bluuebunny/crossref_metadata_2025_split huggingface dataset:
32. Correlation between Body Mass Index and Waist Circumference with Hypertension in Elderly at Seroja Health Center, Bekasi City
Authors: Dewi Anggieta Kumala , Maulida Syifa Nur , Luthfiah Hasna 
Published: April 2023

Background: In 2020, Indonesia is estimated to have around 80,000,000 individuals aged >65 years old. The types of diseases that often occur in the elderly are non-communicable diseases (NCD), chronic and degenerative diseases, especially cardiovascular diseases. Hypertension is one of the diseases with the highest mortality and morbidity rates in Indonesia. The risk factor that is closely related to this disease is obesity. Central obesity has played a significant role in the occurrence of hypertension.

Objective: This study aims to assess the relationship between Body Mass Index (BMI) and Waist Circumference (WC) with the incidence of hypertension in the elderly population at Seroja Public Health Center, Bekasi.

Method: This study is a cross-sectional study, conducted in December 2022 at Seroja Public Health Center, with a total of 65 residents aged $60 years enrolled in this study. A face-to-face questionnaire survey and physical examination were conducted.

Result: The overall prevalence rate of hypertension was 44,6% with 13,8% males and 30,8% females. 43,1% of the samples were obese and 76,9% of the total population had central obesity. There was a positive correlation between BMI and WC with hypertension (P < 0,001 and p = 0,007 respectively). The multivariate logistic analysis showed that age, history of dyslipidaemia, and waist circumference were a predictor of hypertension in the elderly (P
< 0.001).

Conclusion: There is a significant relationship between BMI and WC with the incidence of hypertension, WC is found to be one of the predictors of hypertension in elderly
Skin lesions in a man with end-stage renal disease
Authors: Makowicz Chelsea 
Published: April 2023

ABSTRACT
Calciphylaxis is an uncommon condition most often seen in patients with end-stage renal disease. It is easily mistaken for other more common conditions and requires a high level of suspicion to make a timely diagnosis. Although various treatments such as IV sodium thiosulfate and bisphosphonates have been used for management, calciphylaxis remains a condition with a high mortality that requires an interdisciplinary approach for optimal management.
Stronger together
Authors: Swanson Rebecca K. , Diederich Theresa A. , Jordan-Schaulis Samantha , Reicks Brandon L. , Zimmerman Risa 
Published: April 2023

ABSTRACT
Physician associates/assistants (PAs) and advanced practice RNs (APRNs) are a vital part of the healthcare team. As the PA and APRN workforce continues to grow, collaborations can move beyond the bedside. With organizational support, a shared APRN/PA Council allows these clinicians to raise a collective voice on issues that are unique to their practice and to implement meaningful solutions, thus improving the quality of their work environment and clinician satisfaction.
Racism
Authors: Anderson James , Devine Patricia J. , Greenlee Quanté , Najera Deanna Bridge , Dominguez Delilah 
Published: April 2023

ABSTRACT
Even in the context of major advances in medicine, racial minorities continue to suffer worse medical outcomes. Although race is defined as a social, nonscientific construct, researchers have continued to use it as proxy to explain genetic and evolutionary differences among patients. Poorer health outcomes among Black Americans are known to be related to the psychosocial and physiological stress of racism. Black communities experience premature health deterioration because of the cumulative effects of social, economic, and political oppression and marginalization. Additionally, recent assertions that racism is best seen as a chronic disease has added value to understanding the effect of racism on the health of Black people. Using evidence-based information to assess the health of Black patients is a key step to assist clinicians in promptly addressing this chronic threat to the health of Black patients.
What is the analgesic ceiling dose of ketorolac for treating acute pain in the ED?
Authors: Jaglal Reynold , Nemec Eric C. 
Published: April 2023

ABSTRACT
Recent research has suggested that ketorolac has an analgesic ceiling effect, meaning that despite increased dosages, the patient obtains no additional pain relief and is more likely to suffer adverse drug reactions. This article describes the outcomes of these studies and the recommendation to use the lowest possible dose for the shortest time when treating patients with acute pain.
Postexposure prophylaxis (PEP) of HIV among adults
Authors: El Hussein Mohamed Toufic , Malyshev Ivan 
Published: April 2023

Abstract:
In the last several decades, postexposure prophylaxis (PEP) with antiretroviral therapy (ART) has become an effective tool for the prevention of HIV transmission. The continuous evolution of antiretrovirals and the associated update of clinical practice guidelines create a challenge for NPs caring for patients exposed to HIV. Understanding the life cycle of HIV is of paramount importance in streamlining treatment regimens in exposed individuals. ART is a complex combination of drugs targeting different stages of the virus's life cycle within the host. NPs play an essential role in managing treatment for people exposed to HIV and following up on these patients' response and adherence to the treatment protocol. This article provides a comprehensive overview of HIV and step-by-step guidance for NPs treating patients who have been exposed.
Therapeutic Drug Monitoring of Perampanel in Children With Refractory Epilepsy: Focus on Influencing Factors on the Free-Perampanel Concentration
Authors: Qu Rui , Dai Yuanyuan , Zhu Zengyan , Lu Xiaoyun , Zhou Rui , Qu Xiangju , Chen Xuqin 
Published: April 2023

Background:
This study aimed to assess the effect of perampanel dose, age, sex, and antiseizure medication cotherapy on steady-state free-perampanel concentration in children with refractory epilepsy, as well as the relationship between inflammation and the pharmacokinetics of perampanel.

Methods:
This prospective study in China included 87 children with refractory epilepsy treated with adjunctive perampanel therapy. Free and total perampanel concentrations in plasma were determined using liquid chromatography–tandem mass spectrometry. Free-perampanel concentration was compared among patients with various potential influencing factors.

Results:
A total of 87 pediatric patients (44 female children) aged 2–14 years were enrolled. The mean free-perampanel concentration and free concentration-to-dose (CD) ratio in plasma were 5.7 ± 2.7 ng/mL (16.3 ± 7.7 nmol/L) and 45.3 ± 21.0 (ng/mL)/(mg/kg) [129.6 ± 60.1 (nmol/L)/(mg/kg)], respectively. The protein binding of perampanel in plasma was 97.98%. A linear relationship was observed between perampanel dose and free concentration in plasma, and a positive relationship was found between the total and free-perampanel concentrations. Concomitant use of oxcarbazepine reduced the free CD ratio by 37%. Concomitant use of valproic acid increased the free CD ratio by 52%. Five patients had a plasma high-sensitivity C-reactive protein (Hs-CRP) level of >5.0 mg/L (Hs-CRP positive). The total and free CD ratios of perampanel were increased in patients with inflammation. Two patients with inflammation developed adverse events, which disappeared as the Hs-CRP level returned to normal, and neither required perampanel dose reduction. Age and sex did not influence the free-perampanel concentration.

Conclusions:
This study found complex drug interactions between perampanel and other concomitant antiseizure medications, providing valuable information to enable clinicians to apply perampanel in the future reasonably. In addition, it may be important to quantify both the total and free concentrations of perampanel to assess complex pharmacokinetic interactions.
Stretching Promotes Wound Contraction Through Enhanced Expression of Endothelin Receptor B and TRPC3 in Fibroblasts
Authors: Kawai Kenichiro , Ishise Hisako , Kubo Tateki , Larson Barrett , Fujiwara Toshihiro , Nishimoto Soh , Kakibuchi Masao 
Published: April 2023

Background:
One factor that can contribute to the development of hypertrophic scar contracture is mechanical stress. Mechanical cyclic stretch stimuli enhance the secretion of endothelin-1 (ET-1) from keratinocyte. Cyclical stretching of fibroblasts also increases the expression level of the transient receptor potential ion channel (TRPC3), which is known to couple with the endothelin receptor and induce intracellular Ca2+ signaling via the calcineurin/nuclear factor of activated T cells (NFAT) pathway. The aim of this study was to investigate the relationship between keratinocytes and fibroblasts when they are stretched.

Methods:
The conditioned medium from stretched keratinocyte was added to the fibroblast populated collagen lattice. Then, we analyzed the levels of endothelin receptor in the human hypertrophic scar tissue and stretched fibroblasts. To address the function of TRPC3, we have used an overexpression system with the collagen lattice. Finally, the TRPC3 overexpressing fibroblasts were transplanted to mouse dorsal skin, and the rate of skin wound contraction was assessed.

Results:
Conditioned medium from stretched keratinocytes increased the rate of contraction of fibroblast populated collagen lattice. In human hypertrophic scar and stretched fibroblasts, endothelin receptor type B was increased. Cyclic stretching of TRPC3 overexpressing fibroblasts activated NFATc4, and stretched human fibroblasts showed more activation of NFATc4 in response to ET-1. The wound treated with TRPC3 overexpressing fibroblasts showed more contraction than control wound.

Conclusion:
These findings suggest that cyclical stretching of wounds have an effect on both keratinocytes and fibroblasts, where keratinocytes secret more ET-1, and fibroblasts develop more sensitivity to ET-1 by expressing more endothelin receptors and TRPC3.
Assessment of Health Disparities and Barriers to Accessing Keratoconus and Crosslinking at a Tertiary Referral Center
Authors: Angelo Lize , Gokul Akilesh , Wadhwa Himanshu , McGhee Charles N. J. , Ziaei Mohammed 
Published: April 2023

Purpose:
The aim of this study was to determine the barriers to accessing the crosslinking service in Auckland, New Zealand.

Methods:
This was a prospective 1-year study of patients at Auckland District Health Board. Studied parameters included age, sex, body mass index, ethnicity, New Zealand Deprivation (NZDep; an area-based measure of socioeconomic status, 1 = low deprivation–10 = high deprivation) score of residence, disease severity (maximum keratometry and thinnest corneal thickness), attendance, distance travelled, car ownership, employment status, and visual outcomes. Statistical analysis was performed using independent t tests, Pearson correlation, independent samples ANOVA, MANCOVA, and binomial logistic regression.

Results:
Four hundred fifty-four patients with keratoconus were analyzed and had a mean age of 24.1 ± 0.8 years, mean body mass index of 33.0 ± 9.7 kg/m2, and 43% were female. Pacific Peoples consisted 40.2% of the population; Māori 27.2%; Europeans 21.2%; Asian 9.9%; and Middle Eastern, Latin American, and African (MELAA) 1.3%. The mean distance travelled was 12.5 ± 9.5 km, NZDep score was 6.8 ± 2.6, and attendance was 69.0 ± 42.5%. The lowest attendance was observed in Pacific Peoples (58.9%) and the highest was in Asians (90%) (P = 0.019). The mean worst-eye visual acuity at attendance was 0.75 ± 0.47 logMAR (6/35). Unemployment was associated with worse best-eye visual acuity at FSA (P = 0.01) and follow-up (P < 0.05). Māori and Pacific Peoples had the highest NZDep (P < 0.001), were younger at presentation (P = 0.019), had higher disease severity (P < 0.001), and worse visual acuity (P < 0.001).

Conclusions:
Poor attendance was seen in this cohort. Pacific Peoples and Māori presented younger with worse disease severity and visual acuity but also had the highest nonattendance. These results suggest that deprivation, factors associated with ethnicity, and unemployment are potential barriers to attendance.
Late-Onset Traumatic Corneal Conjunctival Epithelial Disorders due to Granular Formation After Cosmetic Suture Blepharoplasty
Authors: Morishige Naoyuki , Kakizaki Hirohiko 
Published: April 2023

Purpose:
The purpose of this study was to report conjunctival granular formation as one of the causative factors of a traumatic corneal conjunctival epithelial disorder after plastic suture blepharoplasty.

Methods:
Clinical charts of 7 patients who had visited Ohshima Eye Hospital with a symptomatic corneal epithelial disorder and history of suture blepharoplasty were reviewed. Clinical evidence of conjunctival granular formations was observed in all patients at the tarsal conjunctiva facing to corneal conjunctival traumatic epithelial disorders. The desired outcome was to alleviate the disorder. The assessment included tabulating results after the placement of a soft contact lens bandage and subsequent partial tarsal plate resection of the granular formation.

Result:
Seven women (mean age 45.0 ± 10.9 years) enrolled in this study had previously undergone suture blepharoplasty (mean 18.3 ± 6.9 years before). Soft contact lens bandages relieved all of the patients’ complaints immediately. After resecting the granular formation, the traumatic corneal conjunctival epithelial disorder disappeared, and no recurrence was observed after surgery.

Conclusions:
The conjunctival granular formation within the tarsal conjunctiva after suture blepharoplasty caused the late-onset traumatic corneal conjunctival epithelial disorder. A complete cure was obtained after resection of the granular formation at the tarsal conjunctiva. To the best of our knowledge, this is the first report to identify the removal of granular formations in 7 patients with late-onset traumatic corneal conjunctival disorders many years after blepharoplasty. The resection of these lesions is a promising procedure to treat late-onset ocular epithelial disorder after suture blepharoplasty.
Clinical performance of a hybrid presbyopia-correcting intraocular lens in patients undergoing cataract surgery in a multicenter trial
Authors: Chang Daniel H. , Hu Jerry G. , Lehmann Robert P. , Thompson Vance M. , Tsai Linda H. , Thomas Eugenia K. 
Published: April 2023

Purpose:
To compare the clinical performance of TECNIS Synergy intraocular lens (IOL), model ZFR00V, vs TECNIS IOL, model ZCB00, in cataract patients.

Setting:
Multicenter clinical setting.

Design:
Prospective, randomized, subject/evaluator-masked clinical trial.

Methods:
Cataract patients aged ≥22 years were randomly assigned 1:1 to bilateral implantation with ZFR00V or ZCB00. Key end points at 6 months postsurgery included monocular and binocular visual acuities at 4 m, 66 cm, 33 cm, and/or 40 cm, binocular distance-corrected defocus testing, patient-reported outcomes, and safety.

Results:
272 patients were implanted with ZFR00V (135) or ZCB00 (137). At 6 months, 83/131 (63.4%) ZFR00V patients demonstrated 20/25 or better combined monocular distance-corrected vision at far, intermediate, or near, compared with 5/130 (3.8%) ZCB00 patients. ZFR00V demonstrated excellent binocular uncorrected vision at intermediate (0.022 logMAR) and distance-corrected vision at 40 cm (0.047 logMAR). Strong ZFR00V performance persisted under mesopic conditions (0.244 logMAR or ∼20/32 Snellen), where improvement over ZCB00 with distance-corrected vision at near was 3.5 lines. ZFR00V provided a broad range of functional vision (20/32 or better) through −3.5 diopters of defocus (29 cm). Most ZFR00V patients reported no spectacle wear overall (93.1%) or at all 4 viewing distances combined (87.8%), and 55.7% qualified as completely spectacle independent. Relatively low proportions of ZFR00V patients reported being very/extremely bothered by halos (13.7%), starbursts (11.5%), or night glare (8.4%). The safety profile was similar between IOL groups.

Conclusions:
TECNIS Synergy ZFR00V demonstrated improved intermediate and near vision, increased range of vision, and greater spectacle independence vs TECNIS monofocal ZCB00.
Cost-Conscious Colposcopy: A Single-Institution Review of Biopsy Submission Practices and Outcomes
Authors: Cook Ian C. , Fuhr Laura I. , Flores Sarah E. , Novicoff Wendy M. , Cantrell Leigh A. 
Published: April 2023

Objective
Distribution of cervical dysplasia may influence approach for excisional procedures. Separating colposcopy biopsies into multiple specimen cups for pathologic evaluation incurs additional costs. The authors aimed to determine whether the practice of separating biopsy specimens impacts patient outcomes.

Methods
A retrospective review of all colposcopy cases from a single institution was performed. A total of 1,331 cases were reviewed from January 1, 2017, to December 31, 2019. Multibiopsy cohorts were separated by number of specimen cups received by pathology (single or multiple). Cohorts were compared for histology, need for excisional procedure, and final excisional pathology results. Specimen processing fees were acquired from the Department of Pathology ($70/specimen). Statistical analysis performed on MINITAB using Pearson chi-square and Fisher exact tests.

Results
Excisional procedures were required by 30.4% (86/283) of multiple specimen submissions compared with 28.2% (154/547) of single specimen cup submissions (p = .50). There was a higher, although not statistically significant, rate of additional procedures in the multiple specimen cup cohort (8.8 vs 2.9% [p = .08]). Malignancy diagnosis was equivalent in each cohort. Cost analysis revealed adopting a single specimen cup model would reduce costs up to approximately $30,000/year.

Conclusions
Patient outcomes were not improved by the practice of submitting multiple specimen cups. Given the additional cost associated with separating specimens, the authors recommend during routine colposcopy that all cervical biopsies be sent for evaluation as a single pathology specimen unless a lesion of concern is identified in an area not normally excised during traditional excisional procedures.
Utility of Extended HPV Genotyping as Primary Cervical Screen in an Unscreened Population With High HIV Co-Infection
Authors: Botha Matthys H. , Van der Merwe Frederick H. , Snyman Leon C. , Dreyer Gerrit J. , Visser Cathy , Dreyer Greta 
Published: April 2023

Objective
Screening with primary human papillomavirus (HPV) testing has been evaluated in highly prescreened populations with lower HPV and HIV prevalence than what is the case in South Africa. High prevalence of HPV and underlying precancer in women living with HIV (WLWH) affect the clinical performance of screening tests significantly. This study investigates the utility and performance of an extended genotyping HPV test in detection of precancer in a population with a high coinfection rate with HIV.

Methods
A total of 1,001 women aged 25 to 65 years with no cervical cancer screening in the preceding 5 years were tested with cytology and primary extended genotyping HPV testing. The cohort of 1,001 women included 430 WLWH (43.0%) and 564 HIV-negative (56.3%) women.

Results
Abnormal cytology (atypical squamous cells of undetermined significance or higher) was significantly higher in WLWH (37.2% vs 15.9%) and high-grade squamous intraepithelial lesion or above (23.5% vs 5.2%). The WLWH also tested positive more often for any HPV type (44.3% vs 19.6%; p < .0001) The specificity for cervical intraepithelial neoplasia 2+ at 91.2% of a combination of HPV types, 16/18/45 (very high risk) and 31/33/58/52 (moderate risk), performed better than cytology or any HPV-positive result to predict cervical intraepithelial neoplasia 3+ on histology. The additional genotype information supports direct referral to treatment or colposcopy in a larger proportion of the screen-positive population.

Conclusions
The potential contribution of extended genotyping is demonstrated. The ideal choice of sensitivity and specificity ultimately depends on the health budget. More information will allow a screening algorithm, guiding management according to risk.
Outcome of COVID-19 mRNA Vaccination in Patients Treated With Clozapine WHO Previously Went Through SARS-COV-2 Infection
Authors: Moga Silvia , Petric Paula Simina , Miron Ana Aliana , Ifteni Petru , Teodorescu Andreea 
Published: April 2023

Background:
The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had multiple consequences for the health care system, especially for patients with mental illnesses. Schizophrenia patients particularly appear to have a higher risk of complications due to coronavirus-19 (COVID-19). Clozapine remains the gold standard for treatment-resistant schizophrenia (TRS). However, the COVID-19 pandemic had an important negative impact on clozapine treatment, mainly because of its administration protocol, which was very difficult to follow during the restrictions imposed in the pandemic, and its side effects in patients with COVID-19 infection. Vaccination is an effective method of avoiding SARS-CoV-2 infection or its severe complications, especially in susceptible populations. Data on adverse events after vaccination against COVID-19 are limited, both in the general population and in schizophrenia patients.

Study Question:
The study aimed to investigate the safety of COVID-19 vaccination in patients treated with clozapine for hematological parameters.

Study Design:
We conducted an analytical cross-sectional study between July 1, 2021, and June 30, 2022. We compared 2 groups of COVID-19 vaccinated patients who had previously experienced SARS-CoV-2 infection: The first group was treated with clozapine, whereas the second group was treated with other antipsychotics.

Measures and outcomes:
The primary objective was to identify granulocytopenia, leukocytopenia, and lymphocytopenia. The results were measured after the second dose of the Pfizer-BioNTech vaccine.

Results:
This study included 100 patients. White blood cell count changes were limited to a few cases of mild granulocytopenia (8.16% in the clozapine group and 3.92% in the nonclozapine group, P = 0.37) with no cases of severe granulocytopenia or agranulocytosis.

Conclusions:
As far as leukocyte counts are concerned, mRNA COVID-19 vaccination seems to be safe in patients treated with clozapine who previously had SARS-CoV-2 infection. Leukocyte changes had no clinical implications.
Lichen planus esophagitis
Authors: Blonski Wojciech , Slone Samuel , Jacobs John W. 
Published: April 2023

Purpose of review
Dysphagia is one of the most common reasons for patients’ visits to a gastroenterologist. Esophageal lichen planus (ELP) has historically been felt to be a rare disease, when in fact it is often misdiagnosed and unrecognized. Often first diagnosed as an unusual esophagitis, all gastroenterologists will see ELP in their practice, and need to be able to recognize this condition.

Recent findings
Although there is still a relative paucity of data on this condition, this article will update the typical presenting symptoms, endoscopic findings, and ways to differentiate ELP from other inflammatory mucosal diseases. There is still no standardized treatment algorithm, but we will also present the most recent treatment approaches.

Summary
It is critical that physicians maintain an increased awareness of ELP and have a high clinical suspicion in the appropriate patients. While management remains challenging, it is important to treat both the inflammatory and stricturing components of the disease. A multidisciplinary approach is also often required, utilizing dermatologists, gynecologists, and dentists who are familiar with managing patients with LP.