bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge and practice of eye drops instillation technique in India: A survey of 396 optometrists
Authors: Chaurasiya Ritesh K , Gupta Akansha , Goswami Sarbojeet 
Published: March 2023

Abstract

Aim:
The aim of this article is to evaluate the knowledge about perfect eye drops instillation technique among optometrists in India.

Materials and Methods:
An online questionnaire-based, cross-sectional study was conducted. A self-administered, electronic questionnaire with a cover letter explaining the aim of the study was distributed among optometrists practicing in India. Demographic characteristics were summarized using descriptive statistics. Categorical variables were summarized using frequencies and percentages.

Results:
Among 396 respondents, 237 (59.84%) were females and 159 (40.16%) were males with a mean age of 24.5 ± 2.81 years. Two-fifths of the optometrists opted for washing hands before eye drop instillation. Similarly, almost nine-tenths of the participants preferred to instill eye drops asking patients to sit and about one-tenth of the optometrist preferred patients in supine position during administering drops. Most common errors during drop instillation among optometrists were drop instillation without nasolacrimal occlusion (19.95%) and hand hygiene (69.94%).

Conclusion:
Proper education and awareness about eye drop instillation process should be given to all eye care practitioners so that non-compliance and incorrect methods of drop instillation can either be minimized or nullified from patients’ end.
Factors Associated with Neonatal Survival in a Special Care Newborn Unit in a Tertiary Care Hospital in Bangladesh
Authors: Kumar Ananya A. , Lee Kyu Han , Pervez Abu Faisal Md , Bari Sanwarul , Deb Chayon , Arifeen Shams El , Islam Farzana , Gurley Emily S. 
Published: March 2023

ABSTRACT.
The 2020 neonatal mortality rate in Bangladesh was 17 deaths per 1,000 live births, higher than the 2030 Sustainable Development Goal target (12 deaths per 1,000 live births). Over the past decade, Bangladesh has established special care newborn units (SCANUs) in medical facilities countrywide to improve neonatal survival. We conducted a retrospective cohort study in the SCANU of a tertiary-level healthcare facility in Bangladesh to study neonatal survival and associated risk factors using descriptive statistics and logistic regression models. Of 674 neonates admitted to the unit between January and November 2018, 263 (39%) died in hospital, 309 (46%) were discharged against medical advice, 90 (13%) were discharged healthy, and 12 (2%) had other discharge statuses. The median duration of time spent in hospital was 3 days, and 60% were admitted at birth. Neonates delivered via Cesarean section (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.2–5.6) had an increased odds of recovering and being discharged, whereas those diagnosed with prematurity and/or low birth weight at admission (aOR: 0.2; 95% CI: 0.1–0.4) had a decreased odds of doing so. The high mortality rate and large number of neonates discharged against medical advice suggest a need to investigate the etiology of death and the factors leading to children leaving hospital prior to recovery. Medical records lacked information on gestational age that could provide key insights about mortality risk and age of viability in this setting. Addressing these knowledge gaps in SCANUs may enable better support for the improvement of child survival.
Current Helicobacter pylori Infection Is Associated with Early Liver Injury: A Cross-Sectional Study in the General Population
Authors: Chang Wenling , Cai Lin , Chen Tingting , Ni Weigui , Xie Zhihao , Yang Chunxia , Liao Juan 
Published: March 2023

ABSTRACT.
Early prevention of liver injury by controlling risk factors deserves concern because of the heavy liver disease burden. Helicobacter pylori (HP) infection affects half of the world’s population and the relationship between it and early liver damage is unclear. This study focuses on assessing the correlation between them in the general population to provide clues to prevent liver disease. A total of 12,931 individuals underwent liver function and imaging tests as well as 13C/14C-urea breath tests. Results showed that the detection rate of HP was 35.9%, and the HP-positive group had a higher rate of liver injury (47.0% versus 44.5%, P = 0.007). Specifically, Fibrosis-4 (FIB-4) and alpha-fetoprotein levels in the HP-positive group were higher whereas the serum albumin level was lower. HP infection would raise the percentage of elevated aspartate aminotransferase (AST; 2.5% versus 1.7%, P = 0.006), elevated FIB-4 (20.2% versus 17.9%, P = 0.002), and abnormal liver imaging (31.0% versus 29.3%, P = 0.048). Most of these results remained stable after covariate adjustment but, for liver injury and liver imaging, the conclusions only held in young people (ORliver injury, odds ratio of liver injury, 1.127, P = 0.040; ORAST, 1.33, P = 0.034; ORFIB-4, 1.145, P = 0.032; ORimaging, 1.149, P = 0.043). Overall, HP infection might be associated with early liver injury, particularly in youth, suggesting that people with early liver injury should pay more attention to HP infection to prevent the occurrence of severe liver diseases.
Malaria Paradoxes of the U.S. Civil War
Authors: Shanks G. Dennis 
Published: March 2023

ABSTRACT.
The U.S. Civil War (1861–1865) pre-dated modern understanding of malaria. Yet, malarial diseases (remittent fever, intermittent fever, typho-malarial fever) were frequently reported as causes of morbidity and mortality in soldiers. Modern readers find Civil War-era descriptions of malaria contradictory or paradoxical. For example, although the concept of race-specific immunity to tropical diseases was widely accepted, malaria mortality rates were reportedly more than three times higher among Black than White Union soldiers (16/1,000/year versus 5/1,000/year). Also, malaria rates were reportedly lower among prisoners of war at the infamous Andersonville, GA, prison camp than among Confederate soldiers in the same area. Literally tons of quinine were given prophylactically to Union soldiers deployed in the southern United States, but blackwater fever was not reported by medical officers. All three paradoxes have reasonable modern explanations that give credence to the astute clinical observations of our scientific predecessors during the U.S. Civil War.
To Study The Antifungal Susceptibility Pattern, Molecular Profiling And Its Sequencing Analysis Of Trichophyton Rubrum Isolated From Human Sample: A Cross Sectional Case Study From Uttar Pradesh, India
Authors: Manoj Kumar Maurya  
Published: March 2023

Introduction: There has been a sudden, unexplained surge in dermatophytoses in India since past 5 years. T. rubrum being the most common etiological agent isolated from clinically diagnosed lesions of cutaneus dermatophytosis. It has a significantly higher capacity of transmission than other anthropophilic dermatophytes.
Aim and Objective: To study the Antifungal Susceptibility Pattern , Molecular Profiling and its Sequencing Analysis of Trichophyton rubrum isolated from human Sample.
Material and Methods: This was a a prospective study carried out in the Department of Microbiology at Rama Medical College Hospital and Research Centre Mandhana, Kanpur for a period of 1 year i.e, March 2017 to March 2018. A total of 375 clinically suspected cases of superficial fungal infection were collected with proper informed consent. Dermatophytosis was confirmed in cases by direct microscopy and culture methods. Antifungal drug susceptibility profiles, MIC of isolates were 50 90 determined using the broth microdilution method according to the CLSI guidelines. The DNA isolation was done using the Qiagen DNA extraction kit followed by the PCR. The sequencing methods were used for the genetic analysis of virulence gene for the confirmation.
Results: Out of the total of 375 clinically suspected cases of superficial fungal infection 31 isolates of Trichophyton rubrum were studied. The ratio of Male were more 27 (87%) as compared to the Female 4 (12.9% ). The maximum number of isolates was found in the Skin 28 (90.3%) followed by the Nail 3 (9.6%). The ITZ was most sensitive toward T. rubrum than KTZ, TBF, and FCZ. The molecular characterization for the detection of 18s gene was performed which was confirmed by the Sequencing Analysis.
Conclusion: Antifungal resistance against T. rubrum is increasing over the last few decades due to genetic diversity in the fungal genome. The molecular identification is a gold standard technique for the identification of T. rubrum allowing important factor in providing fungal infection prevention and treatment approaches.
An Overview of Being Me
Authors: SAĞLAM DEMİRKAN Fatma 
Published: March 2023

Existentialism, which is a 20th century movement, does not consider the individual as a mere thinking entity; defines it as an entity who acts, feels, and can show the responsibility of taking his own choices with his free will. The individual who has the courage to make a choice with her free will and realizes herself in line with her actions has become the subject of research by existential thinkers. Although existentialism, researching of the individual the first emerged as a philosophical movement, it later showed its effect in the fields of social sciences such as psychology. Existential understanding, which has been influential in many research areas, has tried to understand and make sense of the individual in the process of "being me".
In this article, the person who can take the responsibility of gaining self is discussed. The study is limited within the framework of the common concepts and phenomena of the philosophical and psychology existential movement. The concepts and facts of the research were examined with the phenomenological approach method. In the study, the elements of the process of being me are which the individual's freedom, anxiety to be self, being hopeful in the face of the uncertainty of the future, being aware of having a limited life, and being involved in the process of being me by making choices. Within the scope of this study, the elements of the process of being me are evaluated by associating them with religion. The following conclusions were reached in the research: Not every individual is active in the process of being a self; some individuals involve the process of being me by making choices despite their experiences of anxiety, despair, and death; while some others do not have the courage to be me in the face of anxiety, hopelessness and death.
Chronological and sedimentological investigations of the Late Pleistocene succession in Osterbylund (Schleswig-Holstein, Germany)
Authors: Thiel Christine , Kenzler Michael , Stephan Hans-Jürgen , Frechen Manfred , Urban Brigitte , Sierralta Melanie 
Published: March 2023

Abstract. The age of the push moraine complex Wallsbüll-Böxlund,
Schleswig-Holstein, is unclear despite investigations in this area for
decades. To address the timing of formation of both the push moraine complex
and the peat and soils found in its depressions, an outcrop in Osterbylund
(OBL) was investigated. Optically stimulated luminescence and 230Th/U
dating, as well as pollen analyses, were undertaken with the aim to correlate
the soils OBL 1 to OBL 4 to interglacials and interstadials. The
chronological studies were accompanied by detailed sedimentological
investigations. The results of the pollen analyses put the peat
unambiguously to the Eemian; the peat is equivalent to OBL 1. The overlying
sands and the other intercalated soils are to be placed into the early
Weichselian. While for OBL 2 the assignment to the Brörup interstadial
is clear, it is more difficult to clearly correlate OBL 3 and OBL 4 to an
interstadial due to poor luminescence signal resetting of the sands,
especially above OBL 4. Considering all data available, it is most likely
that OBL 3 formed during the Odderade interstadial and OBL 4 during the
Keller interstadial. From the Eemian to early Weichselian ages of the peat
and soils it is evident that the push moraine complex is of Saalian age; a
Weichselian ice margin further in the west, as assumed in other studies, can
therefore be excluded.
Controls on flood managed aquifer recharge through a heterogeneous vadose zone: hydrologic modeling at a site characterized with surface geophysics
Authors: Perzan Zach , Osterman Gordon , Maher Kate 
Published: March 2023

Abstract. In water-stressed regions of the world, managed aquifer recharge (MAR), the process of intentionally recharging depleted aquifers, is an essential tool for combating groundwater depletion. Many groundwater-dependent regions, including the Central Valley in California, USA, are underlain by thick unsaturated zones (ca. 10 to 40 m thick), nested within complex valley-fill deposits that can hinder or facilitate recharge. Within the saturated zone, interconnected deposits of coarse-grained material (sands and gravel) can act as preferential recharge pathways, while fine-textured facies (silts and clays) accommodate the majority of the long-term increase in aquifer storage. However, this relationship is more complex within the vadose zone. Coarse facies can act as capillary barriers that restrict flow, and contrasts in matric potential can draw water from coarse-grained flow paths into fine-grained, low-permeability zones. To determine the impact of unsaturated-zone stratigraphic heterogeneity on MAR effectiveness, we simulate recharge at a Central Valley almond orchard surveyed with a towed transient electromagnetic system. First, we identified three outcomes of interest for MAR sites: infiltration rate at the surface, residence time of water in the root zone and saturated-zone recharge efficiency, which is defined as the increase in saturated-zone storage induced by MAR. Next, we developed a geostatistical approach for parameterizing a 3D variably saturated groundwater flow model using geophysical data. We use the resulting workflow to evaluate the three outcomes of interest and perform Monte Carlo simulations to quantify their uncertainty as a function of model input parameters and spatial uncertainty. Model results show that coarse-grained facies accommodate rapid infiltration rates and that contiguous blocks of fine-grained sediments within the root zone are >20 % likely to remain saturated longer than almond trees can tolerate. Simulations also reveal that capillary-driven flow draws recharge water into unsaturated, fine-grained sediments, limiting saturated-zone recharge efficiency. Two years after inundation, fine-grained facies within the vadose zone retain an average of 37 % of recharge water across all simulations, where it is inaccessible to either plants or pumping wells. Global sensitivity analyses demonstrate that each outcome of interest is most sensitive to parameters that describe the fine facies, implying that future work to reduce MAR uncertainty should focus on characterizing fine-grained sediments.
The response of sea ice and high-salinity shelf water in the Ross Ice Shelf Polynya to cyclonic atmosphere circulations
Authors: Wang Xiaoqiao , Zhang Zhaoru , Dinniman Michael S. , Uotila Petteri , Li Xichen , Zhou Meng 
Published: March 2023

Abstract. Coastal polynyas in the Ross Sea are important source regions of high-salinity shelf water (HSSW) – the precursor of Antarctic Bottom Water that
supplies the lower limb of the thermohaline circulation. Here, the response
of sea ice production and HSSW formation to synoptic-scale and mesoscale
cyclones was investigated for the Ross Ice Shelf Polynya (RISP) using a
coupled ocean–sea ice–ice shelf model targeted on the Ross Sea. When
synoptic-scale cyclones prevailed over RISP, sea ice production (SIP)
increased rapidly by 20 %–30 % over the entire RISP. During the passage of mesoscale cyclones, SIP increased by about 2 times over the western RISP but decreased over the eastern RISP, resulting respectively from enhancement in
the offshore and onshore winds. HSSW formation mainly occurred in the
western RISP and was enhanced responding to the SIP increase under both
types of cyclones. Promoted HSSW formation could persist for 12–60 h after the decay of the cyclones. The HSSW exports across the Drygalski
Trough and the Glomar Challenger Trough were positively correlated with the
meridional wind. Such correlations are mainly controlled by variations in
geostrophic ocean currents that result from sea surface elevation change and density differences.
Determining the Ability of the Vision, Aphasia, and Neglect (VAN) Stroke Scale to Identify Large Vessel Occlusion Strokes Within the Prehospital Setting: A Prospective Cohort Study
Authors: Lydia Leavitt  
Published: March 2023

Introduction: There are several stroke assessment scales designed to identify large vessel occlusions (LVOs), and a rising area of research is concerned with identifying those that outperform others in accuracy. One scale that has shown promise in identifying identify large vessel occlusions (LVOs) is the vision, aphasia, and neglect (VAN) scale. Our understanding of this scale’s true performance, however, is limited as a majority of studies have been carried out in the hospital setting. The objective of this study is to evaluate the ability of the VAN scale to predict LVOs in the prehospital setting.
Methods: Prospective cohort study comparing emergency medical service personnel administered VAN results to hospital discharge diagnoses to evaluate VAN’s ability to predict a large vessel occlusion stroke. Main outcome measures included VAN sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and accuracy.
Results: Emergency medical service personnel administered the VAN assessment to 185 patients suspected of having a stroke. VAN had a sensitivity of 0.81 (CI, 0.61 to 0.93), specificity 0.56 (CI, 0.48 to 0.64), positive predictive value 0.24 (CI, 0.61 to 0.34), negative predictive value 0.95 (CI, 0.87 to 0.98), positive likelihood ratio 1.87 (CI, 1.45 – 2.40), negative likelihood ratio 0.33 (CI, 0.15 – 0.73), and 60% accuracy (CI, 53% - 61%) for large vessel occlusion identification.
Conclusion: When negative, VAN offers relatively high assurance that the patient is not suffering a large vessel occlusion stroke. However, VAN is non-specific for large vessel occlusions and results in many false positives. Therefore, pre-hospital decision-making regarding triage should not rely exclusively on VAN due to possible over-triage to facilities with endovascular capabilities.
Myasthenia Gravis Exacerbation Following COVID-19 Vaccine: A Case Report
Authors: Gabralla Thoybah Yousif Ibrahim , Bashir Hayat Abdoallah Ahmed , Mohamed Omaima Abdalla Hajahmed 
Published: March 2023

Background: As of December 2021, the World Health Organization (WHO) reports that Coronavirus disease 2019 (COVID-19) led to about 5,403,662 deaths. While COVID-19 has resulted in millions of deaths worldwide to date, vaccination remains the mainstay of infection control. AZD1222 (AstraZeneca vaccine) was distributed in Sudan by the COVID-19 Vaccines Global Access facility in March 2021. It was added to the emergency use list by WHO in the middle of February 2021. However, vaccine safety among patients with autoimmune diseases, such as myasthenia gravis (MG), is yet to be established. MG is a relatively rare illness that could result in life-threatening complications. Myasthenic crisis is considered the most serious complication of MG that can lead to death due to aspiration and respiratory failure. Plasma exchange (PLEX), Immunoadsorption (IA), and intravenous Immunoglobulin (IVIG) are the first-line treatment for myasthenic crisis. It is proven that cortisone has a positive effect when used as add-on therapy with PLEX/IA and IVIG.

The case: We report the case of a 37-year-old Sudanese female who presented to the emergency room with an exacerbation of her previously well-controlled MG following her second dose of AZD1222 vaccination. The exacerbation symptoms at time of presentation were severe generalized body weakness that increasing overtime and shortness of breath. Computerized tomography of the chest was performed, and it revealed no evidence of COVID-19. Management at the ER started with rehydration and IV methylprednisolone 1g, followed by IV hydrocortisone 200mg. She continued to deteriorate and was admitted to the intensive care unit where she was intubated and placed on a mechanical ventilator. IVIG was requested but couldn't be obtained due to the low-income setting, and fourteen days after admission patient died due to circulatory collapse. Our study aims to present an MG case with features of MG exacerbation following the administration of the second dose of AZD1222.

Conclusion: Little is known about the effect of different COVID-19 vaccines on subgroups of patients with autoimmune diseases like MG. Although the safety profile of AZD1222 is generally reassuring, people with severe underlying diseases were excluded from trials. Therefore, more efforts and experimental studies may be needed, with closer vigilance in MG patients. It has not been elucidated how the COVID-19 vaccine might provoke autoimmunity, but several theories have been proposed. Molecular mimicry theory can explain how the genetic material of a virus could provoke autoimmunity, it describes the cross-reactivity of antibodies produced against proteins that are encoded by viral genetic material with the proteins located at the post-synaptic membrane. There is a debate about whether vaccine benefit outweighs the risk in MG patients or not. However, we believed that MG patients should be informed about the benefit and risks of COVID-19 vaccination.
Prevalence of Anemia Among Pregnant Women in Rural Village of Sindhupalchowk District of Nepal - A Cross-Sectional Study
Authors: Thapa Biyas , Bohara Smriti , KC Sistu , Sapkota Madan , Dhakal Bibek , Gaire Binod 
Published: March 2023

Background:
Anemia is a global public health problem all around the world, principally the developing countries like Nepal. Anemia results in maternal mortality alongside low birth weight which contributes to an increased infant mortality rate. The prevalence of anemia ranges from 27% to 42% among pregnant women depending on geographical regions. Iron and folic acid tablets are supplied free of charge to pregnant women as part of the Nepal government's National Anemia Control Strategy and Iron Intensification Program.
Methods:
A cross-sectional study was carried out among pregnant women attending Manekharka health center for an antenatal checkup. Hemoglobin levels of pregnant women from April 2018-2020 were obtained and analyzed. Hemoglobin level was determined using the indirect cyanmethemoglobin method.
Results:
We used the World Health Organization (WHO) standard classification of hemoglobin levels below 11 gm/dl to determine the prevalence of anemia in pregnant women. The result suggested that a total of 30.7%, (n=63) of the pregnant women were anemic. Among which 4.76% had moderate anemia (hemoglobin 7-9.9gm/dl) and 96.58% had mild anemia (hemoglobin ≥9.9mg/dl to <11gm/dl).
Conclusion:
The study and its results suggest that the women in the age group 16-19 had a higher prevalence of anemia whereas the age group 25-29 had the lowest prevalence of anemia. Moreover, the study revealed that the prevalence of anemia in hills is substantial.