bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atypical drug-induced hypersensitivity syndrome with multiple organ failure rescued by combined acute blood purification therapy: a case report
Authors: Oiwa Hideaki , Yoshida Shozo , Okada Hideshi , Yasunishi Masahiro , Kamidani Ryo , Suzuki Kodai , Miyake Takahito , Doi Tomoaki , Shimohata Takayoshi , Ogura Shinji 
Published: May 2023

Abstract
Background
Drug-induced hypersensitivity syndrome (DIHS), including Stevens-Johnson syndrome (SJS), is a severe rash that often develops 2–6 weeks after the intake of the causative drug; however, its diagnosis is sometimes difficult. This article describes a case in which a patient with DIHS-induced multiple organ failure was successfully treated with blood purification therapy.

Case presentation
A male patient in his 60s was admitted to our hospital with autoimmune encephalitis. The patient was treated with steroid pulse therapy, acyclovir, levetiracetam, and phenytoin. From the 25th day, he presented with fever (≥ 38 °C) as well as miliary-sized erythema on the extremities and trunk, followed by erosions. DIHS and SJS were suspected; accordingly, levetiracetam, phenytoin, and acyclovir were discontinued. On the 30th day, his condition further deteriorated, and he was admitted to the intensive care unit for ventilatory management. The next day, he developed multi-organ failure and was started on hemodiafiltration (HDF) for acute kidney injury. Although he presented with hepatic dysfunction and the appearance of atypical lymphocytes, he did not meet the diagnostic criteria for DIHS or SJS/toxic epidermal necrolysis. Therefore, he was diagnosed with multi-organ failure caused by severe drug eruption and underwent a 3-day treatment with plasma exchange (PE) in addition to HDF. Accordingly, the patient was diagnosed with atypical DIHS. After being started on blood purification therapy, the skin rash began to disappear; moreover, the organ damage improved, with a gradual increase in urine output. Eventually, the patient was weaned off the ventilator and transferred to the hospital on the 101st day.

Conclusions
HDF + PE could effectively treat multi-organ failure caused by atypical DIHS, which is difficult to diagnose.
Trends and predictors of incidence of hypospadias in a tertiary hospital in South Africa
Authors: Udatinya Daniel , Ahmad Ahsan , Kabera Gaetan , Nel Marietha 
Published: May 2023

Abstract
Background
Hypospadias is a penile congenital abnormality characterized by an ectopic urethral opening, ventral curvature and incomplete foreskin closure with a dorsal hooded prepuce. Management of the outcome demands high cost. The aim of this study was to determine the trends and predictors of hypospadias among babies born at Charlotte Maxeke Johannesburg Academic Hospital between 01 January 2014 and 31 December 2016.

Methods
Mothers’ files from the transfer unit of the labour ward were reviewed. A case–control study compared boys with hypospadias and those without born approximately at the same time. Data were retrospectively collected on data collection forms. EpiData version 3.1 and STATA version 15.1 were used for statistical analysis. The Mantel Haenszel method determined combined odds ratios for hypospadias outcome on boys whose mothers were exposed to certain conditions versus boys of unexposed mothers. Woolf’s method was used to compute confidence intervals of the odds ratios. Logistic regression analysis was used to assess the independent contributing maternal factors to the risk of hypospadias.

Results
Records of 221 male babies were collected of which 73 were cases and 148 controls in the ratio of 1:2. Hypospadias was more frequent in boys born by Caesarean Section (p < 0.001), those with low birth weight (p < 0.001) and those small for gestational age (p < 0.002). Alcohol use (odds ratio 3.1), smoking (odds ratio 1.54), herbal use (odds ratio 2.05), medical history (odds ratio 2.8), multiple pregnancies (odds ratio 1.69) and maternal congenital abnormalities (odds ratio 3.03) indicated an increased risk of hypospadias. Surgical history (odds ratio 1.29), pre-natal vaccination (odds ratio 0.92), employment (odds ratio 0.85), and education (odds ratio 0.48) were not associated with the risk of hypospadias.

Conclusions
Mothers older than 36 years presented a stratifying effect on disease outcome. Our findings did not indicate major changes in trends of incidence of hypospadias. The years assessed did not have a significant effect on the number of cases.
The plastome reveals new insights into the evolutionary and domestication history of peonies in East Asia
Authors: Chen Qihang , Chen Le , Teixeira da Silva Jaime A. , Yu Xiaonan 
Published: May 2023

Abstract
Backgroud
Paeonia holds considerable value in medicinal, ornamental horticultural, and edible oil industries, but the incomplete state of phylogenetic research in this genus poses a challenge to the effective conservation and development of wild germplasm, and also impedes the practical utilization of existing cultivars. Due to its uniparental inheritance and lack of recombination, the plastome (i.e., plastid genome), which is a valuable molecular marker for phylogenetic analyses, is characterized by an appropriate rate of nucleotide evolution.

Methods
In this study, 10 newly assembled data and available reported data were combined to perform a comparative genomics and phylogenetics analysis of 63 plastomes of 16 Paeonia species, primarily from East Asia, which is the origin and diversity center of Paeonia.

Results
Ranging between 152,153 and 154,405 bp, most plastomes displayed a conserved structure and relatively low nucleotide diversity, except for six plastomes, which showed obvious IR construction or expansion. A total of 111 genes were annotated in the Paeonia plastomes. Four genes (rpl22, rps3, rps19 and ycf1) showed different copy numbers among accessions while five genes (rpl36, petN, psbI, rpl33 and psbJ) showed strong codon usage biases (ENC < 35). Additional selection analysis revealed that no genes were under positive selection during the domestication of tree peony cultivars whereas four core photosynthesis-related genes (petA, psaA, psaB and rbcL) were under positive selection in herbaceous peony cultivars. This discovery might contribute to the wide adaption of these cultivars. Two types of molecular markers (SSR and SNP) were generated from the 63 plastomes. Even though SSR was more diverse than SNP, it had a weaker ability to delimit Paeonia species than SNP. The reconstruction of a phylogenetic backbone of Paeonia in East Asia revealed significant genetic divergence within the P. ostii groups. Evidence also indicated that the majority of P. suffruticosa cultivars had a maternal origin, from P. ostii. The results of this research also suggest that P. delavayi var. lutea, which likely resulted from hybridization with P. ludlowii, should be classified as a lineage within the broader P. delavayi group.

Conclusions
Overall, this study’s research findings suggest that the Paeonia plastome is highly informative for phylogenetic and comparative genomic analyses, and could be useful in future research related to taxonomy, evolution, and domestication.
Respiratory support with nasal high flow without supplemental oxygen in patients undergoing endoscopic retrograde cholangiopancreatography under moderate sedation: a prospective, randomized, single-center clinical trial
Authors: Sawase Hironori , Ozawa Eisuke , Yano Hiroshi , Ichinomiya Taiga , Yano Rintaro , Miyaaki Hisamitsu , Komatsu Naohiro , Ayuse Takao , Kurata Shinji , Sato Shuntaro , Pinkham Maximilian Ichabod , Tatkov Stanislav , Ashizawa Kazuto , Nagata Kazuyoshi , Nakao Kazuhiko 
Published: May 2023

AbstractBackgroundNasal high flow (NHF) may reduce hypoxia and hypercapnia during an endoscopic retrograde cholangiopancreatography (ERCP) procedure under sedation. The authors tested a hypothesis that NHF with room air during ERCP may prevent intraoperative hypercapnia and hypoxemia.MethodsIn the prospective, open-label, single-center, clinical trial, 75 patients undergoing ERCP performed with moderate sedation were randomized to receive NHF with room air (40 to 60 L/min,n = 37) or low-flow O2via a nasal cannula (1 to 2 L/min,n = 38) during the procedure. Transcutaneous CO2, peripheral arterial O2saturation, a dose of administered sedative and analgesics were measured.ResultsThe primary outcome was the incidence of marked hypercapnia during an ERCP procedure under sedation observed in 1 patient (2.7%) in the NHF group and in 7 patients (18.4%) in the LFO group; statistical significance was found in the risk difference (-15.7%, 95% CI -29.1 – -2.4,p = 0.021) but not in the risk ratio (0.15, 95% CI 0.02 – 1.13,p = 0.066).In secondary outcome analysis, the mean time-weighted total PtcCO2was 47.2 mmHg in the NHF group and 48.2 mmHg in the LFO group, with no significant difference (-0.97, 95% CI -3.35 – 1.41,p = 0.421). The duration of hypercapnia did not differ markedly between the two groups either [median (range) in the NHF group: 7 (0 – 99); median (range) in the LFO group: 14.5 (0 – 206);p = 0.313] and the occurrence of hypoxemia during an ERCP procedure under sedation was observed in 3 patients (8.1%) in the NHF group and 2 patients (5.3%) in the LFO group, with no significant difference (p = 0.674).ConclusionsRespiratory support by NHF with room air did not reduce marked hypercapnia during ERCP under sedation relative to LFO. There was no significant difference in the occurrence of hypoxemia between the groups that may indicate an improvement of gas exchanges by NHF.Trial registrationjRCTs072190021.The full date of first registration on jRCT: August 26, 2019.
HIV and AIDS prevention: knowledge, attitudes, practices and health literacy of older persons in the Western Cape and KwaZulu-Natal Provinces, South Africa and in Lesotho
Authors: Kalula Sebastiana Zimba , Blouws Tarryn , Ramathebane Maseabata , Sayed Abdul-Rauf 
Published: May 2023

Abstract
Background
Population ageing and access to anti-retroviral therapies in South Africa have resulted in ageing of the HIV/AIDS epidemic, which has implications for policy, planning and practice. Impactful interventions on HIV/AIDS for older persons require knowledge on effects of the pandemic on this population. A study was undertaken to assess knowledge, attitudes, and practices (KAP) of HIV/AIDS, as well as health literacy (HL) level of a population aged ≥ 50 years.

Methods
A cross-sectional survey was conducted at three sites in South Africa and two sites in Lesotho with an educational intervention at the South African sites. At baseline, data were collected for assessment of KAP of HIV/AIDS and HL levels. The pre- and post-intervention comprised participants at South African sites being familiarised with the contents of a specially constructed HIV/AIDS educational booklet. Participants’ KAP was reassessed six weeks later. A composite score of ≥ 75% was considered adequate KAP and an adequate HL level.

Results
The baseline survey comprised 1163 participants. The median age was 63 years (range 50–98 years); 70% were female, and 69% had ≤ 8 years’ education. HL was inadequate in 56% and the KAP score was inadequate in 64%. A high KAP score was associated with female gender (AOR = 1.6, 95% CI = 1.2–2.1), age < 65 years (AOR = 1.9, 95% CI = 1.5–2.5) and education level (Primary school: AOR = 2.2; 95% CI = 1.4–3.4); (High school: AOR = 4.4; 95% CI = 2.7–7.0); (University/college: AOR = 9.6; 95% CI = 4.7–19.7). HL was positively associated with education but no association with age or gender. The educational intervention comprised 614 (69%) participants. KAP scores increased post intervention: 65.2% of participants had adequate knowledge, versus 36% pre-intervention. Overall, younger age, being female and higher education level were associated with having adequate knowledge about HIV/AIDS, both pre- and post-intervention.

Conclusions
The study population had low HL, and KAP scores regarding HIV/AIDS were poor but improved following an educational intervention. A tailored educational programme can place older people centrally in the fight against the epidemic, even in the presence of low HL. Policy and educational programmes are indicated to meet the information needs of older persons, which are commensurate with the low HL level of a large section of that population.
Understanding public perceptions in social media responses to posts about acute severe hepatitis of unknown etiology in Indonesia: a qualitative study
Authors: Asa Gregorius Abanit , Fauk Nelsensius Klau , Gesesew Hailay Abrha , Foley Kristen Marie , Lunnay Belinda , Ward Paul Russell 
Published: May 2023

Abstract
Background
Acute Severe Hepatitis of Unknown Etiology (ASHUE) emerged as a new global outbreak in Indonesia early May 2022, coinciding with the COVID-19 pandemic. This study aimed to understand public reactions and responses to the emergence of ASHUE Indonesia and to Government-led disease prevention responses. Understanding how the public perceived government-led preventive messaging about the hepatitis outbreak is crucial to controlling viral spread – particularly given the rapid and unforeseen emergence of ASHUE coincided with COVID-19 and public trust in the Indonesian Government to manage health outbreaks was already tenuous.

Methods
Social media users’ responses to information disseminated via Facebook, YouTube, and Twitter were analyzed to understand public perceptions about ASHUE outbreak and their attitudes toward Government-led prevention measures. Data were extracted on a daily basis from 1st May 2022 to 30th May 2022 and analyzed manually. We inductively generated the codes, from which we formed a construct and then grouped to identify themes.

Results
A total of 137 response comments collected from 3 social medial platforms were analyzed. Of these, 64 were from Facebook, 57 were from YouTube, and 16 were from Twitter. We identified 5 main themes, including (1) disbelief in the existence of the infection; (2) suspicion about a potential new business after COVID-19; (3) suspicion that COVID-19 vaccine(s) are the cause; (4) religion-related fatalism and (5) trust in government measures.

Conclusions
The findings advance knowledge about public perceptions, reactions and attitudes towards the emergence of ASHUE and the efficacy of disease countermeasures. The knowledge from this study will provide an understanding of why disease prevention measures might not be followed. It can be used to develop public awareness programs in Indonesia about both the ASHUE and its possible consequences and the available healthcare support.
Endocarditis due to Aggregatibacter Segnis: a rare case report
Authors: Guo Xiaoxiao , Zhang Xinyun , Qin Yanli , Liu Hong , Wang Xinyu 
Published: May 2023

Abstract
Background
As a member of the HACEK group, Aggregatibacter segnis (A. segnis) is a fastidious Gram-negative coccobacillus that resides in the human oropharyngeal flora. Infective endocarditis caused by A. segnis is rarely reported.

Case presentation
A 31-year-old male was admitted to our hospital for a 3-month history of intermittent high fever, chills, and chest distress. On presentation, he was febrile and tachycardic but otherwise with stable vital signs. Physical examination revealed systolic murmurs in the aortic and mitral valve areas. Pitting edema was evident in the lower extremities. Transthoracic echocardiography demonstrated multiple vegetations in the mitral and aortic valves. Severe regurgitation of the aortic valve and left heart dysfunction were also detected. With the suspicion of infective endocarditis and heart failure, we immediately performed microbiological tests and arranged the cardiac replacement surgery. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry and metagenomic next-generation sequencing (mNGS) identified A. segnis from the bloodstream. While the surgical specimen culture was negative, the mNGS was positive for A. segnis. The patient was treated with ceftriaxone for four weeks and discharged. He remained clinically well, with laboratory results restored.

Conclusion
This is the first report of A. segnis infective endocarditis that combined MALDI-TOF and metagenomic next-generation sequencing in the diagnosis. The hypothesis-independent molecular techniques can outperform conventional tools to prevent diagnostic delay.
SABRes: in silico detection of drug resistance conferring mutations in subpopulations of SARS-CoV-2 genomes
Authors: Fong Winkie , Rockett Rebecca J. , Agius Jessica E. , Chandra Shona , Johnson-Mckinnon Jessica , Sim Eby , Lam Connie , Arnott Alicia , Gall Mailie , Draper Jenny , Maddocks Susan , Chen Sharon , Kok Jen , Dwyer Dominic , O’Sullivan Matthew , Sintchenko Vitali 
Published: May 2023

AbstractThe emergence of resistance to antiviral drugs increasingly used to treat SARS-CoV-2 infections has been recognised as a significant threat to COVID-19 control. In addition, some SARS-CoV-2 variants of concern appear to be intrinsically resistant to several classes of these antiviral agents. Therefore, there is a critical need for rapid recognition of clinically relevant polymorphisms in SARS-CoV-2 genomes associated with significant reduction of drug activity in virus neutralisation experiments. Here we present SABRes, a bioinformatic tool, which leverages on expanding public datasets of SARS-CoV-2 genomes and allows detection of drug resistance mutations in consensus genomes as well as in viral subpopulations. We have applied SABRes to detect resistance-conferring mutations in 25,197 genomes generated over the course of the SARS-CoV-2 pandemic in Australia and identified 299 genomes containing resistance conferring mutations to the five antiviral therapeutics that retain effectiveness against currently circulating strains of SARS-CoV-2 – Sotrovimab, Bebtelovimab, Remdesivir, Nirmatrelvir and Molnupiravir. These genomes accounted for a 1.18% prevalence of resistant isolates discovered by SABRes, including 80 genomes with resistance conferring mutations found in viral subpopulations. Timely recognition of these mutations within subpopulations is critical as these mutations can provide an advantage under selective pressure and presents an important step forward in our ability to monitor SARS-CoV-2 drug resistance.
Effectiveness of oral cephalexin in antibiotic-course completion for methicillin-susceptible Staphylococcus aureus-induced bacteremic vertebral osteomyelitis
Authors: Okumura Nobumasa , Hayakawa Kayoko , Yamamoto Kei , Yamada Gen , Mezaki Kazuhisa , Ohmagari Norio 
Published: May 2023

Abstract
Background
Methicillin-susceptible
Staphylococcus aureus (MSSA) is the most common causative microorganism of pyogenic vertebral osteomyelitis (PVO). Although oral antimicrobial therapy with first-generation cephalosporins can treat MSSA infection, data on PVO are scarce. This study evaluated the treatment efficacy of cephalexin as oral antibiotic therapy for MSSA-induced PVO.

Methods
This retrospective study included adult patients treated with oral cephalexin as the completing treatment for PVO with MSSA bacteremia from 2012 to 2020. Treatment effectiveness of cephalexin was evaluated by comparing improvement (5-point scale; score ≥ 4/5 indicates treatment success) in symptoms and laboratory and imaging results between intravenous antimicrobial and oral cephalexin treatment.

Results
Among 15 participants (8 [53%] women; median [interquartile range, IQR], age 75 [67.5–80.5] years; Charlson Comorbidity Index 2 [0–4]), 10 (67%) had lumbar spine lesions, 12 (80%) had spinal abscesses, and 4 (27%) had remote abscesses; no patients had concomitant endocarditis. In 11 patients with normal renal function, cephalexin 1,500–2,000 mg/day was administered. Five patients (33%) underwent surgery. Median (IQR; range) duration (days) of intravenous antibiotics, cephalexin, and total treatment was 36 (32–61; 21–86), 29 (19–82; 8–251), and 86 (59–125; 37–337), respectively. Cephalexin had an 87% treatment success rate without recurrence during a median follow-up of 119 (IQR, 48.5–350) days.

Conclusions
In patients with MSSA bacteremia and PVO, antibiotic treatment completion with cephalexin is a reasonable option, even in cases with spinal abscess, if at least 3 weeks of effective intravenous antimicrobial therapy is provided.
Higher tacrolimus trough levels and time in the therapeutic range are associated with the risk of acute rejection in the first month after renal transplantation
Authors: Nguyen Thi Van Anh , Nguyen Huu Duy , Nguyen Thi Lien Huong , Le Viet Thang , Nguyen Xuan Kien , Tran Viet Tien , Le Dinh Tuan , Ta Ba Thang 
Published: May 2023

Abstract
Background
Tacrolimus trough levels (C0) are used in most transplant centres for therapeutic drug monitoring (TDM) of tacrolimus (Tac). The target range of Tac C0 has been remarkably changed, with a target as low as 3–7 ng/ml in the 2009 European consensus conference and a target of 4–12 ng/ml (preferably to 7–12 ng/ml) following the second consensus report in 2019. Our aim was to investigate whether reaching early Tac therapeutic targets and maintaining time in the therapeutic range (TTR) according to the new recommendations may be necessary for preventing acute rejection (AR) during the first month after transplantation.

Methods
A retrospective study including 160 adult renal transplant patients (113 men and 47 women) with a median age of 36.3 (20–44) years was conducted between January 2018 and December 2019 at 103 Military Hospital (Vietnam). Tac trough levels were recorded in the first month, and episodes of AR were confirmed by kidney biopsy. Tac TTR was calculated as the percentage of time within the target range of 7–12 ng/ml, according to the 2019 second consensus report. Multivariate Cox analysis was performed to identify the correlation between the Tac target range and TTR with AR.

Results
In the first month after RT, 14 (8.8%) patients experienced AR. There was a significant difference in the incidence of AR between the Tac level groups of < 4, 4–7 and > 7 ng/ml (p = 0.0096). In the multivariate Cox analysis, after adjusting for related factors, a mean Tac level > 7 ng/ml was associated with an 86% decreased risk of AR compared with that of 4–7 ng/ml in the first month (HR, 0.14; 95% CI, 0.03–0.66; p = 0.0131). Every 10% increase in TTR was associated with a 28% lower risk of AR (HR, 0.72; 95% CI, 0.55–0.94; p = 0.014).

Conclusion
Gaining and maintaining Tac C0 according to the 2019 second consensus report might reduce the risk of AR in the first month following transplantation.