bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial
Authors: Sánchez-Sánchez Juan Luis , Udina Cristina , Medina-Rincón Almudena , Esbrí-Victor Mariano , Bartolomé-Martín Irene , Moral-Cuesta Débora , Marín-Epelde Itxaso , Ramon-Espinoza Fernanda , Latorre Marina Sánchez- , Idoate Fernando , Goñi-Sarriés Adriana , Martínez-Martínez Blanca , Bonet Raquel Escudero , Librero Julián , Casas-Herrero Álvaro 
Published: July 2022

Abstract
Background
Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult’s population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown effectiveness for reducing fall rates, evidence around their putative cumulative effects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the effectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up.

Methods
This study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥ 1 criteria of the Frailty Phenotype) older adults (≥ 75 years) with high risk of falling (defined by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and flexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, effects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated.

Discussion
This trial will provide new evidence about the effectiveness of an individualized multidomain intervention by studying the effect of additive effects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive effects in the reduction of the incidence of falls and associated adverse outcomes.

Trial registration
NCT04911179 02/06/2021.
Effects of teach-back health education (TBHE) based on WeChat mini-programs in preventing falls at home for urban older adults in China: a randomized controlled trial
Authors: Ye Qiong , Yang Yuting , Yao Miao , Yang Yongwei , Lin Ting 
Published: July 2022

Abstract
Background
Falls are common among adults aged 60 years and older because of physiological changes. Most falls in older adults occur most often at home. Coupled with the lack of awareness and knowledge of preventing falls, the proportion of injuries and deaths among older adults due to falls is increasing yearly. Our study developed a WeChat mini-program for urban elderly to implement teach-back health education (TBHE) that a repeated cycle process of health education, assessment, and re-education in preventing falls at home.

Objectives
This study aimed to evaluate the application effect of the TBHE-based WeChat mini-program on health education knowledge for fall prevention at home for urban older adults.

Design
A single-blinded, two-arm parallel-group, randomized controlled trial was conducted.

Setting
Three residential communities, named Hot Spring Apartment, Hualinyuan, and Dongtang Community in Gulou District, Fuzhou, China.

Participants
Participants were older adults recruited from communities in Fuzhou from January to March 2021.

Methods
Fifty-nine participants agreed to participate and were assigned randomly to the intervention group (n = 29) or the control group receiving traditional health education (n = 30). Each participant in the intervention group received twice a week for a total of 8 weeks of health education interventions performed by the first author that she is intervenor according to specific themes. The trial statistician, recruiters, and participants were blinded to group allocation. The intervenor (first author) was blinded to the study hypotheses. To evaluate the effects of the intervention, we assessed participants’ knowledge total score and scores of physiology and disease; drug application; mental, cognitive, and spiritual well-being; lifestyle; and house environment at baseline and 1-week post-intervention and compared scores between two groups. A two-way repeated-measures analysis of variance was conducted to examine the effects of time, group, and their interaction.

Results
There was a significant difference in knowledge of house environment (p = 0.003) between the two groups. Within groups, total and five dimensions knowledge scores had a significant difference (p < 0.001). Moreover, interaction effects were significant on drug application (p = 0.012) and mental, cognitive, and spiritual well-being (p = 0.015).

Conclusions
The TBHE can improve knowledge on fall prevention at home among urban older adults. The TBHE based on the WeChat mini-program could enhance the efficiency and effectiveness of being educated among urban older adults.

Trial registration
Chinese Clinical Trial Register: ChiCTR2100052946; reg date: 06/11/2021.
Body mass index and trajectories of the cognition among Chinese middle and old-aged adults
Authors: Zhang Wei , Chen Yanan , Chen Na 
Published: July 2022

AbstractThis study aims to investigate the association between trajectories of the cognition and body mass index (BMI) among Chinese middle and old-aged adults. A total of 5693 adults (age 45 +) whose cognitive score is higher than average at the baseline were included from China Health and Retirement Longitudinal Study (CHARLS:2011–2015). Cognitive function was measured by Mini-mental state examination (MMSE) in Chinese version. The Group-based trajectory modeling (GBTM) was adopted to identify the potential heterogeneity of longitudinal changes over the past 5 years and to investigate the relationship between baseline BMI and trajectories of cognitive function. Three trajectories were identified in results: the slow decline (37.92%), the rapid decline (6.71%) and the stable function (55.37%). After controlling for other variables, underweight (BMI < 18.5 kg/m2) was associated with the rapid and slow decline trajectories. Obesity (BMI > 28 kg/m2) was associated with the slow decline trajectory. High-risk people of cognitive decline can be screened by measuring BMI.
Systematic review and meta-analysis of ivermectin for treatment of COVID-19: evidence beyond the hype
Authors: Marcolino Milena Soriano , Meira Karina Cardoso , Guimarães Nathalia Sernizon , Motta Paula Perdigão , Chagas Victor Schulthais , Kelles Silvana Márcia Bruschi , de Sá Laura Caetano , Valacio Reginaldo Aparecido , Ziegelmann Patrícia Klarmann 
Published: July 2022

Abstract
Background
The role of ivermectin in the treatment of COVID-19 is still under debate, yet the drug has been widely used in some parts of the world, as shown by impressive market data. The available body of evidence may have changed over the last months, as studies have been retracted and “standards of care” (SOC) used in control groups have changed with rapidly evolving knowledge on COVID-19. This review aims to summarize and critically appraise the evidence of randomized controlled trials (RCTs) of ivermectin, assessing clinical outcomes in COVID-19 patients.

Methods
RCTs evaluating the effects of ivermectin in adult patients with COVID-19 were searched through June 22, 2022, in four databases, L.OVE platform, clinical trial registries and pre-prints platforms. Primary endpoints included all-cause mortality and invasive ventilation requirement. Secondary endpoint was the occurrence of adverse events. Risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool. Meta-analysis included only studies which compared ivermectin to placebo or SOC. Random-effects were used to pool the risk ratios (RRs) of individual trials. The quality of evidence was evaluated using GRADE. The protocol was register in PROSPERO (CRD42021257471).

Results
Twenty-five RCTs fulfilled inclusion criteria (n = 6310). Of those, 14 compared ivermectin with placebo, in night ivermectin associated with SOC was compared to SOC and two studies compared ivermectin to an active comparator. Most RCTs had some concerns or high risk of bias, mostly due to lack of concealment of the randomization sequence and allocation, lack of blinding and high number of missing cases. Ivermectin did not show an effect in reducing mortality (RR = 0.76; 95%CI: 0.52–1.11) or mechanical ventilation (RR = 0.74; 95%CI: 0.48–1.16). This effect was consistent when comparing ivermectin vs. placebo, and ivermectin associated with SOC vs. SOC, as well as in sensitivity analysis. Additionally, there was very low quality of evidence regarding adverse effects (RR = 1.07; 95%CI: 0.84–1.35).

Conclusions
The evidence suggests that ivermectin does not reduce mortality risk and the risk of mechanical ventilation requirement. Although we did not observe an increase in the risk of adverse effects, the evidence is very uncertain regarding this endpoint.
COVID-19 related acute necrotizing encephalopathy with extremely high interleukin-6 and RANBP2 mutation in a patient with recently immunized inactivated virus vaccine and no pulmonary involvement
Authors: Pongpitakmetha Thanakit , Hemachudha Pasin , Rattanawong Wanakorn , Thanapornsangsuth Poosanu , Viswanathan Anand , Hemachudha Thiravat 
Published: July 2022

Abstract
Background
We report the first case of COVID-19 associated acute necrotizing encephalopathy (ANE) without pulmonary disease in a patient with an extremely high interleukin-6 (IL-6) level and Ran Binding Protein 2 (RANBP2) mutation.

Case presentation
A 29-year-old woman recently immunized with inactivated viral vaccine—BBIBP32-CorV (Sinopharm) presented with alteration of consciousness. Her body temperature was 37° Celsius, blood pressure 42/31 mmHg, heart rate 130 bpm, respiratory rate 20 per minute, and oxygen saturation 98%. Respiratory examination was unremarkable. Neurological examination revealed stupor but preserved brainstem reflexes. Non-contrast computerized tomography of the brain showed symmetrical hypodense lesions involving bilateral thalami and cerebellar hemispheres characteristic of ANE. No pulmonary infiltration was found on chest radiograph. SARS-CoV-2 was detected by PCR; whole genome sequencing later confirmed the Delta variant. RANBP2 gene analysis revealed heterozygous Thr585Met mutation. Serum IL-6 was 7390 pg/mL. Urine examination showed pyelonephritis. Her clinical course was complicated by seizure, septic shock, acute kidney injury, and acute hepatic failure. She later developed coma and passed away in 6 days.

Conclusions
ANE is caused by cytokine storm leading to necrosis and hemorrhage of the brain. IL-6 was deemed as a prognostic factor and a potential treatment target of ANE in previous studies. RANBP2 missense mutation strongly predisposes this condition by affecting mitochondrial function, viral entry, cytokine signaling, immune response, and blood–brain barrier maintenance. Also, inactivated vaccine has been reported to precipitate massive production of cytokines by antibody dependent enhancement (ADE). The true incidence of COVID-19 associated ANE is not known as were the predictors of its development. We proposed these potential two factors (RANBP2 mutation and ADE) that could participate in the pathogenesis of ANE in COVID-19 apart from SARS-CoV2 infection by itself. Further study is needed to confirm this hypothesis, specifically in the post-vaccination period. Role of RANBP2 mutation and its application in COVID-19 and ANE should be further elaborated.
A case report of pre-eclampsia-like endothelial injury in the kidney of an 85-year-old man treated with ibrutinib
Authors: Li Amy , Ambruso Sophia L. , Oto Ozgur Akin , Barry Marc , Edelstein Charles L. 
Published: July 2022

AbstractBackgroundGlomerular endotheliosis is the pathognomonic glomerular lesion in pre-eclampsia that has also been described in those taking tyrosine kinase inhibitors for cancer treatment. Ibrutinib is a Bruton’s tyrosine kinase inhibitor used to treat chronic lymphocytic leukemia (CLL). We report the first known case of glomerular endotheliosis on kidney biopsy in a patient on ibrutinib monotherapy.Case presentationThe patient presented with acute on chronic kidney disease, proteinuria, low C3 and C4 and a high rheumatoid factor titer. A kidney biopsy was performed to confirm a preliminary diagnosis of membranoproliferative glomerulonephritis (MPGN), the most common glomerular disease in patients with CLL. Unexpectedly, the kidney biopsy showed pre-eclampsia-like lesions on light and electron microscopy: occlusion of glomerular peripheral capillary lumens by swollen reactive endothelial cells. Findings of glomerulonephritis were not seen, and there were no specific glomerular immune deposits by immunofluorescence or electron microscopy.ConclusionsCLL is known to cause glomerular lesions, mainly MPGN. There is increasing evidence that ibrutinib, a major treatment for CLL, can cause kidney disease, but the precise pathology is not characterized. We present a patient with CLL on ibrutinib with signs of glomerular endotheliosis. Based on the absence of CLL-induced kidney pathologies typically seen on the kidney biopsy and the non-selectivity of ibrutinib, we attributed the glomerular endotheliosis to ibrutinib. In pre-eclampsia, increased soluble fms-like tyrosine kinase 1 (sFlt1) levels induce endothelial dysfunction by decreasing vascular endothelial growth factor (VEGF). Ibrutinib has been demonstrated to have non-selective tyrosine kinase inhibition, including inhibition of VEGF receptor (VEGFR) and epidermal growth factor receptor (EGFR). VEGFR and EGFR inhibitors have recently been described in the literature to cause hypertension, proteinuria, and glomerular endotheliosis. Kidney biopsy should be performed in CLL patients on ibrutinib that present with acute kidney injury (AKI) or proteinuria to determine whether the clinical picture is attributable to the disease itself or a complication of the therapy.
TAFRO syndrome with renal biopsy successfully treated with steroids and cyclosporine: a case report
Authors: Iwasaki Takahide , Mizusaki Kosuke , Masumoto Miwa , Minagawa Yuko , Azuma Kouta , Furukawa Tetsuya , Yoshida Makoto , Kuragano Takahiro 
Published: July 2022

Abstract
Background
TAFRO syndrome is an acute or subacute systemic inflammatory disease with no apparent cause, presenting with fever, generalized edema, thrombocytopenia, renal damage, anemia, and organ enlargement. Interleukin-6, vascular endothelial growth factor, and other cytokines are thought to be the etiologic agents that increase vascular permeability and cause the resulting organ damage. Only few reports of renal biopsy performed in patients with TAFRO syndrome exist.

Case presentation
A 61-year-old woman, with a history of Sjogren’s syndrome, was admitted to our hospital with anasarca and abdominal distension. Based on the clinical course and various laboratory findings, we diagnosed TAFRO syndrome. Renal biopsy revealed thrombotic microangiopathy, including endothelial cell swelling, subendothelial space expansion, and mesangiolysis. She was treated with oral prednisolone and cyclosporine, with consequent resolution of anasarca, pleural effusion, and ascites, and improvement in renal function and urinary findings. The patient’s platelet count also normalized after 2 months of treatment.

Conclusions
Given that only few reports of improvement in the systemic symptoms of TAFRO syndrome using steroids and cyclosporine exist, our study investigating the relationship between the pathogenesis of TAFRO syndrome and renal disorders, as well as treatment methods, provides valuable insights.
Can residual kidney function affect quality of life and cognitive function in hemodialysis patients?
Authors: Elgendy Asmaa , Abdelsalam Adel I. , Mansour Mostafa , Nassar Mohammed K. 
Published: July 2022

Abstract
Background
Residual kidney function (RKF) may provide many benefits to patients on permanent renal replacement therapy that are reflected in better control of biochemical parameters. In hemodialysis patients, quality of life (QOL) and cognitive function are often impaired. This study aimed to assess the predictors of RKF and its impact on QOL and cognitive function in chronic hemodialysis patients.

Patients and methods
The study involved seventy-eight patients suffering from end-stage renal disease on regular hemodialysis. The patients were divided into two groups according to the presence or absence of RKF (24-hour urine volume ≥ 100 ml). Beside basic laboratory investigations, all patients were subjected to Kidney Disease Quality of Life-Short Form (KDQOL-SF) version 1.3 for assessing the quality of life and Montreal cognitive assessment (MoCA) score for assessing cognitive function.

Results
There was a significantly higher score for KDQOL domains and MoCA score in patients with RKF compared to patients without RKF. There was a significant positive correlation between RKF and both of MoCA score and the physical composite score (PCS) of QOL. Moreover, there were statistically significant positive correlations between the MoCA score and both PCS and mental composite score (MCS). On multivariate analysis, hemodialysis duration was the only predictor for RKF; whereas age was a significant predictor for PCS; and MoCA score could be significantly predicted by the measured RKF and patients’ age.

Conclusion
HD patients with maintained RKF had better QOL and cognitive function. The duration of HD and the age of the patients were found to be related to RKF and PCS in this study. RKF was associated with the cognitive performance of hemodialysis patients.
Comparison of gastrointestinal symptoms and findings in renal replacement therapy modalities
Authors: Karahan Doğu , Şahin İdris 
Published: July 2022

Abstract
Objective
Chronic kidney disease (CKD) affects gastrointestinal system (GIS) and causes histological, functional and mucosal changes. There are scarce data investigating GIS symptoms and findings in patients with CKD stage III-V, receiving hemodialysis (HD) and peritoneal dialysis (PD). In this study, we aimed to evaluate the frequency of gastrointestinal symptoms and findings and compare between renal replacement therapies.

Method
A total of 290 patients (97 in CKD stage III-V, 92 PD, 101 HD) were included in this study. Gastrointestinal complaints, diseases, background characteristics of patients and drugs they used were questioned by interviews, forms were filled and examinations of patients were performed. Results of upper GIS endoscopy, colonoscopy, abdominal ultrasonography and tomography of patients were evaluated.

Results
The most common signs were dyspepsia (50%), nausea (45%) and epigastric pain (44%) among all patients, generally. Gastrointestinal disorders like gastritis (62%) and gastroesophageal reflux (39%) were frequent in patients. Prevalence of patients with weight loss was 20% in predialysis and 8% in PD and the ratio was higher in predialysis group statistically significantly (p = 0,016). The prevalence of gastritis was 70% in PD, 55% in HD and the prevalence of hemorrhoids was 24% in PD and 12% in HD. The prevalence of gastritis and hemorrhoids was higher in the PD group than in the HD group statistically significantly (p = 0.043, p = 0.028), otherwise, there wasn’t a difference between the PD and predialysis groups, statistically significantly.

Conclusion
This study showed that; gastrointestinal symptoms and disorders were very common in CKD, besides this; while gastritis and hemorrhoids were more frequent in the PD, esophagitis and hiatal hernia were more frequent in the HD.
Improving quality of intrapartum and immediate postpartum care in public facilities: experiences and lessons learned from Rajasthan state, India
Authors: Jain Yashpal , Chaudhary Tarun , Joshi Chandra Shekhar , Chotiya Manish , Sinha Bijali , Nair Tapas Sadasivan , Srivastava Ashish , SV Vinod Kumar , Agrawal Abhinav , Srivastava Vineet , Baswal Dinesh , Lalchandani Kamlesh , Shah Hemang , Usmanova Gulnoza , Sood Bulbul , Yadav Vikas , Kumar Somesh 
Published: July 2022

Abstract
Background
In spite of considerable improvement in maternal and neonatal outcomes over the past decade in India, the current maternal mortality ratio and neonatal mortality rate are far from the Sustainable Development Goal targets due to suboptimal quality of maternity care. A package of interventions for improving quality of intrapartum and immediate postpartum care was co-designed with the Ministry of Health as the Dakshata program and implemented in public sector health facilities in selected districts in the state of Rajasthan of India since June 2015. This article describes the key strategies, interventions, results and challenges from four years of Dakshata program implementation.

Methods
We have conducted secondary analysis of program data (government data) collected from 202 public facilities across 20 districts of Rajasthan state. The data collected between June–August 2015 (baseline) and the data collected between May-August 2019 (latest) were analyzed. The data sources included: facility assessments, service statistics, monthly progress reports.

Results
During the period of program implementation, there were 17,94,249 deliveries accounting for 70% of institutional deliveries in intervention districts. As a result of the intervention, there was a notable increase in competency of health care providers, availability of essential resources, achievement of labour room standards and adherence to evidence-based clinical standards. We also observed reductions in the proportion of referrals for pre-eclampsia/eclampsia, postpartum hemorrhage and neonatal asphyxia by 11, 8 and 3 percentage points respectively. Similarly, data revealed a reduction in stillbirth rates in Dakshata intervention facilities (19.3 vs 15.3) compared to non-Dakshata facilities (21.8 vs 18).

Conclusions
Our experience and findings indicate that the quality of intrapartum and immediate postpartum care can be improved in low- and middle-income countries with the approach presented in this paper.