bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early drop in systolic blood pressure is associated with poor diuretic response and prognosis in patients with acute heart failure
Authors: Dotare Taishi , Maeda Daichi , Matsue Yuya , Sunayama Tsutomu , Kida Keisuke , Kitai Takeshi , Kagiyama Nobuyuki , Yamaguchi Tetsuo , Okumura Takahiro , Mizuno Atsushi , Oishi Shogo , Inuzuka Yasutaka , Akiyama Eiichi , Suzuki Satoshi , Yamamoto Masayoshi , Minamino Tohru 
Published: September 2022

Abstract

Aims
Although an excessive drop in systolic blood pressure (SBP) during acute heart failure (AHF) negatively impacts prognosis, the association between changes in SBP and the diuretic response (DR) is unclear. We aimed to clarify the association between an early drop in SBP and DR/prognosis in patients with AHF.

Methods and results
This was a sub-analysis of the REALITY-AHF study, which registered patients with AHF admitted through emergency departments (EDs). An early SBP drop was defined as the difference between baseline SBP and the lowest value during the first 48 h of hospitalization. DR was defined as the urine output achieved per 40 mg of intravenous furosemide administered. SBP was measured on admission, at 90 min, and 6, 24, and 48 h after admission. Patients were divided into four groups according to their median SBP drop and DR: greater SBP drop/poor DR (n = 322), smaller SBP drop/poor DR (n = 409), greater SBP drop/good DR (n = 419), and smaller SBP drop/good DR (n = 314). The study included 1,464 patients. A greater SBP drop/poor DR was associated with higher baseline SBP and vasodilator use. Multivariable linear regression analysis showed that a greater drop in SBP was associated with poorer DR following adjustment for potential covariates. Cox proportional hazards analysis demonstrated that a greater SBP drop/poor DR was independently associated with 1-year mortality. Both SBP and DR changes were independently associated with prognosis.

Conclusion
An early drop in SBP during the first 48 h of hospitalization was associated with poor DR and 1-year mortality in patients with AHF.

Clinical Trial Registration
URL: http://www.umin.ac.jp/ctr/Unique identifier: UMIN000014105
Cardiac screening prior to return to play after SARS-CoV-2 infection: focus on the child and adolescent athlete: A Clinical Consensus Statement of the Task Force for Childhood Health of the European Association of Preventive Cardiology
Authors: D’Ascenzi Flavio , Castelletti Silvia , Adami Paolo Emilio , Cavarretta Elena , Sanz-de la Garza María , Maestrini Viviana , Biffi Alessandro , Kantor Paul , Pieles Guido , Verhagen Evert , Tiberi Monica , Hanssen Henner , Papadakis Michael , Niebauer Josef , Halle Martin 
Published: September 2022

Abstract
Cardiac sequelae after COVID-19 have been described in athletes, prompting the need to establish a return-to-play (RTP) protocol to guarantee a safe return to sports practice. Sports participation is strongly associated with multiple short- and long-term health benefits in children and adolescents and plays a crucial role in counteracting the psychological and physical effects of the current pandemic. Therefore, RTP protocols should be balanced to promote safe sports practice, particularly after an asymptomatic SARS-CoV-2 infection that represents the common manifestation in children. The present consensus document aims to summarize the current evidence on the cardiac sequelae of COVID-19 in children and young athletes, providing key messages for conducting the RTP protocol in paediatric athletes to promote a safe sports practice during the COVID-19 era.
Saturated fat: villain and bogeyman in the development of cardiovascular disease?
Authors: Valk Reimara , Hammill James , Grip Jonas 
Published: September 2022

Abstract

Aims
Cardiovascular disease (CVD) is the leading global cause of death. For decades, the conventional wisdom has been that the consumption of saturated fat (SFA) undermines cardiovascular health, clogs the arteries, increases risk of CVD, and leads to heart attacks. It is timely to investigate whether this claim holds up to scientific scrutiny. The purpose of this paper is to review and discuss recent scientific evidence on the association between dietary SFA and CVD.

Methods and results
PubMed, Google scholar, and Scopus were searched for articles published between 2010 and 2021 on the association between SFA consumption and CVD risk and outcomes. A review was conducted examining observational studies and prospective epidemiologic cohort studies, randomized controlled trials (RCTs), systematic reviews and meta-analyses of observational studies and prospective epidemiologic cohort studies, and long-term RCTs. Collectively, neither observational studies, prospective epidemiologic cohort studies, RCTs, systematic reviews, and meta-analyses have conclusively established a significant association between SFA in the diet and subsequent cardiovascular risk and coronary artery disease, myocardial infarction, or mortality nor a benefit of reducing dietary SFAs on CVD rick, events, and mortality. Beneficial effects of replacement of SFA by polyunsaturated or monounsaturated fat or carbohydrates remain elusive.

Conclusion
Findings from the studies reviewed in this paper indicate that the consumption of SFA is not significantly associated with CVD risk, events, or mortality. Based on the scientific evidence, there is no scientific ground to demonize SFA as a cause of CVD. SFA naturally occurring in nutrient-dense foods can be safely included in the diet.
Managing multimorbidity: a qualitative study of the Australian general practitioner experience
Authors: Damarell Raechel A , Morgan Deidre D , Tieman Jennifer J , Senior Tim 
Published: September 2022

AbstractBackgroundMultimorbidity is prevalent in general practice and general practitioners internationally report challenges in its management. Understanding the perspectives of general practitioners at the frontline of care is important for system sustainability and accessibility as populations age.ObjectiveTo explore Australian general practitioner perspectives on managing multimorbidity, the factors supporting their work, and those impeding their ability to meet their own standards of care provision.MethodA qualitative study conducted with Australian general practitioners using semistructured, in-depth interviews and inductive thematic data analysis.ResultsTwelve interviews with general practitioners were conducted. Three main themes were constructed from the data: Multimorbidity as an encounter with complexity and contingency; Evidence constraints in multimorbidity care; and Concerns for patient safety. System structure and the Australian general practice model restrict general practitioners’ ability to provide care to their level of satisfaction by linking short consultation times to practice remuneration. Attitudes toward the applicability of guideline evidence were mixed despite most general practitioners questioning its generalizability. Patient safety concerns pervaded most interviews and largely centered on system fragmentation and insufficient intersectoral communication. General practitioners rely on multiple sources of information to provide patient-centered care but chiefly the accumulated knowledge of their patients.ConclusionsAustralian general practitioners share many multimorbidity concerns with international colleagues. While multimorbidity-specific evidence may be unrealistic to expect in the immediate term, system investment and adaptation is needed to support general practice sustainability and clinician ability to provide adequate multimorbidity care, suitably remunerated, into the future.
Comedy, Misrule and the Irish Revival
Authors: Hewitt Seán 
Published: September 2022

Abstract
By pairing roughly contemporary comedies by two of the Irish Revival’s leading playwrights, this article sets up a case study for comparison, demonstrating how various forms of comedy were received by Dublin audiences during the Revival, and illustrating the ways in which comedy produced, and unsettled, political myths in the context of the nascent Irish theatre. Attending to plays by J. M. Synge and Lady Gregory, alongside the manifestos and political manoeuvring of the directors of the Abbey Theatre and its earlier iterations, the article suggests that, through comedic misrule, the comedies of the Revival challenged the ‘misrule’ of forms of imperialism, capitalism and modernization, clearing the way for new narratives and myths to take shape. In the fraught conditions of the opening decade of the twentieth century, comedy is the genre through which we can most acutely see the parameters of Irishness being tested on stage.
Implementation of mental health policies and reform in post-conflict countries: the case of post-genocide Rwanda
Authors: Sabey Courtney S 
Published: September 2022

Abstract
The global burden of mental illness is rising, with populations in post-conflict countries contributing significantly to the numbers. Governments in these countries face the dual challenge of responding to increased mental health needs and implementing this response with institutions and economies weakened by war. This research studies the process, successes and challenges of implementing mental health reform in a low-resource, post-conflict country, a subject that is rarely studied. Based on fieldwork conducted in Rwanda in 2019, the study focuses on the implementation of this African country’s post-genocide mental health policy, which relies primarily on strategies of decentralization and integration into the primary health care system. The results are based on 30 interviews conducted in Kigali and Ngoma with primary stakeholders including government officials, representatives from nongovernmental organizations, service providers and academics. These stakeholders held a positive view of the main strategies of the policy as they resulted in increased accessibility and availability of care for Rwandans. However, they also noted the institutionalization and individualization of mental health care as gaps in the implementation that do not respond to the Rwandan context. Building on complexity theory, the analysis found that many of these gaps, as well as opportunities to address them, are missed by the government due to top-down implementation and a lack of collaboration with local organizations and service providers working in the domain. The research results suggest that although it is possible to prioritize mental health in low-resource, complex settings, the implementation of such reform requires collaborative, adaptive and horizontal approaches in order to adequately address and respond to citizen needs and ensure quality mental health care for all.
Low copper levels measured in the aortic wall of New Zealand patients with non-syndromic ascending thoracic aortic aneurysm
Authors: El-Gamel Adam , Mak Josephenine , Bird Steve , Grainger Megan N C , Jacobson Gregory M 
Published: September 2022

Abstract

OBJECTIVES
Studies in animals have shown causal relationships between copper (Cu) deficiency and the development of thoracic aortic aneurysms (TAAs) [1, 2]. Cu deficiency is widespread in New Zealand (NZ) soils; the high soil pH from the use of lime fertilizers reduces the bioavailability of Cu for grazing animals and growing plants; this, in turn, reduces Cu availability in the NZ human food chain. Our study is a pilot study to explore associations between Cu and TAA. We measured Cu levels in aneurysmal aortic tissues in patients undergoing Bentall procedures and non-aneurysmal aortic tissue from coronary artery bypass graft patients.

METHODS
Aortic samples were collected from 2 groups of patients during elective open-heart surgery over 4 months between November 2017 and February 2018. The groups were a TAA group, patients with non-syndromic aortic aneurysm and without the bicuspid aortic valve or known infectious or inflammatory condition (ANEURYSM; n = 13), and a control coronary artery bypass graft group (CONTROL; n = 44). Standardized digested dry tissue weighed samples were analysed from both groups. Tissue extraction of trace elements was carried out using HCl-H2O2 digestion and a highly sensitive analytical technique, inductively coupled plasma mass spectrometry—used to measure elemental concentrations.

RESULTS
Cu concentration (mean ± SD) was significantly lower in ANEURYSM (3.34 ± 0.16 µg/g) when compared to the CONTROL group tissues (4.33 ± 0.20 µg/g) (dry weight; mean ± SD; Student's t-test, P &lt; 0.05). Over 46% of the Aneurysm patients were Maori and live in a geographically Cu-deficient NZ territory.

CONCLUSIONS
Cu deficiency may play a role in the development or progression of non-syndromic ascending aortic aneurysms in NZ. Maori patients are more at risk as they commonly live in rural NZ, dependent on locally grown nutritional sources. Further studies are required to confirm this exciting finding and to establish cause and effect relationship.
Pharmacokinetics of levonorgestrel and etonogestrel contraceptive implants over 48 weeks with rilpivirine- or darunavir-based antiretroviral therapy
Authors: Nakalema Shadia , Chappell Catherine A , Pham Michelle , Byakika-Kibwika Pauline , Kaboggoza Julian , Walimbwa Stephen I , Musaazi Joseph , Nakijoba Ritah , Mbabazi Leah , Kyohairwe Isabella , Nassiwa Sylvia , Jeppson Jeffrey , Winchester Lee , Siccardi Marco , Fletcher Courtney V , Scarsi Kimberly K , Lamorde Mohammed 
Published: September 2022

Abstract

Background
Pharmacokinetic data are lacking for progestin-releasing subdermal contraceptive implants when used with either rilpivirine- or darunavir/ritonavir-based ART.

Objectives
To characterize the pharmacokinetics of etonogestrel or levonorgestrel implants when administered with these ART regimens over 48 weeks.

Patients and methods
Two separate, parallel, three-group, non-randomized, pharmacokinetic studies evaluated either etonogestrel or levonorgestrel in women receiving rilpivirine- or darunavir-based ART compared with women without HIV (control group). Participants on ART were switched to rilpivirine-based ART with a run-in period of 6 weeks or darunavir-based ART with a run-in of 2 weeks prior to implant insertion. Plasma was collected on Day 0, and 1, 4, 12, 24, 36 and 48 weeks post-insertion. Plasma progestin concentrations were compared between ART and control groups by geometric mean ratio (GMR) and 90% CI.

Results
At the primary endpoint of Week 24, progestin concentrations were similar between the rilpivirine and control groups [etonogestrel: 1.18 (0.99–1.37); levonorgestrel: 1.16 (0.97–1.33)]. At Week 24, progestin exposure was higher in the darunavir groups compared with the control group [etonogestrel: 2.56 (1.69–3.28); levonorgestrel: 1.89 (1.38–2.29)]. Results remained consistent through to Week 48. No differences in etonogestrel-related adverse events were observed, but both ART groups experienced more menstrual abnormalities versus the control group with levonorgestrel.

Conclusions
Etonogestrel and levonorgestrel concentrations were not altered by rilpivirine-based ART. Although progestin concentrations were higher in the ART groups containing ritonavir-boosted darunavir, no implant-related serious adverse events were observed. Both progestin-releasing implants are an appropriate contraceptive option with either rilpivirine- or darunavir/ritonavir-based ART.
Heterogeneity and viral replication fitness of HSV-1 clinical isolates with mutations in the thymidine kinase and DNA polymerase
Authors: Schalkwijk Hanna Helena , Gillemot Sarah , Reynders Marijke , Selleslag Dominik , Andrei Graciela , Snoeck Robert 
Published: September 2022

Abstract

Background
Prolonged antiviral therapy in immunocompromised individuals can result in the emergence of (multi)drug-resistant herpes simplex virus 1 (HSV-1) infections, forming a therapeutic challenge.

Objectives
To evaluate spatial and temporal differences in drug resistance of HSV-1 samples from a HSCT recipient and to determine the effect of resistance mutations on viral replication fitness.

Patients and methods
Five HSV-1 isolates were recovered from a HSCT recipient who suffered from persistent HSV-1 lesions, consecutively treated with aciclovir, foscarnet, cidofovir and a combination of ganciclovir and cidofovir. Spatial and temporal differences in HSV-1 drug resistance were evaluated genotypically [Sanger sequencing and next-generation sequencing (NGS) of the viral thymidine kinase (TK) and DNA polymerase (DP)] and phenotypically (plaque reduction assay). Viral replication fitness was determined by dual infection competition assays.

Results
Rapid evolution to aciclovir and foscarnet resistance was observed due to acquisition of TK (A189V and R222H) and DP (L778M and L802F) mutations. Virus isolates showed heterogeneous populations, spatial virus compartmentalization and minor viral variants in three out of five isolates (detectable by NGS but not by Sanger sequencing). Mutations in the TK and DP genes did not alter replication fitness without drug pressure. TK and/or DP mutants influenced replication fitness under antiviral pressure and showed increased fitness under pressure of the drug they showed resistance to.

Conclusions
The use of NGS and dual infection competition assays revealed rapid evolution of HSV-1 drug resistance in a HSCT recipient with spatial and temporal compartmentalization of viral variants that had altered replication fitness under antiviral pressure.
Quandaries of deciding when to change first-line therapy in invasive pulmonary aspergillosis
Authors: Colombo Arnaldo L , De Almeida João N , Lewis Russell E , Kontoyiannis Dimitrios P 
Published: September 2022

AbstractWe read the excellent viewpoint by Slavin et al. (J Antimicrob Chemother 2022; 77: 16–23) that draws upon the experience of an advisory board of notable experts to comprehensively address many of the clinical factors that drive the need for changes in antifungal therapy for invasive aspergillosis (IA). As noted by the authors, there remains a paucity of quality data to support many of the decisions faced by clinicians managing patients with IA. However, we would like to highlight several other important issues, not fully addressed in that viewpoint, that play an important role in deciding when to change antifungal therapy for IA.
Patterns and contextual determinants of antibiotic prescribing for febrile under-five outpatients at primary and secondary healthcare facilities in Bugisu, Eastern Uganda
Authors: Allwell-Brown Gbemisola , Namugambe Juliet Sanyu , Ssanyu Jacquellyn Nambi , Johansson Emily White , Hussain-Alkhateeb Laith , Strömdahl Susanne , Mårtensson Andreas , Kitutu Freddy Eric 
Published: September 2022

Abstract

Objectives
To describe patterns and contextual determinants of antibiotic prescribing for febrile under-five outpatients at primary and secondary healthcare facilities across Bugisu, Eastern Uganda.

Methods
We surveyed 37 public and private-not-for-profit healthcare facilities and conducted a retrospective review of antimicrobial prescribing patterns among febrile under-five outpatients (with a focus on antibiotics) in 2019–20, based on outpatient registers. Multilevel logistic regression analysis was used to identify determinants of antibiotic prescribing at patient- and healthcare facility-levels.

Results
Antibiotics were prescribed for 62.2% of 3471 febrile under-five outpatients. There were a total of 2478 antibiotic prescriptions of 22 antibiotic types: amoxicillin (52.2%), co-trimoxazole (14.7%), metronidazole (6.9%), gentamicin (5.7%), ceftriaxone (5.3%), ampicillin/cloxacillin (3.6%), penicillin (3.1%), and others (8.6%). Acute upper respiratory tract infection (AURTI) was the commonest single indication for antibiotic prescribing, with 76.3% of children having AURTI as their only documented diagnosis receiving antibiotic prescriptions. Only 9.2% of children aged 2–59 months with non-severe pneumonia received antibiotic prescriptions in line with national guidelines. Higher health centre levels, and private-not-for-profit ownership (adjusted OR, 4.30; 95% CI, 1.91–9.72) were significant contextual determinants of antibiotic prescribing.

Conclusions
We demonstrated a high antibiotic prescribing prevalence among febrile under-five outpatients in Bugisu, Eastern Uganda, including prescriptions for co-trimoxazole and ampicillin/cloxacillin (which are not indicated in the management of the common causes of under-five febrile illness in Uganda). Study findings may be linked to limited diagnostic capacity and inadequate antibiotic availability, which require prioritization in interventions aimed at improving rational antibiotic prescribing among febrile under-five outpatients.
Antibiotic utilization study in a teaching hospital in Nigeria
Authors: Sekoni Kehinde F , Oreagba Ibrahim A , Oladoja Farouk A 
Published: September 2022

Abstract

Background
Antibiotics have been the bedrock of modern medical care, particularly bacterial infections. However, globally, antimicrobial resistance has become a well-recognized public health threat in recent years, and interventions to reduce its burden have been launched worldwide.

Objectives
The present study evaluated antibiotic utilization in both hospitalized patients and outpatients in a University Hospital in Nigeria.

Methods
In a 3 year retrospective study between January 2017 and December 2019, 246 case files of patients were selected for the study based on inclusion and exclusion criteria. In addition, the antibiotic consumption rate for hospitalized and outpatients was determined.

Results
The total antibiotic consumption for hospitalized patients in this study was 260.9 DDD/100 bed-days, while the outpatient department’s patients were 72.3 DDD/1000 inhabitants per day. Peptic ulcer disease was the most frequent indication for antibiotic use for outpatients, with the fluoroquinolones and macrolides being the most prescribed antibiotic class and antibiotic class with the highest DDD, respectively. The most frequent indication for antibiotic use for hospitalized patients was chronic kidney diseases, with the fluoroquinolones and second-generation cephalosporins being the most prescribed antibiotic class and antibiotic class with the highest DDD, respectively. DDD per 100 bed-days and DDD per 1000 patient-days were highest in 2018. The P values for the years were 0.019, 0.195 and 0.001 for 2017, 2018 and 2019, respectively.

Conclusions
Our findings revealed irrationality in antibiotic use. Therefore, antimicrobial stewardship programmes should be implemented.