bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of mass casualty incidents in a tertiary care trauma center in eastern India
Authors: Mohanty Chitta Ranjan , Radhakrishnan Rakesh Vadakkethil , Stephen Shine , Jain Mantu , Shetty Asha P , Issac Alwin , Shaji Ijas Muhammed , Chakola Sebastian 
Published: April 2022

OBJECTIVES:
Disasters and mass casualty incidents (MCIs) that cause substantial mortality and morbidity have been increasing worldwide. The emergency department (ED) services manage MCIs by optimizing triage and providing health care with required resources. The present study attempted to describe the epidemiological characteristics and outcomes of MCIs presenting to the ED.

METHODS:
The present retrospective observational study was conducted at the ED of a tertiary care hospital on patients of MCI for 4 years from 2017 to 2021. The data were extracted from the ED disaster records and other paper-based patient records. Information on patient demography, date and time of arrival, mode of transport, method of arrival (direct or referral), type and mechanism of MCI, ED management, and outcome were recorded. Statistical analysis was performed using R, version 4.1.0.

RESULTS:
Analysis of 21 MCIs was conducted. Road traffic accidents (RTAs) were the predominant cause of MCIs. The majority of MCI victims, except for those of blast injuries, were men. The victims in medical emergencies were significantly younger than those in other MCI groups (P < 0.001). The majority of patients were brought to ED through ambulance services (n = 120 [47.1%]), followed by private vehicles (n = 112 [44.2%]). Most of the MCI victims (n = 143 [56.2%]) were brought to the ED during evening hours (4 pm–8 pm). The majority of victims belonged to the “Red” triage category (n = 110 [43.3%]). The injury severity score was significantly higher (P = 0.014) in the disaster group than in other trauma MCI groups (20 vs. 17). Autorickshaw occupants were the most common victims of mass casualty RTAs (n = 38 [40%]). Suturing (n = 97 [50%]) and dressing (n = 167 [88%]) were the most common ED procedures required by the victims of trauma MCIs. Of the total, 167 (66%) patients were discharged from the ED, 47 (19%) patients were admitted to wards, 13 (5%) patients were admitted to intensive care units, and 24 (9%) patients got referred to other centers. In addition, two patients died in the ED during treatment, whereas one patient was brought dead.

CONCLUSIONS:
RTAs dominate the MCIs and are affecting the young producative male population. The present study exhibited the severity of the cases in MCIs and their impact in the health-care setting, therefore signifying the importance of standardized MCI management protocols.
Manual versus mechanical chest compression in in-hospital cardiac arrest
Authors: Şener Alp , Günaydın Gül Pamukçu , Tanrıverdi Fatih , Özhasenekler Ayhan , Gökhan Şervan , Çelik Gülhan Kurtoğlu , Sağlam Özcan , Ertürk Nihal 
Published: April 2022

OBJECTIVE:
Mechanical chest compression (CC) devices are frequently used in in-hospital and out-of-hospital settings. In this study, mechanical and manual CC in in-hospital cardiac arrest was compared in terms of survival.

METHODS:
Adult patients who were admitted to the emergency department (ED) for 2 years period and had cardiac arrest in the ED were included in this retrospective, observational study. Return of spontaneous circulation (ROSC), 7-day and 30-day survival and hospital discharge data were compared between the two groups of patients who underwent manual CC and those who had mechanical CC with the Lund University Cardiac Assist System-2 device.

RESULTS:
Although the rate of ROSC in the mechanical CC group was lower than in the manual CC group, this difference was not statistically significant (41.7% vs. 50.4%; P = 0.133). The 7-day survival rate was found to be statistically significantly higher in the mechanical CC group (19.4% vs. 8.9%; P = 0.012). The 30-day survival rate was also found to be high in the mechanical CC group, but this difference was not statistically significant (10.6% vs. 7.3%; P = 0.339).

CONCLUSION:
In the light of these results, we can say that the use of piston-based mechanical CC devices in ED may be beneficial. More reliable results can be obtained with a prospective study to be performed in the ED.
The effect of calcium gluconate in the treatment of hyperkalemia
Authors: Celebi Yamanoglu Nalan Gokce , Yamanoglu Adnan 
Published: April 2022

OBJECTIVES:
Intravenous (IV) calcium salts are routinely recommended as a cardio-protective therapy in the emergency treatment of severe hyperkalemia. However, this recommendation is supported by a low level of evidence and is anecdotal. The aim of this study is to determine the effectiveness of IV Calcium (Ca) gluconate in the treatment of hyperkalemia.

MATERIALS AND METHODS:
Patients with hyperkalemia and with the electrocardiogram (ECG) changes due to hyperkalemia over a 1 year period were included in this prospective observational study. Patients’ ECGs were measured, before and after IV Ca-gluconate treatment and after normalization of potassium levels. Wilcoxon test and McNemar's test were used to compare the ECG parameters before and after Ca-gluconate therapy.

RESULTS:
The mean potassium value of 111 patients who met the inclusion criteria was 7.1 ± 0.6 mmol/l. In this study, a total of 243 ECG pathology related to hyperkalemia, 79 of which included main rhythm disorders, and the remaining 164 were nonrhythm disorders in ECG parameters, were analyzed. No statistically significant changes were determined in patients’ nonrhythm ECG disorders with IV Ca-gluconate treatment (P = 0.125). However, nine of the 79 main rhythm disorders due to hyperkalemia improved with calcium gluconate treatment and this change was statistically significant (P < 0.004).

CONCLUSION:
IV Ca-gluconate therapy was found to be effective, albeit to a limited degree, in main rhythm ECG disorders due to hyperkalemia, but it was not found to be effective in nonrhythm ECG disorders due to hyperkalemia. Therefore, Ca-gluconate may be effective only in the main rhythm disorders due to hyperkalemia.
Epidural Analgesia and Abnormal Coagulation in Patients Undergoing Minimal Invasive Repair of Pectus Excavatum
Authors: Media Ara S. , de Paoli Frank V. , Pilegaard Hans K. , Hvas Anne-Mette , Juhl-Olsen Peter , Christensen Thomas D. 
Published: April 2022

Background:
Epidural analgesia (EA) is effective in patients undergoing minimal invasive repair of pectus excavatum (MIRPE) but is associated with major complications such as epidural hematomas. It is recommended to assess coagulation status in patients receiving anticoagulant therapy prior to EA, although no consensus exists in patients without a history of bleeding tendency or anticoagulant therapy. Thus, the aim of this paper was to assess 1) the prevalence of abnormal routine coagulation parameters, i.e., international normalized ratio (INR) and platelet count, and 2) the safety of EA in patients undergoing MIRPE.

Methods:
In this retrospective study, we identified 1,973 patients undergoing MIRPE at our center between 2001 and 2019. Complications related to EA were registered for all patients. Information on coagulation parameters was present in 929 patients. Patients with spontaneously elevated INR ≥1.5 were referred for assessment of coagulation factor VII in order to assess the cause of the elevated INR.

Results:
Of 929 patients with coagulation information available, 18 patients had spontaneously elevated INR ≥1.5 (1.9%). In patients with INR ≥1.5, 12 patients underwent further assessment of factor VII, with all patients having a slightly reduced factor VII close to the lower reference range. The majority of the 1,973 patients undergoing MIRPE received EA (99.6%) with very low complication rates (0.2%) and no incidence of epidural hematomas.

Conclusion:
In patients undergoing MIRPE, coagulation screening prior to EA should not be mandatory as it revealed no clinically relevant consequences. EA is safe with very low complication rates.
The Neurocognitive Outcomes of Hemodilution in Adult Patients Undergoing Coronary Artery Bypass Grafting Using Cardiopulmonary Bypass
Authors: Soliman Rabie , Saad Dalia , Abukhudair Walid , Abdeldayem Sabry 
Published: April 2022

Objective:
The study aimed to evaluate the effect of mild and moderate hemodilution during CPB on the neurocognitive dysfunction in patients undergoing coronary artery bypass grafting.

Design:
A randomized clinical study.

Setting:
Cardiac center.

Patients:
186 patients scheduled for cardiac surgery with cardiopulmonary bypass.

Intervention:
The patients were classified into 2 groups (each = 93), Mild hemodilution group: The hematocrit value was maintained >25% by transfusion of packed-red blood cells plus hemofiltration during CPB. Moderate hemodilution group: the hematocrit value was maintained within the range of 21-25%.

Measurements:
The monitors included the hemofiltrated volume, number of transfused packed red blood cells, and the incidence of postoperative cognitive dysfunction.

Main Results:
The hemofiltrated volume during CPB was too much higher with mild hemodilution compared to the moderate hemodilution (p = 0.001). The number of the transfused packed red blood cells during CPB was higher with mild hemodilution compared to the moderate hemodilution (p = 0.001), but after CPB, the number of the transfused packed red blood cells was lower with the mild hemodilution group than the moderate hemodilution (p = 0.001). The incidence of total postoperative neurological complications was significantly lower with the mild hemodilution group than moderate hemodilution (p = 0.033). The incidence of neurocognitive dysfunction was significantly lower with mild hemodilution group than moderate hemodilution (p = 0.042).

Conclusions:
The mild hemodilution was associated with a significant decrease in the incidence of neurocognitive dysfunction compared to moderate hemodilution in patients undergoing coronary artery bypass grafting. Also, the transfused packed red blood cells increased during CPB and decreased after CPB with the mild hemodilution than moderate hemodilution.
Prospective National Audit of Major Gastrointestinal Complications of Transesophageal Echocardiography Studies in Children
Authors: Murphy Tim , McCheyne Alan 
Published: April 2022

Background:
Perioperative trans-esophageal echocardiography ('TEE') is widely used for the assessment of anatomy/repair of congenital cardiac defects. It is recognised that there are risks associated with its use.

Aims:
We wished, by means of a contemporaneous prospective national audit over a six-month period, to establish what proportion of TEE studies in children are complicated by major upper gastrointestinal or upper aerodigestive tract trauma.

Methods:
After obtaining appropriate local institutional ethics committee approval, a national prospective audit of the rate and severity of gastrointestinal complications of trans-esophageal echocardiography studies in anaesthetised adult cardiology and cardiac surgical patients was conducted by the Association of Cardiothoracic Anaesthesia and Critical Care in the United Kingdom and Ireland during the twelve months of 2017. During the second six months of the audit, the Congenital Cardiac Anaesthesia Network (an organisation including anaesthetists with a paediatric cardiac anaesthetic practice in all the United Kingdom cardiac surgical centres) prospectively audited the incidence of such complications of TEE studies in children.

Results:
A total of 1,059 studies were included in this six-month paediatric audit. There were no reports of the specified major complication.

Statistical Analysis:
The zero incidence of the major complication is consistent with a worst possible incidence of five per thousand TEE examinations.

Conclusions:
Such potentially reassuring information could be included in discussions with patients or families about the risk of trans-esophageal studies in children.
HIV oral self-screening test among HIV/STD/TB clinic attendees: A mixed-method pilot investigation examining merit for larger evaluation
Authors: Rao Amrita , Patil Sandip , Nirmalkar Amit , Bagul Rajani , Ghule Ujjwala , Panchal Narayan , Panda Samiran 
Published: April 2022

Background & objectives:
Globally, several countries consider HIV self-test as an important element in the toolbox to end AIDS by 2030. Against this background, the present investigation was conducted to pilot test the performance of an indigenous HIV oral self-test (HIVOST) and explore its acceptability. The overall purpose was to examine if this kit could serve as a promising tool and merit future larger clinical evaluation.

Methods:
A concurrent mixed-method investigation was undertaken during March-October 2019. One hundred and thirty two consecutive HIV/sexually transmitted diseases/tuberculosis clinic attendees were invited for participation; of whom, 100 were enrolled, and among them, 40 provided consent for qualitative in-depth interviews. The HIVOST kit assessed for its performance served as the ‘index test’, which worked on the principle of lateral flow chromatography. The results of the HIVOST were interpreted independently by the study physicians and participants at 20 min. HIVOST kit performance was assessed against the HIV confirmatory blood test result based on the national algorithm (3 rapid test or 1 ELISA and 2 rapid test) serving as the ‘reference’. Sensitivity, specificity, positive predictive value, negative predictive value and inter-rater agreement were estimated. The voices and concerns of the study participants were coded followed by identification of qualitative themes and ideas.

Results:
The sensitivity and specificity of the index test at the end of 20 min as interpreted by the participants were 83.3 per cent [95% confidence interval (CI): 69.8 to 92.5] and 98 per cent (95% CI: 89.4 to 99.5), respectively. Study physicians and participants independently interpreted HIVOST results with substantial inter-rater agreement (kappa value 0.88; 95% CI: 0.78-0.97). All HIVOST test strips were valid. Majority of the participants preferred saliva over blood for HIV self-test. ‘Comfort’, ‘confidentiality’ and ‘convenience’ were the perceived advantages of HIVOST. Some of the participants wished the package inserts contained ‘how-to-do instructions in local languages’, ‘expiry date (if any)’ and ‘contact helpline number’. A few of them highlighted the need for a confirmatory HIV result following oral self-test. Concerns of the participants revolved around potential self-harm following HIVOST-positive result and safe disposal of kits.

Interpretation & conclusions:
Two major highlights of the present investigation are (i) high level of concordance in HIVOST results interpreted by participants and physicians, and (ii) encouraging level of acceptance of HIVOST. These findings and encouraging HIVOST performance statistics lend support towards large-scale clinical evaluation of this index test.
Co-circulation of Chikungunya Virus during the 2015–2017 Zika Virus Outbreak in Pernambuco, Brazil: An Analysis of the Microcephaly Epidemic Research Group Pregnancy Cohort
Authors: Lobkowicz Ludmila , Miranda-Filho Demócrito de Barros , Montarroyos Ulisses Ramos , Martelli Celina Maria Turchi , de Araújo Thalia Velho Barreto , De Souza Wayner Vieira , Bezerra Luciana Caroline Albuquerque , Dhalia Rafael , Marques Ernesto T. A. , Sanchez Clemente Nuria , Webster Jayne , Vaughan Aisling , Webb Emily L. , Brickley Elizabeth B. , Ximenes Ricardo Arraes de Alencar , _ _ 
Published: April 2022

ABSTRACT.
Co-circulation of arthropod-borne viruses, particularly those with shared mosquito vectors like Zika (ZIKV) and Chikungunya (CHIKV), is increasingly reported. An accurate differential diagnosis between ZIKV and CHIKV is of high clinical importance, especially in the context of pregnancy, but remains challenging due to limitations in the availability of specialized laboratory testing facilities. Using data collected from the prospective pregnancy cohort study of the Microcephaly Epidemic Research Group, which followed up pregnant persons with rash during the peak and decline of the 2015–2017 ZIKV epidemic in Recife, Pernambuco, Brazil, this study aims to describe the geographic and temporal distribution of ZIKV and CHIKV infections and to investigate the extent to which ZIKV and CHIKV infections may be clinically differentiable. Between December 2015 and June 2017, we observed evidence of co-circulation with laboratory confirmation of 213 ZIKV mono-infections, 55 CHIKV mono-infections, and 58 sequential ZIKV/CHIKV infections (i.e., cases with evidence of acute ZIKV infection with concomitant serological evidence of recent CHIKV infection). In logistic regressions with adjustment for maternal age, ZIKV mono-infected cases had lower odds than CHIKV mono-infected cases of presenting with arthralgia (aOR, 99% CI: 0.33, 0.15–0.74), arthritis (0.35, 0.14–0.85), fatigue (0.40, 0.17–0.96), and headache (0.44, 0.19–1.00). However, sequential ZIKV/CHIKV infections complicated discrimination, as they did not significantly differ in clinical presentation from CHIKV mono-infections. These findings suggest clinical symptoms alone may be insufficient for differentiating between ZIKV and CHIKV infections during pregnancy and therefore laboratory diagnostics continue to be a valuable tool for tailoring care in the event of arboviral co-circulation.
Financial Incentives, Not Behavioral Nudges, Led to Optimized HIV Testing among Pregnant Women in a High-Burden Urban Population in Ecuador
Authors: Reina Ortiz Miguel , Grunauer Michelle , Gutierrez Erika , Izurieta Ricardo , Macis Mario , Phan Phillip , Rosas Carlos , Teran Enrique 
Published: April 2022

ABSTRACT.
Behavioral economic principles are increasingly being used in the fight against HIV, including improving voluntary testing in sub-Saharan Africa and South America. However, behavioral nudges have not been widely tested as a strategy to optimize HIV testing in pregnant women. Here, we assessed whether behavioral nudges or financial incentives were effective in optimizing HIV testing among pregnant women in a high-HIV burden setting. A randomized clinical trial was conducted between May 21 and Oct 5, 2018, to allocate pregnant women in Ecuador into three study arms: information only, soft commitment (i.e., a behavioral nudge), and financial incentives. All participants received an informational flyer, including the address of a testing location. Participants in the soft-commitment arm signed and kept a form on which they committed to get tested for HIV. Those in the financial incentive arm received a $10 incentive when tested for HIV. A stepwise logistic regression analysis estimated the effect of the study arms on HIV testing rate. Participants in the financial-incentive arm had higher odds of getting an HIV test (adjusted odds ratio 17.06, P < 0.001) as compared with information-only participants. Soft-commitment had the opposite effect (adjusted odds ratio 0.14, P = 0.014). Financial incentives might be useful in improving HIV testing among pregnant women, especially among those who might be at higher risk but who have not completed an HIV test.
Detection of Japanese Encephalitis Virus RNA in Host-Questing Ticks in Japan, 2019–2020
Authors: Kobayashi Daisuke , Kuwata Ryusei , Kimura Toshiya , Faizah Astri Nur , Azerigyik Faustus Akankperiwen , Higa Yukiko , Hayashi Toshihiko , Sawabe Kyoko , Isawa Haruhiko 
Published: April 2022

ABSTRACT.
Japanese encephalitis virus (JEV), a mosquito-borne virus, causes severe clinical symptoms in humans in the Asian-Pacific region, where it circulates in a primary transmission cycle among Culex tritaeniorhynchus mosquitoes, domestic swine (Sus scrofa domesticus), and wading birds. We report here an anomalous result that mosquito-borne JEV was detected in unfed host-questing ticks collected from the field in Japan. JEV genomic RNA was detected in four pools of Haemaphysalis flava nymphs collected in November and December 2019, and March 2020, when Cx. tritaeniorhynchus adults were not presumed to be active. Moreover, JEV antigenomic RNA was detected in some JEV-positive tick samples, suggesting virus replication in ticks. However, taken together with no infectious virus isolated, the possibility that the antigenomic RNA was derived from the undigested bloodmeal source in ticks cannot be ruled out. Thus, the role of the ticks as a natural reservoir for JEV remains to be confirmed.
Analysis of Brucellosis Cases Between 2010 and 2020 in Guangdong Province, China
Authors: Wang Xiaoxiao , Zhao Yunhu , Liu Suling , Gu Bing 
Published: April 2022

ABSTRACT.
Brucellosis is a zoonotic disease with more than half a million people diagnosed worldwide. In China, 99% of cases were historically reported in the northern part of the country, and few were diagnosed in Guangdong province. Recently, Guangzhou has become as an emerging focus for brucellosis, with personal awareness of brucellosis and inexperience of clinicians hindering timely clinical diagnosis. To improve clinical management of this disease, we retrospectively analyzed 60 brucellosis cases from 2010 to 2020 in Guangdong Provincial People’s Hospital. There were no manifestation differences between southern and northern patients. However, 68.3% of patients lacked awareness of risk factors for Brucella infection. Therefore, to prevent its spread and avoid delays in diagnosis, implemented infected-animal control programs and enhanced education on brucellosis are necessary.
Case Report: Pulmonary Tuberculosis Accompanied by Pure Red Cell Aplasia and Autoimmune Hemolytic Anemia
Authors: Shimizu Hayato , Yamamoto Hiroshi , Hiramoto Nobuhiro , Nishioka Hiroaki 
Published: April 2022

ABSTRACT.
Tuberculosis is one of the most common infections worldwide. It has been associated with some hematologic disorders; however, pure red cell aplasia or autoimmune hemolytic anemia is rarely reported. We describe the case of a 68-year-old woman with pulmonary tuberculosis accompanied by pure red cell aplasia and autoimmune hemolytic anemia. These hematologic disorders were improved by treatment of pulmonary tuberculosis. This case suggests that physicians should consider the possibility of tuberculosis as a cause of pure red cell aplasia.
An Effective Barrier to Prevent Crop Contamination by Slug Vectors of Angiostrongylus cantonensis
Authors: Pang Lorrin , Coppolo Christy , Hauptman Sara 
Published: April 2022

ABSTRACT.
The accidental ingestion of slugs, intermediate hosts to the Angiostrongylus cantonensis parasite, is the most common cause of rat lungworm disease (RLWD) found in humans in Hawaii. This disease has high morbidity and can be complicated to diagnose and treat. With these considerations, efforts in prevention of the initial infection are of high priority. Management of the slug and snail population in food crops is a primary focus to reduce contamination of produce with the rat lungworm (RLW) parasite. The purpose of this study was to prevent RLW crop contamination by preventing the intermediate slug hosts from infesting produce. Our studies showed that an electrified metal tape was a very effective barrier first in the laboratory and then in a garden/farm setting. The intervention is simple to install and maintain and with monitoring for occasional barrier breaches should be able to significantly reduce slug invasion. An integrated pest management program will benefit from the addition of this barrier method to prevent slug carriers of RLWD from infesting produce.