bluuebunny/crossref_metadata_2025 huggingface dataset:
Persistent left superior vena cava with retrograde flow and absent coronary sinus in a child with ventricular septal defect and patent ductus arteriosus
Authors: Kishore Rashmi , Gudipati Rajesh Babu , Sairam Palaparthi , Mathew Thomas , Vyas Suman Y. , Rao Nitin K.
Published: December 2024

Coronary sinus (CS) defects are rare congenital cardiac anomalies that occur in isolation or with other congenital heart diseases. Persistent left superior vena cava (LSVC) is a relatively common entity that usually drains into the CS, is of no hemodynamic consequence, and is easily diagnosed on echocardiography by a dilated CS and an antegrade flow toward the heart. However, a combination of LSVC and CS defect may reverse its flow direction and CS dilation may be absent. In the absence of echocardiographic clues, the reversed flow can be easily misdiagnosed for other structures such as the more common vertical vein of anomalous pulmonary venous connection or the rarer levoatrial cardinal vein. Here, we report a 2-year-old boy with ventricular septal defect, patent ductus arteriosus, absent CS, and a persistent LSVC with retrograde flow producing a hemodynamically significant pretricuspid left-to-right shunt along with its diagnostic challenges. He underwent successful surgical closure of these defects and had been asymptomatic on follow-up.
Trim the sail: A rare cause of newborn hypoxia
Authors: Katranji Khalid A. , Spiro Max Jacob , Albaro Cecilia A. , Turbendian Harma K. , Kopec Gretchen L.
Published: December 2024

The right venous valve is critical to the proper development of the fetal heart. As the right venous valve degenerates later in fetal development, residual structures can remain, such as the terminal crest, Eustachian valve, Thebesian valve, and a prominent Chiari network, with a sail-like appearance resembling a spinnaker. While these structures are often incidentally found on adult echocardiograms, we present a case of a term neonate with hypoxia secondary to a persistent right valve of the sinus venosus.
Comparative Evaluation of a Modified Laryngoscope Blade for Apneic Oxygenation during Airway Management of Pediatric Patients: A Prospective, Randomized Clinical Trial
Authors: Pandey Jitendra , Dubey Prakash K. , Singh Swati
Published: December 2024

Background:

Pediatric patients are prone to oxygen desaturation during the induction of general anesthesia. The effectiveness of apneic oxygenation in preventing adverse respiratory events necessitates the use of various strategies to increase safe apneic time. The study aimed to compare the efficacy of the modified Miller’s laryngoscope with oxygen insufflation with that of the normal Miller’s laryngoscope.

Patients and Methods:

One hundred and sixty children (age = 1–10 years) undergoing general anesthesia with endotracheal intubation for surgery were recruited and randomly assigned to one of the two groups: oxygenation group (intubation performed using laryngoscopy performed with modified Miller’s blade) or control group (classical Miller blade). The primary outcome measure was successful and uneventful intubation. Secondary outcomes included the need for multiple attempts at intubation and hemodynamic parameters throughout the study period.

Results:

The median (interquartile range) time for intubation on the first attempt was 58 s (50–108 s) in the oxygenation group compared to 55 s (48–106 s) in the control group (P = 0.071). However, the overall lowest oxygen saturation (SpO2) level observed within 6 min was significantly lower in the control group as compared to the oxygenation group (P < 0.001). The oxygenation group observed SpO2 levels of 100% in 75% of patients, whereas the control group observed them in 52.5% (P = 0.003).

Conclusion:

Using a modified Miller’s laryngoscope for apneic oxygen insufflation effectively extended the safe apneic time, while maintaining hemodynamic stability during pediatric intubations.
Secondary Trigeminal Neuralgia after a Brainstem Hemorrhagic Stroke with Adverse Reaction to Carbamazepine: A Case Report
Authors: Yusari I Gusti Agung Ayu Andra , Wijayanti Ida Ayu Sri , Widyastuti Ketut , Adnyana I Made Oka
Published: December 2024

Secondary trigeminal neuralgia (TN) is a rare manifestation of neuropathic pain in post-stroke patients, which is characterized by paroxysmal unilateral pain in the trigeminal nerve distribution, especially in strokes that occur in the brainstem. We present a case of a female patient, 28 years old, with attacks of right-sided severe pain in the face, which felt like burning and electric shock. The pain began after hospitalization due to a brainstem hemorrhagic stroke in the right pons and mesencephalon, and the pain persisted for several months. She was diagnosed with secondary TN associated with brainstem hemorrhagic stroke. She experienced severe adverse reactions with the first-line pharmacological therapy, carbamazepine and gabapentin. Fluoxetine was given as an alternative therapy, and the patient began to experience improvement in the pain intensity and frequency within a few weeks. Secondary TN is a complication of hemorrhagic stroke in the brainstem, the site of the trigeminal nerve somatosensory component. Management of secondary TN after stroke has its own challenges in selecting the best medication to achieve remission of symptoms, especially when there is an adverse reaction to the first-line treatments, in this case to anticonvulsants. Antidepressants, such as fluoxetine, can be the treatment of choice to improve the symptoms of TN patients in such cases.
Cardiac Tamponade Following Port-a-Cath Insertion: A Case Report
Authors: Viswanathan Ranjitha , Selvaraj Venkatesh , Phani Madhuri Galidevara , Pavazhakannan Priadharsan , Manohar Sai Sanjana
Published: December 2024

Implantable port devices such as the port-a-cath device, inserted in infants, and the associated complications are under-reported, likely because of the limited indications for port placement. This case report describes the incidence of cardiac tamponade during insertion of a port-a-cath device in a 10-month-old infant with protein C and S deficiency. Chemo port insertion was planned in view of requirement of multiple fresh frozen plasma (FFP) transfusions. After induction of endotracheal general anesthesia, under ultrasound guidance, soon after insertion of the catheter over the guidewire, the child underwent hemodynamic instability, resulting in hypotension and bradycardia. On persistence of signs, immediate transthoracic echocardiography was carried out, which showed pericardial effusion. Needle pericardiocentesis was performed immediately under ultrasound guidance, and 20 mL of blood was aspirated. A pericardial pig tail catheter was left in situ. The 5 French port-a-cath is the smallest size available commercially, which we have used in this patient. The outer diameter of the 5 French port-a-cath is around 2.5 mm, which is equal to the average diameter of the internal jugular vein in infants, resulting in a catheter-to-vein diameter ratio of almost 1. The smaller size of the infant and the mismatch in the available sizes of this device contribute significantly to the technical difficulty of inserting this device in infants, leading to rare complication of pericardial tamponade. Ultrasound guidance should be used to locate the vein and confirm the position of the tip of the guidewire and the catheter during the process of insertion, which could have avoided this critical complication.
Managing Atrophic Thin Crest by Ridge Splitting Technique before Implant Placement
Authors: Kriouach Nada , Erraji Samir , Ismaili Zouheir
Published: December 2024

Critical alveolar ridge defects can result from several causes. Ridge expansion is a technique that aims to increase the width of the bone crest. A male patient presented an edentulous segment which leads to be careful concerning the adjacent teeth. Through this case report, the used technique was explained with all steps and was combined with guided bone regeneration (GBR). The particularity of this case was the membrane exposure during the healing period before placing the crowns, resulting in bone resorption. This resorption was stable after restauration and follow-up. Ridge split is indicated in cases where the width of the ridge is at least 3.5 mm. The procedure demonstrated a safe and predictable alternative for implant placement in a knife-edge ridge, with a high survival rate of ridge expansion. The patient presented good healing at the follow-up with a little resorption that remained stable in time after crown placing.
Clinical Effectiveness of Pit and Fissure Sealants Using Solvents for Improving Surface Wettability of Enamel: A Randomized Controlled Trial
Authors: Deshpande Anshula N , Bane Pooja V , Baishya Simron , Shah Yash , Dori Sneha
Published: December 2024

Background:

Preventive dental procedures are cornerstones of caries management.

Introduction:

This research aims to analyze the clinical effectiveness of pit and fissure sealants when applied to etched enamel pretreated with solvents compared to the conventional etch and seal technique.

Subjects and Methods:

Children and adolescents with clinically healthy occlusal surfaces or noncavitated occlusal carious lesions on permanent first and/or second molars in all four quadrants were randomly allocated into four groups. A total population of 87 participants (348 teeth) were selected for the research based on the inclusion criteria. Following the enrollment, teeth were etched and sequentially assigned for application of Group 1 = Conventional Etch Seal (control group), Group 2 = isopropyl alcohol (IPA), Group 3 = acetone, and Group 4 = ethanol before sealant application. All participants were evaluated for marginal integrity, discoloration, and clinical retention of pit and fissure sealant after 6-month intervals and 12-month intervals using Feigal’s criteria.

Results:

At 6-month and 12-month intervals, the collected data were compiled and statistically analyzed using the Chi-square test of significance for marginal integrity between groups all four groups. The Wilcoxon rank test was assigned to assess the difference between parameters measured at 6 months and 12 months. A highly significant difference was found between the groups (P < 0.05) for marginal integrity and anatomic form at 6 months and 12 months when intergroup comparison was done using the Kruskal–Wallis test.

Conclusion:

Surfactants such as IPA and acetone can be adopted while choosing methods for the long-term clinical success of resin-based sealants for increasing wettability and penetration depth.
Orthodontic Treatment of Anterior Open Bite Caused by a Car Accident
Authors: Hirose Naoto , Yanoshita Makoto , Nishiyama Sayuri , Kubo Naoki , Kita Daiki , Tsuboi Eri , Tanimoto Kotaro
Published: December 2024

This article outlines the orthodontic treatment of a 21-year-old female patient with an open bite and temporomandibular joint disorders (TMDs) that developed after a severe car accident. The treatment plan utilized temporary anchorage devices (TADs) for upper molar intrusion to correct the open bite without resorting to orthognathic surgery. Over a period of 3 years, the treatment achieved a stable occlusion, normalized molar relationships, and improved esthetics. Despite the persistent of TMD symptoms, the patient experienced enhanced jaw movement and a reduction in abnormal chewing cycles. The combination of orthodontic treatment with TADs and splint therapy contributed to successfully restoring both esthetic and functional aspects. This case underscores the efficacy of TADs in addressing trauma-induced malocclusions, highlighting the potential for minimal intervention to achieve comprehensive treatment outcomes.
The Nonmetric Cusp Traits of Maxillary Molars in Tamil Population: A Cross Sectional, Descriptive and Sex Identification study using the Turner Scott dental Anthropology Standards
Authors: Pillai Jayasankar P. , Parmar Girish , Vyas Jayantkumar M. , Babu Rajesh
Published: December 2024

Context:

Dental nonmetric traits, the morphological characteristics in teeth exhibit variations between populations and sexes.

Aim:

The aim of the study was to analyse the expression of the cusp traits in maxillary molars in the Tamil Nadu population.

Settings and Design:

A descriptive, cross-sectional, and population-based study was designed.

Methods and Material:

The pre-treatment dental models of 236 boys (44.6%) and 293 girls (55.45%) in Tamil Nadu and Pondicherry were used for this study. The expressions of the cusp of Carabelli trait in the maxillary 1st molar and the hypocone trait in the 2nd molar were recorded using the Turner-Scott Dental Anthropology standards.

Statistical Analysis Used:

The non-parametric Mann–Whitney U test was used to compare the results of males and females. Chi-square test was used to test the inter-trait and intra-trait association. The discriminant function analysis was performed to test the potential of the two traits for sex classification.

Results:

The prevalence of cusp of Carabelli was only in 7.5%–11.4% of the study sample. The hypocone presence was observed in around 53%–61%. Only 57%–59% of the correct sex classification could be possible using the studied two traits.

Conclusions:

There was a low prevalence of the maxillary 1st molar Carabelli’s trait in the Tamil population when compared to the prevalence of the distolingual cusp (hypocone) trait in the maxillary 2nd molar. There was an excellent intra-trait correlation while the inter-trait correlation is weak. However, there was a significant association between the two traits on both sides.
Influences of Online Education System on the Quality of Life of Children During the COVID-19 Pandemic Lockdown - An Evaluative Study
Authors: Usha Kiran V , Vabbalareddi Rajasekhar , Pandranki Jayalakshmi , Nandan V Bhavesh
Published: December 2024

Background:

Conventional classroom learning took a beating during the COVID-19 lockdown. This was not the first time educational institutions had to shut down globally. Alternative teaching methods needed to be incorporated into the educational system, and therefore, it was prudent to study the effects of such novel teaching methods on the quality of life of children. The aim of the study was to evaluate factors affecting the general and oral health-related quality of life of children during online classes during the COVID-19 pandemic.

Material and Methods:

A digital questionnaire-based study was conducted among children aged nine to fourteen years who attended online classes during the COVID-19 lockdown. Pearson’s Chi-square test was used for comparative evaluation between variables.

Results:

A total of 182 children responded to the questionnaire. Among them 36.3% of children reported having headaches, 32.4% had eyestrain, 13.7% had watering eyes, 10% had back pain, 23.6% had neck pain, 14.8% complained of disturbed sleep and 6% had hearing disturbances during the phase of online classes. In addition, 32.4% of children had the habit of snacking between meals and 8.2% reported tooth pain. There was a statistically significant difference (P = 0.036) between the time spent per day attending online classes and the number of problems reported.

Conclusions:

Several factors have been identified that affected the children’s quality of life during their online classes. Increased screen time without maintaining ergonomics could lead to adverse effects. Also, children need to be educated about snacking habits and oral hygiene practices to achieve optimal oral health.
Effect of Antimicrobial Photodynamic Therapy on Aggregatibacter actinomycetemcomitans Biofilm using Confocal Fluorescence Imaging—An In vitro Study
Authors: Sindhujaa R , Ravi Shankar PL , Pandian K Raja , Chandrasekharan Deepak , Dolly A Sheryl , Rashik KM Mohamed
Published: December 2024

Introduction:

Periodontitis is a significant oral health issue caused by specific microorganisms, leading to the destruction of tooth-supporting tissues. Aggressive periodontitis (AgP) is a rapidly progressing form of the disease, particularly affecting young adults. Photodynamic therapy (PDT) has emerged as a potential treatment modality for periodontitis, utilizing visible light combined with a photosensitizer to inactivate bacteria.

Aim:

The aim of the current in vitro study is to investigate the effect of antimicrobial photodynamic therapy on Aggregatibacter actinomycetemcomitans (A.a) biofilm using confocal fluorescence imaging.

Materials and Methods:

Bacterial cultures were cultured in Brain Heart Infusion broth, supplemented with horse blood, hemin, and menadione. Biofilms were inoculated into 24-well plates, treated with purpurin dye, and exposed to laser irradiation. Following treatment, biofilms were fixed, stained with a LIVE/DEAD staining kit, and examined using confocal laser scanning microscopy (CLSM) to assess bacterial viability and biofilm formation. Additionally, an MTT assay was performed to evaluate cell viability quantitatively after laser exposure.

Results:

Treatment groups exhibited a significant reduction in A.a viability compared to the control group. CLSM imaging revealed a decrease in viable bacterial colonies within the biofilm after PDT, with complete bacterial kill observed in some cases. Additionally, PDT resulted in alterations in biofilm structure and morphology.

Conclusion:

These findings demonstrate the potential of purpurin-mediated PDT as an effective antimicrobial therapy for periodontitis, offering a promising adjunct to conventional in vivo periodontal treatment approaches and has high potential in clinical applications.
Demographics and Haematological Parameters in Patients with Type II Diabetes Mellitus in Uttar Pradesh – A Comparative study
Authors: Singh Priyanka , Vijay Pradakhshana , Chandra Shaleen , Singh Sanjay Kumar , Singh Diksha , Devi Priya
Published: December 2024

Introduction:

Pathophysiology and clinical relevance of haematological parameters in various populations have always been a keen interest of research for haematologists. Various factors may have a role in the values of serum biochemical parameters. These might include gender, age, altitude and disorders like diabetes mellitus, hypertension or both.

Aim:

To compare the demographics and haematological parameters like haemoglobin, white blood cell and platelet values in type II diabetes mellitus patients.

Materials and Method:

Record of 1,200 patients, who came to the haematology section of the department in the regular outpatient department (OPD) services, was randomly selected from the daily record data. The record of selected patients was categorized into Group A – (Control group) subjects with no morbidity and Group B – patients with diabetes mellitus type II. Blood parameters of each were noted and analysed in the Department of Oral Pathology and Microbiology.

Results and Discussion:

The study found no significant association between age and gender and diabetes occurrence. However, there was a significant difference in total leukocyte count (TLC) levels, particularly in males, among diabetics. Additionally, there was a significant variation in platelet count among diabetics, with more variation in females.

Conclusion:

We found a significant positive correlation between TLC and the platelet count among males and females of diabetes mellitus patients. This surely affects the lifestyle and general health, and so the patients must be educated and motivated to maintain a regular blood sugar level through diet, exercise and medicines as poor control can definitely lead to complications.
Modulation of Long Non-coding RNA FAS-AS1/FAS/Caspase3 Axis in Endometriosis: A Cross-sectional Study
Authors: Shayanfard Amir Hossein , Salehi Zivar , Mashayekhi Farhad , Zahiri Ziba
Published: December 2024

ABSTRACT

Background:

An increasing number of studies have demonstrated that excessive proliferation and apoptosis play a pivotal role in the development of endometriosis.

Aim:

The aim of the study was to evaluate the expression of long non-coding RNA (lncRNA) FAS-AS1, FAS, soluble Fas (sFas) and caspase-3 in patients with different stages of endometriosis.

Setting and Design:

The design of the study was a cross-sectional study.

Materials and Methods:

The relative expression of lncRNA FAS-AS1 and FAs gene was evaluated by the quantitative real-time polymerase chain reaction in 60 ectopic endometrial samples from women with endometriosis in relation to 85 normal endometrial tissues from healthy women, whereas the protein level of sFAs in the peritoneal fluid samples and cleaved caspase-3 in ectopic and normal endometrial tissue samples were determined using the enzyme-linked immunosorbent assay and western blot, respectively. Furthermore, in silico analyses were performed to investigate protein–protein interactions as well as molecular function and cellular location of selected proteins.

Statistical Analysis Used:

The student’s t-test was used to analyse the difference between the means of the two groups.

Results:

The expression of FAS and sFas increased in endometriosis tissues as compared to the control group (P < 0.05). However, lncRNA FAS-AS1 and cleaved caspase-3 decreased in ectopic endometrial tissues compared to normal endometrial tissues and low lncRNA FAS-AS1 expression was correlated with disease stages. In addition, the in silico analysis revealed the importance of FAS/caspase3 in the biological processes involved in the development of endometriosis.

Conclusion:

The current study suggests that lncRNA FAS-AS1 may function as an ectopic endometriotic suppressor. Moreover, the results showed that severity of endometriosis is also closely correlated with the expression of lncRNA FAS-AS1 and sFAS.
Transvaginal natural orifice specimen extraction surgery for left-sided colorectal resection: A single-centre cohort study
Authors: Xavier Ruben Gregory , Ke Tao-Wei , Chen William Tzu-Liang
Published: December 2024

Introduction:

Transvaginal natural orifice specimen extraction surgery (NOSES) is an innovative and feasible approach for left-sided colorectal resections in females. This study aimed to report our experience with transvaginal NOSES for left-sided laparoscopic colorectal resections.

Patients and Methods:

We analysed data for all patients with transvaginal extraction performed for left-sided laparoscopic colorectal resections between 2011 and 2021 at a tertiary teaching hospital in Taiwan.

Results:

The 18 post-menopausal patients were of a mean age of 69.2 ± 10.14 years. The lesions were located at the descending (n = 5), sigmoid colon (n = 12) and rectum (n = 1). The operative time was 262.5 ± 83.91 min, and the blood loss was 34 ± 35.98 mL. All patients had an end-to-end anastomosis, and the anastomotic height was 15.06 ± 8.57 cm. Two patients received diversion stoma. The mean length of hospital stay was 5.1 days (standard deviation ± 2.42; range: 3–12 days). There were no cases of clinical infection. The pathology was malignancy (n = 14, 77.8%), diverticulitis (n = 2, 11.2%) and benign (n = 2, 11.2%). In cancers, they were Stage I (n = 1, 7.1%), IIa (n = 1, 7.1%), IIIb (n = 15, 78.7%) and IV (n = 1, 7.1%). Malignant specimens (n = 14) were mostly moderately differentiated (n = 11, 78.6%), with two poorly differentiated (14.3%) and one well-differentiated (7.1%). The lymph nodes harvested were 16.1 ± 8.11. The widest dimension of the lesion was 3.43 cm ± 1.28 (range: 1.5–6) and the length of the specimen was 14.69 cm ± 5.01 (range: 8–27).

Conclusion:

Transvaginal NOSES is safe and feasible for left-sided colorectal resection. Factors to consider are the characteristics of the specimen, anal canal and vagina.
A case report and review of literature on idiopathic ascites after laparoscopic appendectomy - A surgeon’s dilemma
Authors: Bangaradka Nithin , Kumar S. Saravana , Christopher Pradeep Joshua , Cumar Bharath , Natarajan Ramesh , Ramakrishnan Parthasarathi , Chinnusamy Palanivelu
Published: December 2024

Acute appendicitis is one of the most common emergency surgical conditions, typically treated by laparoscopic appendectomy in most centres. Post-operative ascites is a rare complication after laparoscopic surgery, especially in the absence of a bowel, urinary tract or lymphatic injury. This condition creates a diagnostic challenge for surgeons, even after thorough investigation. While the typical post-operative course following laparoscopic appendectomy is well documented, our case offers a unique perspective to this sequela. We present a case of idiopathic ascites following laparoscopic appendectomy for acute appendicitis, with literature review.
A case report on the loss of an Iglesias resectoscope beak during hysteroscopic myomectomy
Authors: Indraccolo Ugo
Published: December 2024

This case report describes the dynamics of the detachment of the ceramic beak of an Iglesias resectoscope that was lost in the uterine cavity during ‘cold loop’ hysteroscopic myomectomy. Our aim is to increase awareness of this issue and caution our colleagues against using Iglesias resectoscopes for hysteroscopies. The ceramic beak of an Iglesias resectoscope can detach itself if hard tissue is encountered during operative hysteroscopy.
Endobronchial stenting in a rare case of severe necrotic tracheal mucormycosis
Authors: Deepak T.H. , Deshmukh Karan , Kumar S. Santha , Venugopal J.
Published: December 2024

We present a case of tracheal necrosis due to mucormycosis in a young diabetic male. He presented with stridor due to airway obstruction from the necrosed tracheal wall. We used a silicon tracheal stent to maintain airway patency and support the airway. This case highlights the use of tracheal stenting to stabilize the airway in an extremely necrosed and friable trachea, which is not fit for surgical resection due to the involvement of the long segment of the trachea. To the best of our knowledge, the use of stents to stabilize necrosed tracheal walls in cases of mucormycosis has not been reported so far.
House dust protein level of pigeon drooping and feather in environmental bird exposure-related hypersensitivity pneumonitis “A pilot study”
Authors: Spalgais Sonam , Ranga Vikrant , Mavi Anil K. , Kumar Raj
Published: December 2024

Background:

Bird fancier’s disease is a type of HP occurring due to exposure to bird’s antigen. The diagnosis is quite difficult as it requires the identification of an inciting agent with findings of HRCT and lung biopsy. The exposure is usually done by history with antigen-specific IgG and/or specific inhalational challenge testing. The study aimed to investigate the role of pigeon allergens in house dust in bird exposure-related HP patients.

Methods:

This was a descriptive, mixed-method observational study. We retrospectively screened all the files of HP patients for exposure history and pigeon-specific IgG of one-year duration. Finally, Finally house dust from 18 cases with HP was collected for analysis of concentration of pigeon droppings and feather proteins.

Results:

The mean age was 47.8 ± 11.5 years with 78% being female. The median duration of symptoms was 1.75 years with a median exposure history to pigeons of 7 years. The level of specific IgG was raised in 11 (60%) patients with a mean level of 50.6 ± 39.5. The concentration of pigeon-drooping protein was present in all the dust samples with a mean of 17.6 ± 5.6 μg/mg. The highest concentration was 27 μg/mg and the lowest of 9 μg/mg. The concentration of pigeon father protein was present in nearly 50% of the dust sample with a mean of 5.6 ± 6.7 μg/mg and the highest concentration was 15.8 μg/mg.

Conclusion:

The confirmation history of exposure in bird exposure-related HP is difficult because bird antigen exposure can be presents anywhere. The house dust bird protein concentration measurement is a simple, non-invasive, adjunct test for confirmation of bird exposure.
COPD in females- Seeing through the smoke
Authors: Sreedevi S R , Holla Ramesh , Vishak A. K , Unnikrishnan Bhaskaran , Rekha T , Mithra P Prasanna , Kumar Nithin , Rao Mithun
Published: December 2024

Chronic obstructive pulmonary disease (COPD) is a type of lung disease marked by permanent damage to tissues in the lungs. Over time, chronic obstructive pulmonary disease (COPD) can make breathing difficult due to permanent lung damage. COPD encompasses two main conditions chronic bronchitis, where inflammation and scarring narrow the large airways, and emphysema, where the tiny air sacs in the lungs are damaged. The widespread lung condition, chronic obstructive pulmonary disease (COPD), is largely preventable and treatable, affecting people of all genders globally. There are many studies estimating the burden of COPD in men and women, however, only a few studies have estimated the prevalence of COPD in women aged more than 40 years. Women are equally susceptible to COPD, as they are exposed more to domestic smoke, but they are often neglected and the disease goes unnoticed, which makes them more vulnerable to respiratory failure following a respiratory infection. To gain a comprehensive understanding, this review explores the existing research through a narrative analysis of primary research articles retrieved from PubMed. In total 15 relevant papers were extracted and reviewed. The review finds significant differences exist in the prevalence of COPD among women 40 years of age and older, with greater rates found in rural areas. Women have more severe symptoms and higher fatality rates; contributing factors to this increase are exposure to biomass fuels and growing smoking rates.
Intratracheal Surfactant Administration Attenuates Hyperoxia-Induced Lung Injury and Fibrosis in Neonatal Rats
Authors: Jiang Jiunn-Song , Hsieh Chi-Chun , Chou Hsiu-Chu , Chen Chung-Ming
Published: December 2024

Background:

Hyperoxia decreases surfactant production and suggests exogenous surfactant may be a potential treatment for hyperoxia-induced lung injury. This study aimed to investigate the effects of an animal-derived surfactant on hyperoxia-induced lung injury and fibrosis in newborn rats.

Methods:

Sprague Dawley rat pups were randomly reared either in room air (RA) or hyperoxic conditions (85% O2) from postnatal days 1–14. On postnatal day 4, the rats received an intratracheal injection of either 20 μL of normal saline (vehicle) or 20 μL of surfactant (Survanta). Our study included four study groups: RA + vehicle, RA + surfactant, 85% O2 + vehicle, and 85% O2 + surfactant. Body weights were recorded at birth and on postnatal days 4 and 14. On postnatal day 14, the lungs were dissected for histology, Western blotting, and cytokine measurements.

Results:

The hyperoxia-reared rats exhibited significantly higher lung injury scores, tumor necrosis factor-α (TNF-α) expression, transforming growth factor-β1 (TGF-β1) expression, and collagen deposition compared with the RA-reared rats. The surfactant alleviated hyperoxia-induced lung injury, inflammation, and fibrosis, as evidenced by the lower lung injury score, TNF-α expression, TGF-β1 expression, and collagen deposition in the lungs.

Conclusion:

The intratracheal administration of the surfactant ameliorated hyperoxia-induced lung injury and fibrosis and downregulated TNF-α and TGF-β1 expression, most likely by inhibiting lung inflammation and collagen deposition.
Critical Pertussis: “Prevention is better than cure”
Authors: Jayashree M. , Kavitha T. K.
Published: December 2024

The global incidence of pertussis has increased in the last two decades. Critical pertussis (cases necessitating intensive care unit admission or resulting in death) is a major health concern, especially among infants. Inadequately transferred maternal immunity, high susceptibility to disease before completion of the primary immunization schedule, and differential expression of pertussis toxins are some of the proposed reasons for higher disease burden in infancy. Adolescent children with waning immunity and susceptible adults contribute to the transmission of the disease. Siblings and parents are a major source of infection in infants. Multisystem involvement includes respiratory failure, central nervous system manifestations, shock, and pulmonary artery hypertension. Hyperleukocytosis, a characteristic feature of critical pertussis, is a proven risk factor for increased mortality. Other predictors of mortality include pulmonary artery hypertension, requirement of mechanical ventilation, and vasoactive requirements. Early macrolide antibiotics and organ support measures are the major domains of management. Intensive care needs include mechanical ventilation, inotropic support, and leukodepletion measures. Studies regarding optimal management strategies are scarce, and strategies like leukapheresis or ECMO have shown variable mortality benefit in literature. Routine immunization along with adolescent booster dose and immunization of pregnant mothers have shown promising impacts on reducing pertussis-related morbidity and mortality. We describe the updates regarding the risk factors for resurgence, disease morbidity, and management strategies in children with critical pertussis.
Coercion in Psychiatry and Mental Health Care: Ethical, Legal, and Human Rights Considerations
Authors: Evans Michael , Tezak Taneka , Gooding Piers , Gill Neeraj
Published: December 2024

The practice of coercion in mental health care is a critically important point of discussion for international human rights bodies, governments, professional bodies, lived-experience representative organizations, and for individuals living with mental illness and their families and carers. This article aims to provide a balanced overview and exploration of the history of coercive practices in psychiatry, current international practices, key ethical, human rights, and legislative considerations, current efforts to develop, investigate, and promote alternatives to coercion, and international recommendations for the future of mental health care. The article highlights current challenges, limitations, and opportunities for further research to enrich the field of study in the intersection of human rights and mental health. We conclude by emphasizing the essential need for mental health promotion and prevention of mental disorders by strengthening primary mental health care and interventions aimed at addressing the social determinants of mental health with a holistic response incorporating all sectors of government services and nongovernmental organizations.
Coercion in Psychiatry – Harms and Need for Action
Authors: Wullschleger Alexandre , Kaiser Stefan , Khazaal Yasser , Jäger Matthias
Published: December 2024

Coercion is a central issue of psychiatric care. Coercion is a complex phenomenon that should best be conceived as multidimensional. Three categories of coercion can be described: formal coercion (i.e., coercive measures such as seclusion or restraint), informal coercion (i.e., pressures and leverages used to influence patients), and subjective coercion (i.e., the perceived level of coercion, regardless of the legal status of the patient). Some of the consequences of coercion are well known, but new research has highlighted its impact on psychiatric symptoms. This should urge institutions to implement strong coercion reduction policies and efficient interventions.
The Canadian Experience with Coercion and Restraint: From Physical Restrictions to Coercive Decision-making - With Special Reference to Medical Assistance in Dying
Authors: Gaind K. Sonu
Published: December 2024

Coercion and restraint involve forced actions or restricting choices and have implications for issues of dignity, autonomy, risk and safety, ethics, and medico-legal ramifications, among others. This article examines the Canadian experience with coercion and restraint, including considering that restraints can be physical, chemical, or environmental and that coercion can occur through lack of options leading to lack of autonomous choice. Issues are explored from a social psychiatry and public policy perspective, ranging from the concept of minimal restraint use to implications for physician-assisted suicide policies.
Road to Freedom: Experiences of Unfettering and Rehabilitating Chained Mentally Ill Persons in Rural India
Authors: Gupta Dhanesh Kumar , Verma Kamal Kumar , Baniya Girish Chandra , Chaurotia Vijay , Sidana Roop , Khandelwal Sudhir K.
Published: December 2024

Background and Objectives:

Chaining or physical seclusion of persons with mental illnesses by their caregivers is still prevalent in many countries including India. This paper presents preliminary experiences from the Mukti program, an innovative community-based initiative to treat and rehabilitate physically restrained mentally ill patients in Northern India.

Methods:

This retrospective chart review focussed on program processes and their impact on patients and their families. Patients enrolled in the program during its 1st year were included. Data were retrieved from patients’ case records for 5 years from the launch of the program. Descriptive statistics and paired t-test were used for quantitative data analysis.

Results:

Forty-six out of 50 enrolled patients received treatment. The mean duration of chaining or seclusion was 8.61 years (standard deviation [SD] 6.49). 79% of patients received only one or two medicines (mean: 1.92, SD: 0.84). At the end of 5-year follow-up, 81% of patients were free from chains and seclusion. More than one-third (37%) of patients were leading a normal or nearly normal life. The improvement was also reflected in clinical global impression-I (80% scored 1 or 2), and on the global assessment of functioning (two-thirds had more than 30% improvement).

Conclusions:

Program Mukti demonstrates that community-based intervention is an effective and feasible approach to rehabilitating chained mentally ill patients in India. The innovative, bottom-up approach with indicated intervention in the program Mukti proved to be effective for this highly marginalized subgroup and their families. Low-cost interventions at patients’ doorsteps with adequate community involvement in the program Mukti have ensured sustained engagement of patients and carers in the recovery process resulting in better outcomes.
Coercion in Mental Health Practice: An Overview
Authors: Ayinde Olatunde , Gureje Oye
Published: December 2024

Coercion in psychiatric practice remains a controversial topic. Coercive practices take different forms that include the use of physical or psychological force or pressure directly to patients or through proxies in the process of delivering mental health care. While coercion may have socioanthropological origins, its current perpetuation in different forms around the world reflects historical, developmental, sociocultural, and health system contexts and realities. Most high-income countries have evolved strong institutions, legislations, and well-resourced health systems to address coercion. However, many low- and middle-income countries are still constrained by health system inadequacies at both macro and micro levels that put pressure on families, communities, and service providers that lead to the continued use of coercion in the care of persons with mental ill health. In this regard, pragmatic approaches to addressing coercion in these settings will include greater investment in the expansion of evidence-based mental health services, and the earmarking of resources not only to develop relevant policies and legislation but to implement them. Furthermore, training is required for healthcare workers in the use of alternatives to coercion and for service users and civil society organizations to serve as society’s watchdog against the use of coercion. More research is needed on how best to improve the services provided by traditional and faith healers where the use of coercive practices tends to be more common.
Practices and Attitude Regarding Restraint of Psychiatric Patients among Mental Health Professionals of Nepal
Authors: Sharma Pawan , Shah Bigya , Bhandari Anup Raj , Sapkota Nidesh , Shakya Rabi
Published: December 2024

Background:

There is significant controversy regarding restraint during treatment in psychiatry. Although seen as an assault on autonomy clinical scenarios often necessitate its use. In the Nepalese context, there is regular practice of restraint, but there is a dearth of literature. We aim to study the existing practices and attitudes among mental health professionals regarding the use of restraints.

Methods:

This was a cross-sectional descriptive internet-based survey among psychiatrists and clinical psychologists of Nepal using a questionnaire prepared by the research team in All India Institute of Medical Sciences, New Delhi. The questionnaire was converted to a Google form after some modification and contextualization. The data were collected after taking ethical approval from the Instutional Review Committee. The data analysis n (%) of each response was done using MS Excel.

Results:

The questionnaire was filled out by 43 psychiatrists and 20 clinical psychologists. Among 55 participants who dealt with inpatients, 50 (90%) practiced restraint and the maximum had no formal protocol for restraint 40 (72.7%) or audits of restraint 45 (81.8%). Among 63 participants, 36 (57%) believed that restraint was necessary and an essential part of patient management. The majority 52 (82.5%) agreed that patients had a limited role in decision-making. The legitimate major reasons for use of restraint as per participants were harm to others 53 (84.1%), harm to self -53 (84.1), aggression toward family/other patients 50 (79.4%), or staff 47 (74.6%).

Conclusion:

The Nepalese mental health experts routinely practiced restraint. They reported that patients had limited role in decision-making and there is a need of making a clinical and legal provision for restraint.
Act of Commission or Omission: Coercion in the Context of Rehabilitation of Persons Disabled with Mental Illness in India
Authors: Sivakumar Thanapal
Published: December 2024

Psychiatric rehabilitation caters to persons disabled with mental illness. The treatment gap for easily identifiable and treatable mental illnesses like schizophrenia is >70%. A proportion of them wander away. Some of them who are hospitalized and treated may end up as long-stay patients as there are no alternatives. For some persons disabled with mental illness, the Indian family with collectivistic values burns out and looks to accommodate the person elsewhere. There is a paucity of government-funded or run residential rehabilitation facilities. In the context of persons disabled with mental illness, coercion may be an act of commission or omission from the person with mental illness, the family, and mental health services. This paper discusses the practical aspects and what needs to be done to offer dignity and care to persons disabled with mental illness and their families.
Monitoring Psychiatric Inpatient Coercion in India – A 6-Month Prospective Evaluation of Incidence, Patterns, and Factors Affecting Restraint Use at a Tertiary Care Center
Authors: Sobhani Aayushi , Harsha  , Sharma Panna , Deb Koushik Sinha , Verma Rohit , Sagar Rajesh , Prerna  , Bhagat Laxman , Soni Pankhuri
Published: December 2024

Background:

The use of restraint in psychiatric inpatient settings is a contentious issue, balancing patient safety with ethical concerns. Despite India’s Mental Healthcare Act of 2017, which prohibits seclusion and mandates stringent restraint regulations, restraint remains a critical intervention in managing acute behavioral crises. This study investigates the prevalence, patterns, and determinants of restraint use in a tertiary care psychiatric facility in Northern India.

Materials and Methods:

This hospital-based, observational, prospective study was conducted over 6 months in a 32-bedded psychiatry ward. Data were collected from ward registers, treatment charts, and patient records, documenting restraint events. Sociodemographic and clinical factors were analyzed using descriptive statistics, comparisons, and logistic regression.

Results:

Among 128 admissions (5,518 inpatient days), 35.1% of patients experienced restraint, yielding a restraint patient rate of 8.15 per 1000 inpatient days and an event rate of 26.1 per 1000 inpatient days. Chemical restraint was predominant (74.3% of events), followed by combined (22.9%) and physical restraint (2.8%). Restraint occurred primarily in young adults with mood and psychotic disorders, with no significant association between restraint use and sociodemographic or clinical factors. Most restraints were applied within the 1st week of admission.

Conclusions:

Restraint, primarily chemical, remains common in managing acute agitation and violence, especially early in hospitalization. The findings underscore the importance of balancing clinical needs with patient rights while striving for noncoercive, patient-centered psychiatric care. The findings also highlight the need for standardized reporting and continued training to minimize restraint use and promote ethical healthcare delivery.
Analysis of Severe and Relapse Risks of Imported Malaria in Five Provinces of China
Authors: Gao Chen , Cotter Chris , Zhang Tao , Lu Shen-Ning , Lu Hong-Zheng , Su Hong , Li Shi-Zhu , Wang Duo-Quan
Published: December 2024

Although China has achieved malaria elimination certification, the risk of malaria transmission reintroduction due to imported malaria remains. We analyzed data on imported malaria cases collected from January 1, 2014 to December 31, 2021, using multivariable logistic regression analysis to identify the factors associated with severe and relapsing malaria. The odds of severe malaria were around 4-fold greater for patients who were initially diagnosed with a nonmalarial illness than for patients initially diagnosed with malaria. The risk of relapse from Plasmodium vivax or Plasmodium ovale varied depending on the regions of Africa where patients resided. Patients residing in western and southern Africa (compared with Central Africa) had a lower relative risk of relapse. In addition, treatment with primaquine provided protection against malaria relapse. Improving the timeliness of treatment of malaria patients could help reduce the severity of illness, and use of primaquine can mitigate the risk of relapse after treatment.
Goričan Mihael Rabatta, avtor potopisa Iter sancti sepulcri
Authors: Pavlin Vojko
Published: December 2024

Michele Rabatta went to the Holy Sepulchre with his friend Morando Porcia in 1396 and left a chronicle of their journey, which is preserved in the State Archives in Gorizia (Archivio di Stato di Gorizia). The transcription of his travelogue Iter sancti sepulcri was published in 2007 in Pordenone by the Accademia San Marco.
The travel diary describes a journey that lasted three months, from 27 August to 28 November 1396. Drawings and sketches of some of the places have been preserved. The text draws particular attention to the indulgences that were awarded to pilgrims visiting Jerusalem and other biblical sites.
Michele Rabatta served the Carrara lords of Padua as a soldier and diplomat from the early 1370s, remaining loyal to them until the fall of Padua to the Venetian Republic in 1405. He was known in diplomatic circles not only in the northern Italian area but also, and above all, at the royal court of Hungary. His diplomatic skills were in demand both by the Patriarchs of Aquileia in Friuli and by the Counts of Gorizia. Michele’s father, Antonio, came to Gorizia from Tuscany. The family got its name after the village of Rabatta near Borgo San Lorenzo. The late medieval trilingual Gorizian environment in which Michele grew up gave him knowledge also of Slovene and German.
Shortly after he arrived from the Holy Land, Michele received Dornberk Castle as a fief from the Counts of Gorizia. Dornberk Castle thus became the core of the Rabatta family’s estate in the county of Gorizia until the family’s extinction in 1794.
In March 1398, Michele and his brother Giovanni, who was the governor of Henry IV, Count of Gorizia, obtained Pope Boniface IX’s permission to build the Church of the Holy Spirit below Gorizia Castle. A third brother, Pietro, the parish priest of Solkan-Gorizia, was also indirectly involved. The Rabattas were therefore a prestigious family in Gorizia in their time.