer researchers’ experiences
Authors: Spuerck Inga , Stankovic Milos , Fatima Syeda Zeenat , Yilmas Elmas , Morgan Nicholas , Jacob Jenna , Edbrooke-Childs Julian , Vostanis Panos 
Published: May 2023

Abstract
Background
The involvement of young people as peer researchers, especially with lived experience, is increasingly considered important in youth mental health research. Yet, there is variation in the understanding of the role, and limited evidence on its implementation across different research systems. This case study focusses on the barriers and enablers of implementing peer researcher roles within and across majority world countries contexts.

Methods
Based on an international youth mental health project involving different levels of peer researchers and participants from eight countries, peer researchers and a co-ordinating career researcher reflect on lessons regarding enabling and challenging factors. These reflections are captured and integrated by a systematic insight analysis process.

Results
Building on existing international networks, it was feasible to actively involve peer researchers with lived experience in a multi-country mental health study, who in turn recruited and engaged young participants. Identified challenges include the terminology and definition of the role, cultural differences in mental health concepts, and consistency across countries and sites.

Discussion
Peer researchers’ role could be strengthened and mainstreamed in the future through ongoing international networks, training, sufficient planning, and active influence throughout the research process.
Trial registration: Not applicable.
Knowledge, usability, and impact of wearable fitness devices among community exercisers in Ghana
Authors: Worlanyo Johnson Kwakye , Adams Caleb , Adedugbe Benjamin Oluwole , Lokoyi Ose-Lovet Osita , Moses Monday Omoniyi 
Published: May 2023

AbstractBackgroundThere has been a rapid evolution of wearable technologies such as wearable fitness devices (WFDs) in recent years globally. The continuous release of upgraded WFDs with diverse qualities presents new opportunities for research into their knowledge, usability, and impact in developed countries. Although few studies have separately examined the knowledge, usability, and impact of WFDs in Sub-Saharan Africa, more information is needed on combined knowledge, usability, and impact of smart WFDs among Ghanaians. The present study (1) assessed the knowledge, usability, and impact of WFDs among healthy community exercisers, and (2) investigated the factors that affect the usage and barriers to the use of WFDs in Ghana.MethodsThe quantitative descriptive design study had 152 healthy community exercisers (mean age = 23.37 ± 5.18 years) as participants. Self-structured questionnaire and System Usability Scale were administered.ResultsThere were more non-users of WFDs (73.7%) than users (26.3%). Knowledge on WFDs among participants was high, usability was poor (mean SUS score = 66.87 ± 13.67) among users, and a positively fair impact on users was obtained. Performance expectancy was among the other factors that affected the usage of WFDs and price value was among the significant barriers identified.ConclusionThere are more non-users of WFDs than users. Knowledge on WFDs among participants was high, usability was poor among users with positively fair impact on users.
Psychotropic medication for problem behaviours in intellectual disability and autism spectrum disorder: the need for caution
Authors: Bertelli Marco O. 
Published: May 2023

SUMMARYMany persons with intellectual developmental disorders and/or autism spectrum disorder presenting problem behaviours undergo pharmacotherapy without receiving an appropriate psychiatric assessment and diagnosis. Instead, prescription of psychotropic medication should have specific aims and involve interdisciplinary assessment, personalisation and patient and family participation. Current knowledge about pharmacological management of problem behaviours in this population is limited, necessitating extreme caution in clinical practice and more research into the complex interrelated factors that affect presentation, course and treatment response.
Understanding self-harm and suicidal behaviours in South Asian communities in the UK: systematic review and meta-synthesis
Authors: Özen-Dursun Büşra , Kaptan Safa Kemal , Giles Sally , Husain Nusrat , Panagioti Maria 
Published: May 2023

Background
Previous findings have indicated that self-harm and suicide are associated with different rates, and different risk and protective factors in South Asian people compared with White people in the UK. Substantial qualitative research has explored experiences of self-harm and suicide in South Asian people.

Aims
The study aims to review the existing qualitative evidence on self-harm and suicidal behaviours in South Asian communities in the UK.

Method
Systematic searches were conducted on Medline, EMBASE, PsycINFO, CINAHL, Open Dissertations and the British Library Ethos databases. We selected qualitative studies from both journals and grey literature that included South Asian participants who were resident in the UK and presented perceptions or experiences of self-harm and/or suicidal behaviour. Analysis was undertaken based on the meta-ethnographic approach.

Results
Fifteen studies were included in the analysis. Experience of self-harm was discussed based on three aspects: behind self-harm, functions of self-harm and recovery from self-harm. ‘Behind self-harm’ refers to factors associated with self-harm and suicide. ‘Functions of self-harm’ captures the meaning attributed to self-harm and suicide. ‘Recovery from self-harm’ encapsulates personal and professional help, and practical suggestions for the improvement of mental health services.

Conclusions
Although some similarities with the majority White population were present, there were also crucial differences that need consideration when shaping health policies, improving access to health services and developing culturally sensitive psychosocial interventions for self-harm and suicide specific to South Asian communities in the UK.
SARS-CoV-2 susceptibility and COVID-19 illness course and outcome in people with pre-existing neurodegenerative disorders: systematic review with frequentist and Bayesian meta-analyses
Authors: Smadi Muhannad , Kaburis Melina , Schnapper Youval , Reina Gabriel , Molero Patricio , Molendijk Marc L. 
Published: May 2023

BackgroundPeople with neurodegenerative disease and mild cognitive impairment (MCI) may have an elevated risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and may be disproportionally affected by coronavirus disease 2019 (COVID-19) once infected.AimsTo review all eligible studies and quantify the strength of associations between various pre-existing neurodegenerative disorders and both SARS-CoV-2 susceptibility and COVID-19 illness course and outcome.MethodPre-registered systematic review with frequentist and Bayesian meta-analyses. Systematic searches were executed in PubMed, Web of Science and preprint servers. The final search date was 9 January 2023. Odds ratios (ORs) were used as measures of effect.ResultsIn total, 136 primary studies (total sample sizen= 97 643 494), reporting on 268 effect-size estimates, met the inclusion criteria. The odds for a positive SARS-CoV-2 test result were increased for people with pre-existing dementia (OR = 1.83, 95% CI 1.16–2.87), Alzheimer's disease (OR = 2.86, 95% CI 1.44–5.66) and Parkinson's disease (OR = 1.65, 95% CI 1.34–2.04). People with pre-existing dementia were more likely to experience a relatively severe COVID-19 course, once infected (OR = 1.43, 95% CI 1.00–2.03). People with pre-existing dementia or Alzheimer's disease were at increased risk for COVID-19-related hospital admission (pooled OR range: 1.60–3.72). Intensive care unit admission rates were relatively low for people with dementia (OR = 0.54, 95% CI 0.40–0.74). All neurodegenerative disorders, including MCI, were at higher risk for COVID-19-related mortality (pooled OR range: 1.56–2.27).ConclusionsOur findings confirm that, in general, people with neurodegenerative disease and MCI are at a disproportionally high risk of contracting COVID-19 and have a poor outcome once infected.
Tbx5 overexpression in embryoid bodies increases TAK1 expression but does not enhance the differentiation of sinoatrial node cardiomyocytes
Authors: Dai Yunkai , Nasehi Fatemeh , Winchester Charles D. , Foley Ann C. 
Published: May 2023

ABSTRACT
Genetic studies place Tbx5 at the apex of the sinoatrial node (SAN) transcriptional program. To understand its role in SAN differentiation, clonal embryonic stem (ES) cell lines were made that conditionally overexpress Tbx5, Tbx3, Tbx18, Shox2, Islet-1, and MAP3k7/TAK1. Cardiac cells differentiated using embryoid bodies (EBs). EBs overexpressing Tbx5, Islet1, and TAK1 beat faster than cardiac cells differentiated from control ES cell lines, suggesting possible roles in SAN differentiation. Tbx5 overexpressing EBs showed increased expression of TAK1, but cardiomyocytes did not differentiate as SAN cells. EBs showed no change in the expression of the SAN transcription factors Shox2 and Islet1 and decreased expression of the SAN channel protein HCN4. EBs constitutively overexpressing TAK1 direct cardiac differentiation to the SAN fate but have reduced phosphorylation of its targets, p38 and Jnk. This opens the possibility that blocking the phosphorylation of TAK1 targets may have the same impact as forced overexpression. To test this, we treated EBs with 5z-7-Oxozeanol (OXO), an inhibitor of TAK1 phosphorylation. Like TAK1 overexpressing cardiac cells, cardiomyocytes differentiated in the presence of OXO beat faster and showed increased expression of SAN genes (Shox2, HCN4, and Islet1). This suggests that activation of the SAN transcriptional network can be accomplished by blocking the phosphorylation of TAK1.
T1 mapping and multimodel diffusion-weighted imaging in the assessment of cervical cancer: a preliminary study
Authors: Li Shujian , Liu Jie , Zhang Wenhua , Lu Huifang , Wang Weijian , Lin Liangjie , Zhang Yong , Cheng Jingliang 
Published: May 2023

Objective: To evaluate the clinical feasibility of T1 mapping and multimodel diffusion-weighted imaging (DWI) for assessing the histological type, grade, and lymphovascular space invasion (LVSI) of cervical cancer. Methods: Eighty patients with cervical cancer and 43 patients with a normal cervix underwent T1 mapping and DWI with 11 b-values (0–2000 s/mm2). Monoexponential, biexponential, and kurtosis models were fitted to calculate the apparent diffusion coefficient (ADC), pure molecular diffusion (D), pseudo-diffusion (D*), perfusion fraction (f), mean diffusivity (MD), and mean kurtosis (MK). Native T1 and DWI-derived parameters (ADCmean, ADCmin, Dmean, Dmin, D*, f, MDmean, MDmin, MKmean, and MKmax) were compared based on histological type, grade, and LVSI status. Results: Native T1 and DWI-derived parameters differed significantly between cervical cancer and normal cervix (all p < 0.05), except D* (p = 0.637). Native T1 and MKmean varied significantly between squamous cell carcinoma (SCC) and adenocarcinoma (both p < 0.05). ADCmin, Dmin, and MDmin were significantly lower while MKmax was significantly higher in the high-grade SCC group than in the low-grade SCC group (all p < 0.05). LVSI-positive SCC had a significantly higher MKmean than LVSI-negative SCC (p < 0.05). Conclusion: Both T1 mapping and multimodel DWI can effectively differentiate cervical cancer from a normal cervix and cervical adenocarcinoma from SCC. Furthermore, multimodel DWI may provide quantitative metrics for non-invasively predicting histological grade and LVSI status in SCC patients. Advances in knowledge: Combined use of T1 mapping and multimodel DWI may provide more comprehensive information for non-invasive pre-operative evaluation of cervical cancer.
Clinical efficacy of breathing training combined with core stability training in chronic nonspecific low back pain
Authors: Yu Duoduo , Yu Yaming , Peng Qian , Luo Jingting , He Xu 
Published: May 2023

Objective: The study aimed to assess the clinical efficacy of breathing training combined with core stability training in chronic nonspecific low back pain (CNLBP).
Methods: This was a retrospective study. Of 60 included patients with CNLBP admitted by the Sichuan Province Orthopedic Hospital between December 2020 and February 2022. Random number table method was used to divide thirty patients to a control group, and the rest 30 to an observation group. The control group received core stability training, while the observation group underwent breathing training in addition to the exact treatment provided for the control group. To assess the utility of breathing and core stability training for CNLBP treatment, intergroup comparisons were made for clinical outcomes, the VAS, SF‐36, and SCODI scores before treatment and at three and seven weeks post‐treatment, and static and dynamic low‐back muscular endurance before and after treatment.
Results: The observation group had an overall response rate (ORR) of 96.67%, significantly higher than that (73.33%) of the control group (p< 0.05). Following the intervention, the VAS and SCODI scores declined in both groups; The SF‐36 score was elevated in both groups, and likewise. At the end of treatment, both groups exhibited improved static and dynamic muscular endurance of the low back, and the improvement was significantly more distinct in the observation group (p< 0.05).
Conclusion: Compared with core stability training as a sole treatment, breathing training combined with core stability training can yield better outcomes, ameliorate lumbar spine function, relieve pain and enhance low‐back muscular endurance in patients with CNLBP.
doi: https://doi.org/10.12669/pjms.39.4.6918
How to cite this: Yu D, Yu Y, Peng Q, Luo J, He X. Clinical efficacy of breathing training combined with core stability training in chronic nonspecific low back pain. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.6918
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Healthcare Simulation: An effective way of learning in health care
Authors: Munazza Saleem  , Khan Zuhera 
Published: May 2023

Background and Objective: Simulation-based learning has been a part of teaching in healthcare for a long time; however, in recent decades, simulation-based learning has been adopted by a significant number of healthcare institutes at different levels to improve practical skills, confidence, and preparedness to ensure patient safety and its application in real-life situations towards better patient care. The main objective of this paper was to use existing literature to explore aspects of simulation in healthcare teaching.
Methods: It is a narrative review on simulation in healthcare that was conducted by using various search engines for English-language articles published between 2010 and August 2020. The main search terms were simulation, healthcare teaching, and simulation in healthcare. All articles found relevant to the title and/or abstract were retrieved. Searches were conducted using the academic databases PubMed, Google Scholar, MEDLINE, CINAHL, and Athabasca University (AU) library site. The studies were reviewed if they were considered relevant to the search by the primary authors.
Results: Thirty-nine articles, which met the pre-set criteria, were analyzed and employed as a reference in this paper to support the idea that simulation is an effective way of learning in healthcare.
Conclusion: This paper reviewed various aspects of simulation, including its background, philosophies, and highlighted the advantages and disadvantages of incorporating simulation as a pedagogical approach into current educational curriculums for healthcare students. Furthermore, it presents a brief discussion on the current uses of simulation, followed by the educational strategies related to simulation and the importance of debriefing in simulation activities.
doi: https://doi.org/10.12669/pjms.39.4.7145
How to cite this: Saleem M, Khan Z. Healthcare Simulation: An effective way of learning in health care. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7145
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Significance of tumor markers combined with neutrophil to lymphocyte ratio, D-dimer and T-lymphocyte in the diagnosis of colon cancer
Authors: Li Qianying , Geng Shumei , Zhang Xiaowei , Jia Zilong 
Published: May 2023

Objective: To analyze the value of combined detection of tumor markers, neutrophil to lymphocyte ratio (NLR), D-dimer and T lymphocyte in the diagnosis of colon cancer.
Methods: This is a retrospective study. A total of 80 patients with colon cancer and 80 patients with benign colon mass admitted to Baoding NO.1 Central Hospital from June 10, 2021 to December 10, 2022 were divided into the study group and the control group. Further comparison was performed on the tumor markers, NLR, D-dimer and T-lymphocyte levels between the two groups, associated with the comparison of corresponding levels of colon cancer at different stages. In addition, correlation analysis was carried out focusing on the above indicators with colon cancer.
Results: Carcinoembryonic antigen (CEA), CA199, NLR, D-dimer and CD8+ cell count levels in the study group were significantly higher than those in the control group, while CD4+ cell count and CD4+/CD8+ ratio were obviously lower (P<0.05). Among I-IV colon cancer, the highest levels of CEA, CA199, NLR, D-dimer, CD4+ and CD4+/CD8+ ratio were found in patients with Stage-IV colon cancer, while the level of CD8+ was the lowest (P<0.05). Correlation analysis indicated that CEA, CA199, NLR, D-dimer and CD8+ were positively correlated with whether the patient had colon cancer (r=0.841, 747,991,889,565, all P<0.05), but negative correlations with CD4+ and CD4+/CD8+ ratio (r=-0.999, -0.994, all P<0.05).
Conclusion: The detection of tumor markers combined with NLR, D-dimer and T-lymphocytes has reference value in the diagnosis of colon cancer.
doi: https://doi.org/10.12669/pjms.39.4.7157
How to cite this: Li Q, Geng S, Zhang X, Jia Z. Significance of tumor markers combined with neutrophil to lymphocyte ratio, D-dimer and T-lymphocyte in the diagnosis of colon cancer. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7157
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Causal attributions of failure among post graduate medical residents in exit fellowship examination in Pakistan: A qualitative study
Authors: Mahmood Malik Lamees , Khalid Dr. Tanzeela , Ashar Abid 
Published: May 2023

Background and Objective: Causal attributions are reasons given to certain events in life including failure and success. The objective of this qualitative study was to explore the attributions perceived as the cause of failure by post graduate residents, failing the final clinical exit examination of Fellowship of College of Physicians and Surgeons Pakistan (FCPS).
Methods: This exploratory study was conducted from July 2021 to July 2022, at Jinnah Hospital, Lahore. Study population was selected by purposeful maximal variation sampling. A total of ten post graduate residents from four specialties, failing in FCPS part two clinical examination were included. After written informed consent, semi structured face to face, in depth interviews were conducted. Data saturation was achieved after eight interviews after which two more interviews were carried out. All interviews were recorded and transcribed verbatim. Thematic analysis of the data was done by synthesizing codes into categories and themes.
Results: A total of 17 attributions noted were grouped into five categories namely ‘Inadequate exam preparation’, ‘Personal factors,’ ‘Exam related factors,’ ‘Training related factors and ‘Luck’. Two main themes of External and Internal factors emerged from these. Common attributions were; lack of effort (8/10), inadequate knowledge (8/10), family commitments (7/10), luck (8/10) and examiner’s attitude (5/10).
Conclusions: Most of the residents attributed internal, unstable and controllable factors like inadequate knowledge and lack of effort. In addition, external uncontrollable factors of bad luck and harsh attitude of examiners were considered as contributory factors towards failure.
doi: https://doi.org/10.12669/pjms.39.4.7693
How to cite this: Malik LM, Khalid T, Ashar A. Causal attributions of failure among post graduate medical residents in exit fellowship examination in Pakistan: A qualitative study. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7693
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.