bluuebunny/crossref_metadata_2025_split huggingface dataset:
A conceptual framework on the role of backward integration in sustainable access to malaria intervention commodities in Nigeria
Authors: Mokuolu Olugbenga A. , Idachaba Innocent O. , Babatunde Musibau A. , Suleiman Kafayat O. , Mokuolu Toluwani A. , Lawal Lukman , Osofisan Adenike O. 
Published: July 2023

Abstract
Background
Over the last two decades, global stakeholders and the Nigerian government have invested approximately $2 billion in malaria control, reducing parasite prevalence to 23% from 42% to 2010. However, there is a risk that the modest gains will be reversed due to unmet resource gaps. Backward integration is presented in this paper as a viable option for sustainable funding of malaria intervention commodities in Nigeria.

Methods
Following a critical appraisal of the resource profile and malaria expenditure, a conceptual framework on backward integration as a means of ensuring long-term supply of malaria intervention commodities was developed. The study analysed secondary annual data from the National Malaria Elimination Programme to estimate commodity needs for the period 2018–2020, as well as total resources committed and the financial gap.

Results
The funds needed to implement national malaria interventions from 2018 to 2020 totaled US$ 1,122,332,318, of which US$ 531,228,984 (47.3%) were funded. The Nigerian government contributed 2.5%, the Global Fund (26.7%), the President’s Malaria Initiative (16.5%), and the UK Department for International Development (6.2%). The funding shortfall was $591,103,335, or 52.7% of the needs. Various funding scenarios were evaluated for their relative merits and limitations, including advocacy for more external funding, bank borrowing, increased domestic resources, and backward integration.

Conclusions
The study concluded that backward integration should be used, based on a government-led public-private partnership that will increase local production of malaria intervention commodities that are accessible and affordable through market-based demand and supply arrangements.
Antiosteoporosis effect and possible mechanisms of the ingredients of Radix Achyranthis Bidentatae in animal models of osteoporosis: systematic review and meta-analysis of in vivo studies
Authors: Lian Yong , Zhu Haoran , Guo Xiaxia , Fan Yinuo , Xie Zhixing , Xu Jinfan , Shao Min 
Published: July 2023

Abstract
Background
The effect and mechanisms of the ingredients (IRAB) of Radix Achyranthis Bidentatae (RAB) on treating osteoporosis (OP) remains debated. We aimed to summary the evidence to evaluate the efficacy of IRAB for animal model OP and elucidate the potential mechanism of IRAB in the treatment of OP.

Methods
In this review and meta-analysis, we searched PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature Database, as well as Chinese VIP databases for targeting articles published from inception to March 2023 in English or Chinese. All randomized controlled animal trials that assessed the efficacy and safety of IRAB for OP were included. We excluded trials according to exclusion criteria. The CAMARADES 10-item quality checklist was utilized to test the risk of potential bias for each including study and modifications were performed accordingly. The primary outcome measures were bone mineral density of the femoral neck (F-BMD), serum calcium (Ca), serum phosphorus (P), serum alkaline phosphatase (ALP), bone gla protein (BGP), bone maximum stress (M-STRESS). The secondary outcome measure was the antiosteoporosis mechanisms of IRAB.

Results
Data from nine articles were included in the systematic review and meta-analysis, which focused on 196 animals. Egger’s test revealed the presence of publication bias in various studies regarding the primary outcome. Administration of IRAB or RAB could significantly increases the F-BMD (SMD = 2.09; 95% CI = 1.29 to 2.89; P < 0.001, I2 = 76%), Ca (SMD = 0.86; 95% CI = 0.39to1.34; P = 0.07, I2 = 49%); P (SMD = 1.01; 95% CI = 0.45–4.57; P = 0.08, I2 = 50%), BGP (SMD = 2.13; 95% CI = 1.48 to 2.78; I2 = 46%, P = 0.10), while the ALP (SMD = − 0.85; 95% CI =  − 1.38 to − 0.31; I2 = 46%, P = 0.10) was remarkably decreased in OP model animals. Moreover, the bone biomechanical indicator M-STRESS (SMD = 2.39; 95% CI = 1.74–3.04; I2 = 32%, P = 0.21) was significantly improved.

Conclusion
Collectively, the findings suggest that the RAB or IRAB could be an effective drug or an ingredient in diet for the clinical treatment of OP in future.
Severe dysphagia due to an esophageal duplication cyst in sixth decade, unusual presentation of a rare pathology
Authors: Endara Santiago A. , Pinto Jaime R. , Torres Gustavo A. , Arias Pablo A. , Ponton M. Patricia , Molina Gabriel A. 
Published: July 2023

Abstract
Background
Esophageal duplication cysts are rare congenital tumors usually diagnosed and treated during childhood. Most of them are located in the mediastinum and appear as a mass besides the esophagus. Unfortunately, symptoms are non-specific and depend on the size and location of the mass; therefore, they can easily be missed. If symptoms appear, surgical resection is necessary to prevent troublesome complications.

Case Presentation
We present the case of a 60-year-old woman who presented with severe progressive dysphagia and epigastric pain. After further evaluation, a paraesophageal cystic mass was found, and surgery was required. Non-communicating esophageal duplication cyst was the final diagnosis.

Conclusion
Esophageal duplication cysts are a rare pathology in adults; their symptoms will vary depending on their size and location. Preoperative diagnosis is difficult as symptoms are non-specific and can be missed. If severe dysphagia, pain, or any other complication appears, surgery should not be delayed.
Effectiveness of a training program for a patient with non-cardiac chest pain that combines intervention to improve quality of life, psychological state, and functional capacity: a case report
Authors: Huzmeli Irem , Ozer Aysel Yildiz 
Published: July 2023

Abstract
Background
Noncardiac chest pain (NCCP) is persistent angina-like chest pain without cardiac origin that affects the patient’s health related quality of life (HrQoL), although it does not affect mortality. The effect of a comprehensive training program for NCCP focused on quality of life, psychological state, peripheral muscle strength, physical activity, and quality of life has not been previously established or published. Therefore, this study aimed to show the effectiveness of our combined training program that focuses on functional capacity, physical activity, pulmonary function, respiratory and peripheral muscle strength, dyspnea, fatigue, anxiety, and depression perception in NCCP patients with dyspnea.

Case presentation
A 38-year-old man with shortness of breath and NCCP was referred to to us for cardiopulmonary rehabilitation. Respiratory muscle strength (mouth pressure device), functional capacity (6 min walking test, 6-MWT), peripheral muscle strength (dynamometer), pulmonary function (spirometry), fatigue (fatigue severity scale), shortness of breath (MMRC, Modified Medical Council Research, Modified Borg Scale-MBS), physical activity (International Physical Activity Questionnaire, IPAQ), health related quality of life (SF-36, Short Form-36), and depression and anxiety (Hospital Depression and Anxiety scale, HADs) were assessed. Aerobic training combined with inspiratory muscle training (loading 30% maximal inspiratory pressure (MIP)) was administered at least 5 days/week for 6 weeks. Functional capacity, physical activity, pulmonary function, and respiratory and peripheral muscle strength improved, and dyspnea, fatigue, anxiety, and depression perception were decreased after the management.

Conclusions
This combined training program was effective for patients with NCCP and shortness of breath. Future studies should be conducted to find the most effective biopsychosocial training protocol for NCCP patients.
Prosthetic knee joint infection caused by α-hemolytic Streptococcus species: a case report
Authors: Mardani Masoud , Mohammadshahi Jafar , Teimourpour Roghayeh 
Published: July 2023

Abstract
Background
Knee arthroplasty is an orthopedic surgical procedure in which a damaged joint is replaced with an artificial one. It is estimated that 1–2% of knee arthroplasties will encounter infection over their lifetime. Although α-hemolytic Streptococcus species play an important role in prosthetic joint infection, they are less common than staphylococcal species.

Case presentation
In this report, a 50-year-old Iranian woman was diagnosed with prosthetic knee joint infection based on clinical, radiological, and laboratory findings. She was diabetic and had undergone a left total knee arthroplasty, which, 18 months after the surgery, presented pain, erythema, and edema in that knee. The primary culture of knee aspirate was positive for α-hemolytic Streptococcus species, but following antibiotic medication, culture was negative. The primary antibiotic regime was vancomycin and meropenem, which was changed to cefepime for the management of the infection based on the results of antimicrobial susceptibility testing.

Conclusions
This report indicated the clinical presentation and management of the patient with prosthetic joint infection in which the patient recovered without any severe complications or surgical intervention.
Standard versus innovative robotic balance assessment for people with multiple sclerosis: a correlational study
Authors: Podda Jessica , Marchesi Giorgia , Squeri Valentina , De Luca Alice , Bellosta Alice , Pedullà Ludovico , Konrad Giovanna , Battaglia Mario Alberto , Brichetto Giampaolo , Tacchino Andrea 
Published: July 2023

Abstract
Introduction
Balance disorders are common in people with Multiple Sclerosis (PwMS) and, together with other impairments and disabilities, often prevent PwMS from performing their daily living activities. Besides clinical scales and performance tests, robotic platforms can provide more sensitive, specific, and objective monitoring. Validated technologies have been adopted as gold standard, but innovative robotic solutions would represent an opportunity to detect balance impairment in PwMS.

Aim
Study’s aim was to compare postural assessment of 46 PwMS with a relapsing–remitting form during static tasks performed with the novel robotic platform hunova® and the gold standard EquiTest®,

Methods
Pearson’s r was run on Center of Pressure (COP)-related parameters and global static balance measures computed from hunova® and EquiTest® in eyes-open (EO) and eyes-closed (EC) conditions. In addition, agreeableness level toward the use of both devices was tested through numeric rating scale.

Results
Considering COP-related parameters, correlations were significant for all measures (p < .001). Interestingly, in EO, a strong correlation was shown for sway area (r = .770), while Medio-Lateral (ML) and Anterior–Posterior (AP) oscillation range, path length, ML and AP speed, ML and AP root mean square distance had a relatively strong association (.454 ≤ r ≤ .576). In EC, except for ML oscillation range showing a relatively strong correlation (r = .532), other parameters were strongly associated (.603 ≤ r ≤ .782). Correlations between global balance indexes of hunova® and EquiTest® revealed a relatively strong association between the Somatosensory Score in EquiTest® and the Somatosensory Index in hunova® (r = − .488). While in EO Static Balance Index from hunova® was highly correlated with Equilibrium score of EquiTest® (r = .416), Static Balance Index had a relatively strong association with both the Equilibrium (r = .482) and Strategy Score (r = .583) of EquiTest® in EC. Results from agreeableness rating scale revealed that hunova® was highly appreciated compared to EquiTest® (p = .044).

Conclusions
hunova® represents an innovative adjunct to standard robotic balance evaluation for PwMS. This confirms that combining traditional and robotic assessments can more accurately detect balance impairments in MS.
Risk-stratified multi-round PSA screening for prostate cancer integrating the screening reference level and subgroup-specific progression indicators
Authors: Liu Xiaomin , Zhang Yu , Duan Hongyuan , Yang Lei , Sheng Chao , Fan Zeyu , Liu Ya , Gao Ying , Wang Xing , Zhang Qing , Lyu Zhangyan , Song Fangfang , Song Fengju , Huang Yubei 
Published: July 2023

Abstract
Background
Although prostate-specific antigen (PSA) is widely used in prostate cancer (PCa) screening, nearly half of PCa cases are missed and less than one-third of cases are non-lethal. Adopting diagnostic criteria in population-based screening and ignoring PSA progression are presumed leading causes.

Methods
A total of 31,942 participants with multi-round PSA tests from the PLCO trial were included. Time-dependent receiver-operating-characteristic curves and area under curves (tdAUCs) were performed to determine the screening reference level and the optimal subgroup-specific progression indicator. Effects of risk-stratified multi-round PSA screening were evaluated with multivariable Cox regression and measured with hazard ratio [HR (95%CIs)].

Results
After a median follow-up of 11.6 years, a total of 3484 PCa cases and 216 PCa deaths were documented. The tdAUC of 10-year incidence PCa with PSA was 0.816, and the cut-off value was 1.61 ng/ml. Compared to subgroup with stable negative PSA in both first-round (FR) and last-round (LR) tests [FR(−)/LR(−)], HRs (95%CI) of PCa incidence were 1.66 (1.20–2.29), 8.29 (7.25–9.48), and 14.52 (12.95–16.28) for subgroups with loss of positive PSA[FR(+)/LR(−)], gain of positive PSA[FR(−)/LR(+)], and stable positive PSA[FR(+)/LR(+)]; while HRs(95%CI) of PCa mortality were 1.47 (0.52–4.15), 5.71 (3.68–8.86), and 5.01 (3.41–7.37). After excluding regressive PSA [(namely FR(+)/LR(−)], absolute velocity was the shared optimal progression indicator for subgroups with FR(−)/LR(−), FR(−)/LR(+), and FR(+)/LR(+), with tdAUCs of 0.665, 0.681 and 0.741, and cut-off values of 0.07, 0.21, and 0.33 ng/ml/year. After reclassifying participants into groups with positive and negative progression based on subgroup-specific progression indicators, incidence HR (95%CI) were 2.41 (1.87–3.10), 2.91 (2.43–3.48), and 3.16 (2.88–3.46) for positive progression compared to negative progression within subgroups of FR(−)/LR(−), FR(−)/LR(+), and FR(+)/LR(+), while mortality HR (95%CI) were 2.22 (0.91–5.38), 2.37 (1.28–4.38), and 2.98 (1.94–4.59). To improve screening performances by excluding regressive PSA and low-risk positive progression in FR(−)/LR(−), optimized screening strategy not only significantly reduce 32.4% of missed PCa (54.0% [1881/3484] vs. 21.6% [754/3484], P < 0.001), but also detected additional 8.0% of high-grade PCa (Gleason score 7–10: 36.0% [665/1849] vs. 28.0% [206/736], P < 0.001) than traditional screening strategy.

Conclusions
Risk-stratified multi-round PSA screening strategy integrating the screening reference level and the optimal subgroup-specific progression indicator of PSA could be recommended as a fundamental strategy to reduce missed diagnosis and improve the detection of high-grade PCa cases.
Occurrence and outcome of COVID-19 in AIRD patients on concomitant treatment with Tofacitinib- results from KRA COVID COHORT (KRACC) subset
Authors: Chebbi Pramod , Shobha Vineeta , Rao Vijay K , Haridas Vikram , Janardana Ramya , Pinto Benzeeta , Kumar Sharath , Patil Abhishek , Tekkatte Roopa , Salanke Manasa , Mahendranath K M 
Published: July 2023

Abstract
Introduction
We assessed the risk factors and outcome of COVID-19 in patients with autoimmune rheumatic diseases(AIRD) who contracted infection while on background treatment with tofacitinib.

Methods
This is a non-interventional, cross-sectional, questionnaire based telephonic study which included consecutive AIRD patients on tofacitinib co-treatment. Data related to the AIRD subset, disease modifying anti rheumatic drugs(DMARDs) including glucocorticoids and comorbidities, was collected from 7 rheumatology centers across Karnataka during the second wave of COVID-19 pandemic. The information about COVID-19 occurrence and COVID-19 vaccination was recorded.

Results
During the study period (Jun-July 2021), 335 AIRD patients (80.6% female) on treatment with tofacitinib were included. The mean duration of tofacitinib use was 3.4+/-3.1months. Thirty-six(10.75%) patients developed COVID-19. Diabetes mellitus (p = 0.04 (OR 2.60 (1.13–5.99)) was identified as a risk factor for COVID-19 in our cohort. Almost half of our cohort was COVID-19 vaccinated with at least one dose, with resultant decline in incidence of COVID-19(OR 0.15 (0.06–0.39) among the vaccinated. Recovery amongst COVID-19 infection group was 91.2%.

Conclusions
The subset of AIRD patients who were on treatment with tofacitinib were found to have a higher rate of COVID-19 infection as compared to our KRACC cohort. Pre-existing comorbidity of diabetes mellitus was the significant risk factor in our cohort. This subset of the KRACC cohort shows RA patients had a lesser infection and PsA patients had a higher infection.
Evaluation of obstetric outcomes in Brazilian pregnant women with Takayasu arteritis
Authors: Ávila Marcela Ignacchiti Lacerda , Marques Marcela Gaiotti , da Rocha Maria Eduarda Araújo Machado , dos Santos Flávia Cunha , Ochtrop Manuella Lima Gomes , de Jesús Nilson Ramires , de Jesús Guilherme Ribeiro Ramires , Elias Camila Souto Oliveira 
Published: July 2023

Abstract
Objective
Takayasu arteritis (TAK) is a rare chronic granulomatous vasculitis that affects large vessels and usually begins in women of childbearing age, so it is not uncommon for pregnancies to occur in these patients. However, there is limited information about these pregnancies, with reports of adverse maternal and obstetric outcomes. The objective of this study is to evaluate adverse maternal, fetal and neonatal events in pregnant patients with TA.

Methods
This is a cross-sectional study with retrospective data collection. We reviewed 22 pregnancies in 18 patients with TAK, according to the American College of Rheumatology criteria, that were followed up in a high-risk prenatal clinic specialized in systemic autoimmune diseases and thrombophilia (PrAT) at Hospital Universitário Pedro Ernesto, from 1998 to 2021.

Results
In twenty-two pregnancies, the mean age of patients was 28.09 years and the mean duration disease was 10.9 years. Of the 18 patients with TAK studied, only one had the diagnosis during pregnancy and had active disease. All other patients had a previous diagnosis of TAK and only 3 had disease activity during pregnancy. Twelve patients (66.6%) had previous systemic arterial hypertension and eleven (61.1%) had renal involvement. Among maternal complications, eight patients (36.3%) developed preeclampsia and six (27.2%) had uncontrolled blood pressure without proteinuria, while 10 (45%) had puerperal complications. Four (18.1%) births were premature, all due to severe preeclampsia and eight newborns (34.7%) were small for gestational age. When all maternal and fetal/neonatal outcomes included in this study were considered, only 6 (27.2%) pregnancies were uneventful.

Conclusion
Although there were no maternal deaths or pregnancy losses in this study, the number of adverse events was considerably high. Hypertensive disorders and small for gestational age newborns were more common than general population, while the number of patients with active disease was low. These findings suggest that pregnancies in patients with TAK still have several complications and a high-risk prenatal care and delivery are necessary for these patients.
Cytogenetic profile of Acute Myeloid Leukemia and Acute Lymphoblastic Leukemia in Northern Pakistan
Authors: Maria Khan  , Chaudhry Altaf Hussain  , Hamid Saeed Malik  , Mohammad Abdul Naeem  
Published: July 2023

Objective: To determine the frequencies of different cytogenetic abnormalities in patients of Acute Myeloid Leukemia and Acute Lymphoblastic Leukemia in Northern Pakistan.
Methods: It was descriptive cross-sectional study conducted in Hematology Department of a Tertiary care referral institute from June 2015 to July 2017. All newly diagnosed cases of Acute Leukemia were analyzed. Cytogenetic analysis was performed on bone marrow aspirate samples using Giemsa-trypsin banding technique. Karyotypes were identified and interpreted according to ISCN criteria.
Results: A total of 355 newly diagnosed patients of Acute Leukemia were analyzed. Out of these, 180 patients had AML and 175 had ALL. In Acute Myeloid Leukemia chromosomal abnormalities were detected in 28.2 % cases. Of these the common ones included t(8;21),t(15;17),+8, Inversion 16 and Monosomy 7. Other abnormalities included Complex karyotype, Down’s syndrome related AML, Hyperdiploidy, del 16q,-8,+Y and t(3p;17q)del 10. In Acute Lymphoblastic Leukemia chromosomal abnormalities were detected in 40% cases. Common ones included Hyperdiploidy, Tetraploidy and t(9;22). Other abnormalities included t(1;19) and t(2;8)t(8;14).
Conclusion: Cytogenetically favorable abnormalities are commonest occurring chromosomal defects in both Acute Myeloid Leukemia and Acute Lymphoblastic Leukemia in Northern Pakistan, i.e., t(8;21) in AML and Hyperdiploidy in ALL.
doi: https://doi.org/10.12669/pjms.39.5.6405
How to cite this: Khan M, Altaf C, Malik HS, Naeem MA. Cytogenetic profile of Acute Myeloid Leukemia and Acute Lymphoblastic Leukemia in Northern Pakistan. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/10.12669/pjms.39.5.6405
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.
X-RAY BEAM GEOMETRY AS APPLIED TO CIRCULAR EXTERNAL FIXATOR IMAGING
Authors: Harris Peter C , Lacey Stephen , Steward Adam , Sertori Mikayla , Homan James 
Published: July 2023

IntroductionThe various problems that are managed with circular external fixation (e.g. deformity, complex fractures) also typically require serial plain x-ray imaging.One of the challenges here is that the relatively radio-opaque components of the circular external fixator (e.g. the rings) can obscure the view of the area of interest (e.g. osteotomy site, fracture site).In this presentation we describe how the geometry of the x-ray beam affects the produced image and how we can use knowledge of this to our advantage.Whilst this can be applied to any long bone, we have focused on the tibia, given that it's the most common long bone that is treated by circular external fixation.Materials & MethodsIn the first part of the presentation we describe the known attributes (geometry) of the x-ray beam and postulate what effect it would have when we x-ray a long bone that is surrounded by a circular external fixator.In the second part we demonstrate this in practice using a tibia and a 3 ring circular external fixator. Differing x-ray beam orientations are used to demonstrate both how the geometry of the beam affects the produced image and how we can use this to our advantage to better visualise part of the bone.ResultsThe practical part of the study confirmed the theoretical part.ConclusionsKnowledge of the beam geometry can be used to minimise the obscuring nature of the circular fixator. This technique is simple and can be easily taught to the radiographer. It is a useful adjunct for the limb reconstruction surgeon.