Difficulty In Breathing Research Articles

Isolated congenital cleft mitral valve: a rare cause of mitral regurgitation presented as poor weight gain in children

The anterior mitral leaflet cleft is very rare congenital lesion often encountered in association with other congenital heart defects. The isolated anterior leaflet cleft is a rare anomaly and is usually the cause of mitral valve regurgitation which is correctable. Children with poor feeding exhibit weight loss, growth retardation and sometimes heart failure. Clinically echocardiography is the first investigation of choice for evaluation of mitral valve disease providing useful information about valve anatomy and hemodynamic parameters. A case of 6-month-old male child with chief complaint of poor feeding and difficulty in breathing especially in early morning is being presented in this case report. A pan-systolic murmur of grade 4/6 heard on apex and back side of chest wall. Echocardiography revealed an isolated anterior mitral leaflet cleft producing moderate-severe mitral regurgitation. Isolated cleft of mitral valve is a very rare defect that has to be identified and diagnosed. All children presented with poor weight gain or failure to thrive should be screened with TTE to rule out congenital heart diseases.

A unique and rare presentation of Henoch-Schonlein purpura: a case report

Henoch-Schönlein purpura (HSP), or IgA vasculitis, is a common small vessel vasculitis in children, typically presenting with palpable purpura, abdominal pain, arthritis, and renal involvement. However, atypical presentations can delay diagnosis and management. A 12-year-old girl presented with multiple episodes of loose stools and abdominal pain. The initial diagnosis focused on acute gastroenteritis, and she was treated symptomatically. Subsequently, she developed urticarial rashes with breathing difficulty, complicating the diagnosis. Despite symptomatic treatment, she experienced severe abdominal pain, hematemesis and melena. Further investigations revealed antral gastritis, duodenitis, and cystitis. On the 14th day of admission, the patient developed characteristic palpable purpura on the lower limbs. Skin biopsy confirmed leukocytoclastic vasculitis with IgA deposits, consistent with HSP. The patient recovered with supportive care and remained symptom-free on follow-up. This case underscores the importance of considering HSP in pediatric patients with atypical presentations, such as gastrointestinal symptoms and urticaria without initial purpura. Early recognition and appropriate management are essential to prevent complications and ensure favourable outcomes. The variability in HSP presentations necessitates a high index of suspicion for timely diagnosis and treatment.

Trends in Injectable Biomaterials for Vocal Fold Regeneration and Long-Term Augmentation.

Human vocal folds (VF), a pair of small, soft tissues in the larynx, have a layered mucosal structure with unique mechanical strength to support high-level tissue deformation by phonation. Severe pathological changes to VF have causes including surgery, trauma, age-related atrophy, and radiation, and lead to partial or complete communication loss and difficulty in breathing and swallowing. VF glottal insufficiency requires injectable VF biomaterials such as hyaluronan, calcium hydroxyapatite, and autologous fat to augment VF functions. Although these biomaterials provide an effective short-term solution, significant variations in patient response and requirements of repeat reinjection remain notable challenges in clinical practice. Tissue engineering strategies have been actively explored in the search of an injectable biomaterial that possesses the capacity to match native tissue's material properties while promoting permanent tissue regeneration. This review aims to assess the current status of biomaterial development in VF tissue engineering. The focus will be on examining state-of-the-art techniques including modification with bioactive molecules, cell encapsulation, composite materials, as well as, in situ crosslinking with click chemistry. We will discuss potential opportunities that can further leverage these engineering techniques in the advancement of VF injectable biomaterials.

Are There Benefits to Breastfeeding for Long Durations That Continue after Breastfeeding Has Stopped? An Analysis of Acute Respiratory Illness in Nigerian Children.

Background: While an abundance of evidence exists regarding infectious outcomes in children as they relate to the short-term benefits of breastfeeding, there is limited evidence related to similar impacts beyond one year and after breastfeeding has stopped. Specifically, little is known about the long-term benefits of breastfeeding for acute health outcomes after infancy, particularly in Nigeria. Methods: The Nigeria Demographic and Health Survey data was used in this study. We utilized data (n = 5391) on children who had stopped breastfeeding for at least 12 months before the survey. Breastfeeding duration was categorized into 1-6 months, 7-12 months, 13-18 months, 18-24 months, and > 24 months. Any recent incident of acute respiratory illness in children was operationalized using the responses to related questions (recent incidents of fever, cough, running nose, and short, rapid, or difficulty breathing in children). Adjusted logistic regression was used to estimate odds ratios, and statistical significance was determined at p ≤ 0.05. Results: Post-infancy and after breastfeeding had stopped, the odds of recent acute respiratory illness were significantly less (AOR = 0.37, 95% CI [0.15-0.79], p = 0.04) in children breastfed for 19-24 months compared to those breastfed for 1-6 months. No significant association was found between the other durations and ARI post-infancy (p > 0.05). Conclusions: These findings indicate that breastfeeding for up to 24 months has a long-term protective effect from an acute health condition that contributes to the high under-five mortality rates recorded for decades in Nigeria specifically, and more broadly, in sub-Saharan Africa.

Retrospective analysis of the upper airway anatomy and Sella turcica morphology across different skeletal malocclusions: a computerized technique

ObjectiveThis study aimed to investigate the normal volumetric space and variations in the measurements of different landmarks in adults with different skeletal relations of the maxilla and the mandible based on CBCT data. The study also analyses these landmarks to locate any correlations.BackgroundNumerous studies in orthodontics have found a relationship between orthodontic treatment and changes in the anatomy and function of the airway. Severe changes in airway morphology can cause breathing difficulties, lower quality of life, and even result in life-threatening conditions such as obstructive sleep apnoea. Consequently, orthodontic diagnosis and treatment planning require a thorough understanding of the airway space and its function.MethodsThe present retrospective study was conducted using CBCT records of 120 adult patients, containing 40 samples of each skeletal class (20 males and 20 females). The boundaries were defined for the 3 major regions: the nasopharynx, the oropharynx, and the hypopharynx. Various measurements were recorded across these regions, as well as selective cephalometric landmarks. The obtained data was used to calculate average and standard deviation, while regression analysis was used to evaluate correlations and t-test was used to test statistical significance of gender differences.ResultsThe results demonstrate that skeletal Class III individuals exhibit a reduced airway volume in the nasopharynx compared to other groups, whereas skeletal Class II individuals displayed a diminished airway volume in the hypopharynx. A strong correlation was observed for Sella turcica parameters. There were no significant differences in skeletal parameters across genders. Nasopharynx cavity volume demonstrated significant differences between skeletal Class I–Class III as well as between skeletal Class II–Class III. Hypopharynx cavity volume also demonstrated significant differences between skeletal Class I–Class II and between skeletal Class II–Class III.ConclusionThe major findings are the presence of a reduced nasopharyngeal volume in skeletal Class III malocclusions while skeletal Class II individuals displayed a diminished hypopharyngeal volume, making these critical areas to consider during the diagnostic and orthodontic treatment planning stages. This study also revealed a consistent correlation between Sella turcica parameters across various facial skeletal profiles, with skeletal Class II patients exhibiting a distinct pattern and skeletal Class I and Class III demonstrating an average relationship.

Rabbitry and Emerging Rabbit Haemorrhagic Disease Virus in Nigeria: A Concern for Food Safety and Security

For many decades, small-scale livestock, including rabbit production, has been a veritable pro-poor poverty alleviation venture in Africa. With the rising population and increasing demand for food, the need to introduce and expand small-scale rabbit farms for long-term sustainability cannot be overemphasized. While increasing the production and commercialization of domestic rabbit production is desirable, the intensification of livestock also comes with some animal health problems. One of these is the emergence of Rabbit Haemorrhagic Disease (RHD) caused by Rabbit Haemorrhagic Disease Virus (RHDV). The virus causes sudden death in rabbits, and does not yet pose any public health risk. Symptoms of RHD may include: loss of appetite, lethargy, high fever, seizures, jaundice, bleeding from natural orifices, difficulty in breathing and sudden death. The first known outbreak of RHD in Nigeria was reported in September 2020 at rabbit farms in Kwara and Oyo States,in Nigeria. Despite several intervention strategies, the disease has continued to spread across the country. In this review, we search literature on the current state and knowledge of RHD as it affects rabbits and the economic impact on livelihood and animal health implication of this emerging viral disease on rabbit farms in Nigeria.

A - 146 Psychiatric Drugs Can Precipitate Neuropsychological Predicates of Homicide

Abstract Objective A man inexplicably killed his beloved wife. He had no history of violence, was a prominent member of the community, and gave no indications of the impending horrific act. He had been recently commenced treatment with psychiatric drugs, and his condition deteriorated, culminating in homicide. After his incarceration, he stopped taking psychiatric drugs and his mental health improved. Many practitioners are not aware that psychiatric drugs can create a risk for violence - or precursors of violence - such as anger, hostility, and agitation. This risk is often described on the product label. Method The subject was an intensive care nurse who became exhausted and despondent serving long hours during the Covid epidemic, when many of his patients were put on ventilators and died. He had suffered panic attacks from his difficulty breathing through the respiratory masks. He temporarily left employment and sought psychiatric assistance for his professional “burn-out” condition. After three doses of venlafaxine, he reported side effects including increased anxiety, blood pressure and heart rate. He was then prescribed escitalopram without tapering of the venlafaxine. As his anxiety progressed, he was prescribed escitalopram once daily and buspirone three times daily, yet he continued to deteriorate until the homicide. Results Expert genetic analysis found susceptibility to the psychiatric drugs prescribed. The neuropsychological evaluation, months post-homicide, found excellent neuropsychological function, although psychomotor and processing speed was deficit. Personality testing found no disorders, with a profile inconsistent with violent behavior. Conclusions Prescribers need to monitor patients carefully for potentially adverse and violent outcomes of treatment.

DIGITAL IMPRESSION VERSUS CONVENTIONAL IMPRESSION FROM THE POINT OF VIEW OF DENTIST PREFERENCES

Nowadays digital impression represents a new breakthrough for dental offices, since more and more dentists use dental scanners. From the point of view of the dentist's preferences, there are not many studies regarding the use of the digital impression in comparison with the conventional impression. (1) Background: The aim of this study was to make a comparison between the digital impression and the classic impression and highlight the advantages and disadvantages of using the two methods, both in terms of the patient and the dentist; (2) Methods: To fulfill the objectives of this study, the Google Forms Platform was used to distribute a questionnaire regarding digital impression and classic impression. The questionnaire included 14 questions with the possibility of choosing only one answer and was addressed to dentists. (3) Results: 42 responses were recorded to the 14 questions contained in the questionnaire; (4) Conclusions: Intraoral scanning dental impression compared to traditional impression has less effect on patient gag effect, breathing difficulties, stress and anxiety, and results in better patient perception and comfort.

Effects of Heart Rate Variability (HRV) Biofeedback in Pulmonary Indicators and HRV Indices Among Patients with Chronic Obstructive Pulmonary Disease.

Patients with chronic obstructive pulmonary disease (COPD) exhibit reduced cardiac autonomic activity, linked to poor prognosis and exercise intolerance. While heart rate variability biofeedback (HRVB) can enhance cardiac autonomic activity in various diseases, its use in patients with COPD is limited. This study explored the impact of the HRVB on cardiac autonomic activity and pulmonary indicators in patients with COPD. Fifty-three patients with COPD were assigned to either the HRVB (n = 26) or the control group (n = 27), with both groups receiving standard medical care. The HRVB group also underwent one-hour HRVB sessions weekly for six weeks. All participants had pre- and post-test measurements, including the Six-Minute Walking Test (6MWT), lead II electrocardiogram (ECG) recording, Modified Medical Research Council Dyspnea Scale (mMRC), body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index. ECG data were analyzed for heart rate variability (HRV) as an index of cardiac autonomic activity. A two-way mixed analysis of variances demonstrated significant interaction effects of Group × Time in pulmonary indicators and HRV indices. The HRVB group exhibited significant post-test improvements, with decreased mMRC and BODE scores and increased 6MWT distance and HRV indices, compared to pre-test results. The 6MWT distance significantly increased and mMRC significantly decreased at post-test in the HRVB group compared with the control group. This study confirmed the efficacy of HRVB as an adjunct therapy in patients with COPD, showing improvements in exercise capacity, breathing difficulties, and cardiac autonomic activity.

Environmental Impact of Heavy Metals on Health in Soils Polluted with Medical Waste in Baiji City

Due to the environmental concerns of improper medical waste management inside and outside hospitals and health institutions, this issue is one of the most important environmental studies topics. Four places in Baiji City in Iraq were selected as study areas: Al-Hajjaj Health Center, Al-Boutama Health Center, Al-Zuwai Health Center, and Baiji General Hospital. This study investigates the environmental health risks of incineration treating hospital waste and health centers. According to the data obtained from practical and laboratory studies, Baiji General Hospital had the highest concentrations of the five toxic heavy metals tested, i.e., lead, cadmium, chromium, zinc, and nickel. These values peaked at 98.36, 59.54, 58.74, 79.52, and 13.32 mg/l for Pb+2, Cd+2, Cr+3, Ni+2, and Zn+2, respectively. Exceeding the measured values of toxic metal elements within internationally permissible limits increases the concentration of these toxic metals, posing greater health risks to the population. This process appears clearly and significantly if medical waste is burned in random locations, producing toxic fumes and gases that can cause diseases dangerous to health when inhaled; therefore, there must be mechanisms and scientific management to control the combustion process in private health incinerators. The survey results showed that the indiscriminate burning of medical waste in surveyed areas leads to diseases and can pose a tangible and immediate threat to human life, such as high blood pressure, eye irritations, suffocation of patients with difficulty and shortness of breath, and asthma, especially the elderly and newborns. Original overshooting of the measured values of toxic metal elements within the internationally permissible limits can increase the concentration of these toxic metals, posing more significant health risks to the population.

Clinical phenotype and molecular genetic analysis of seven children with CHARGE syndrome

To explore the clinical phenotype and genetic etiology for seven children with CHARGE syndrome (CS). Clinical data of seven children with CS diagnosed between March 2020 and December 2022 at the Children's Hospital Affiliated to Zhengzhou University were analyzed. Genomic DNA was extracted from peripheral blood samples from the children and their parents, and subjected to whole exome sequencing. Candidate variants were verified by Sanger sequencing and pathogenicity analysis. The ages of the children had ranged from 1 day after birth to 12 years old, and all of them had shown growth retardation. The reasons for their admission had included postnatal breathing, swallowing and feeding difficulties in five cases. One child was found to have abnormal external genitalia in conjunct with hearing impairment, whilst another child had shown no secondary sexual characteristics during puberty. All of the children were found to harbor CHD7 gene variants, which included 3 nonsense variants, 2 frameshifting variants and 2 missense variants, i.e., c.6292C>T (p.R2098*), c.2754G>A (p.W918*), c.469C>T (p.R157*), c.3308T>A (p.V1103D), c.7111delC (p.Q2371Kfs), c.6023delA (p.D2008Vfs) and c.3565C>T (p.R1189C). All of the variants were de novo in origin. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the c.3308T>A (p.V1103D) and c.3565C>T (p.R1189C) variants were rated as likely pathogenic (PS2+PM2_Supporting+PP3), whilst the remainders were rated as pathogenic (PVS1+PS2+PM2_Supporting). There is strong clinical and genetic heterogeneity in CS. Early genetic testing may facilitate accurate diagnosis. The detection of novel variants has expanded the phenotypic spectrum of CS and the mutational spectrum of the CHD7 gene.

Efektivitas Pelaksanaan Vaksin Polio dalam Meningkatkan Kesadaran Masyarakat Desa Sialang indah Terhadap Pentingnya Imunisasi di Desa Sialang Indah Kecamatan Pangkalan Kuras, Kabupaten Pelalawan

Real Work Lecture (KKN) is a form of community service activity by students with a cross-scientific and sectoral approach at a certain time and area. The implementation of KKN activities usually lasts between one to two months and takes place in villagelevel areas. The Directorate General of Higher Education in Indonesia has requires every university to carry out KKN as an intracurricular activity that combines the tri dharma of higher education, namely: education, research, and community service. We observed how the effectiveness of polio vaccine implementation in increasing community awareness of the importance of immunization in Sialang Indah Village, Pangkalan Kuras Sub-district, Pelalawan Regency. The virus will damage the nervous system of the sufferer's body so that there can be a risk of paralysis, difficulty breathing, or even death. The polio virus often affects toddlers or children under 5 years old, especially if they have not had the polio vaccination. However, it is not impossible that polio can also be experienced by adults.

Association between the C-reactive protein to albumin ratio with asthma and mortality in adult: a population-based study

Asthma is a prevalent chronic disease characterized by airflow obstruction, causing breathing difficulties and wheezing. This study investigates the association between the C-reactive protein to albumin ratio (CAR) and asthma prevalence, as well as all-cause and respiratory mortality among asthma patients, using data from the 2001–2018 National Health and Nutrition Examination Survey. We included participants aged 20 years and older with complete CAR data, excluding those who were pregnant or lost to follow-up. The analysis employed weighted logistic regression and Cox proportional hazards models with stepwise adjustment, restricted cubic spline analysis for nonlinear relationships, and time-dependent ROC curves for predictive accuracy. Results showed that the highest CAR quartile significantly increased the risk of asthma (OR 1.56, 95% CI 1.38–1.78), all-cause mortality (HR 2.20, 95% CI 1.67–2.89), and respiratory mortality (HR 2.56, 95% CI 1.30–5.38). The impact of CAR on all-cause mortality was particularly significant in hypertensive patients. These findings highlight CAR’s potential as a valuable biomarker for predicting asthma prevalence and mortality, underscoring its role in asthma management and prognostication.

Clinical profiles and related factors in tuberculosis patients with positive sputum smear mycobacterium tuberculosis tests

The aim of this study was to explore the related factors linked to the development and infectivity of tuberculosis. This was achieved by comparing the clinical characteristics of patients with pulmonary tuberculosis (TB) who tested positive in smear Mycobacterium tuberculosis tests with this who tested negative in smear mycobacterium tests but positive in sputum Gene Xpert tests. We gathered clinical data of 1612 recently hospitalized patients diagnosed with pulmonary tuberculosis who tested positive either in sputum Gene-Xpert test or sputum smear Mycobacterium tuberculosis tests. The data was collected from January 1, 2018 to August 5, 2023, at Sichuan Provincial People's Hospital. We conducted separately analyzes and comparisons of the clinical characteristics between the two groups of patients, aiming to discussed the related factors influencing the development and infectivity of tuberculosis. In comparison to the GeneXpert positive group, the sputum smear positive group exhibited a higher proportion of elderly patients (aged 75–89) and individuals classified as underweight (BMI < 18.5 kg/m2). Furthermore, this group was more prone to experiencing symptoms such as weight loss, coughing and sputum production, hemoptysis, shortness of breath, and difficulty breathing. Moreover, they are also more likely to develop extrapulmonary tuberculosis, such as tuberculous meningitis, tuberculous pleurisy, and tuberculous peritonitis. These clinical features, when present, not only increase the likelihood of a positive result in sputum smear tests but also suggest a high infectivity of pulmonary tuberculosis. Elderly individuals (aged 75 to 89) who are underweight (BMI < 18.5 kg/m2), display symptom of cough, expectoration, hemoptysis and dyspnea-particularly cough and expectoration-and those with extra pulmonary tuberculosis serve as indicators of highly infectious pulmonary tuberculosis patients. These patients may present with more severe condition, carrying a higher bacteria, and being more prone to bacterial elimination. Identification of these patients is crucial, and prompt actions such as timely and rapid isolation measures, cutting off transmission routes, and early empirical treatment of tuberculosis are essential to control the development of the disease.

Clinical spectrum of tuberculosis in adolescents (10–19 years) in a tertiary care center of North India

Background\\objectivesThere is limited literature available to characterize tuberculosis (TB) in adolescents despite them sharing a high burden of the disease. Ours is the first prospective study in India and worldwide to study the clinical profile of tuberculosis in adolescents aged 10–19 years.Methods: We enrolled 82 children and adolescents between March 2021 to March 2022. The diagnosis of TB was made on the basis of National Tuberculosis Elimination Program (NTEP) guidelines 2020. Adolescents were divided into 3 age groups: early (10–13 years), middle (14–17 years), and late adolescents (18–19 years)and the results were compared among the three groups. A two-sided p value of <0.05 was considered statistically significant.Results: The middle age adolescents comprised majority of our study population and females were more than males. The common presenting features were fever, chest pain, breathing difficulty with majority belonging to lower socioeconomic status. The pulmonary TB accounted for 56% and extrapulmonary constituted 44% of the cases. The notable extrapulmonary cases were disseminated TB with secondary lymphangiectasia, compressive myelopathy, sacroiliac joint arthropathy among others. Infiltrates/consolidation were the most frequent radiological findings in patients with pulmonary TB. The microbiological confirmation was available in 44% of the cases. The microbiological positivity was higher in histopathological specimens and in late adolescents. Two patients were rifampicin resistant. Conclusion: There was a varied clinical presentation of TB in this population. The extrapulmonary cases as well as the microbiological yield increased with increasing age of the cases.

Optimizing Lung Cancer Diagnosis with Machine Learning and Feature Selection Methods

Lung cancer is a prevalent disease, with nearly 238,000 new cases diagnosed in 2023. This study utilizes clinical predictors from a Kaggle dataset containing 309 observations across 15 variables to aid in lung cancer diagnosis. The variables include swallowing difficulty, peer pressure, gender, allergy, yellow fingers, anxiety, wheezing, alcohol consumption, chronic disease, chest pain, coughing, fatigue, smoking, age, and shortness of breath. The research aims to develop and compare various supervised machine learning models for classifying and predicting lung cancer, while also identifying key clinical tests and parameters using unsupervised statistical models. The dataset was divided into training and test sets, balanced, and preprocessed for unbiased training. Feature selection and machine learning models were applied to identify crucial predictors. The study explored tree models, logistic regression, Naïve Bayes, support vector machine (SVM), ensemble, neural network, and kernel models. Among these, the linear SVM achieved the highest accuracy of 93.75% with 5-fold cross-validation. However, it showed overfitting, with a lower test accuracy of 82.55%. The Gaussian Naïve Bayes model emerged as the optimal choice, providing consistent performance between validation and test cases. It achieved the highest cross-validation classification accuracy of 82.81% using only 9 variables: swallowing difficulty, peer pressure, gender, allergy, yellow fingers, anxiety, wheezing, alcohol consumption, and chronic disease. This model allows for effective training with fewer predictors without compromising classification

Disparities in allergy and asthma prevalence among schoolteachers

BackgroundEvidence suggests that school factors influence the prevalence of allergic diseases in students. However, very little is known about how such factors affect the health of teachers. ObjectiveWe sought to compare the prevalence of allergic and respiratory conditions among teachers from urban, suburban, and rural schools. MethodsElectronic survey data were collected from a random sample of Pre-Kindergarten through Grade 12 teachers in Massachusetts. Comparisons were made between teacher demographics and allergic respiratory symptoms. ResultsOf the 398 respondents, median age was 45 years (SD 12.32). 71.8% of teachers taught in suburban schools, 76.6% were female, and 87.1% were White, similar to teacher demographics collected by the Massachusetts Department of Higher Education. Although there were more female teachers, males more frequently reported adverse breathing symptoms, such as wheezing (P=0.007). Over half of rural teachers (54.54%) experienced respiratory symptoms such as disrupted sleep due to coughing compared to 34.61% of suburban schoolteachers (P=0.03). Almost half (48.26%) of public schoolteachers experienced exercise-induced chest pain compared to 37.03% of private schoolteachers (p=0.05). A higher proportion of urban school teachers with asthma commonly missed school due to food allergy compared to suburban and rural schoolteachers with asthma (P=0.02). In teachers undiagnosed with asthma, associations existed between school absences and nighttime awakening due to trouble breathing (P < 0.0001), persistent cough (P = 0.002), and sore throat (P<0.0001) ConclusionsRural and public teachers reported proportionately more respiratory symptoms compared to suburban and private teachers, suggesting disparities. Future studies towards evidence-based solutions are needed.

A case report on cefoperazone induced cardiogenic shock - kounis syndrome

Background: Kounis Syndrome is a hypersensitive coronary artery disease caused by the body being exposed to allergens that can be triggered by various medications and environmental factors. The body's defense mechanism launches a surge of chemicals during an anaphylactic reaction that could cause a state of shock, drop in blood pressure and constriction of the breathing passage, which makes breathing difficult. Case presentation: A 55-year-old woman presented in our department with edema and a growth over her right buccal mucosa. A punch biopsy performed was indicative of squamous cell carcinoma. Considering Chronic Kidney Disease (CKD), consultation with a nephrologist was scheduled and proceeded with the advised recommendations. Following the first injection dose of Cefoperazone and Sulbactum, within 5 minutes, the patient reported chest discomfort and difficulty in breathing. CPR was given according to ACLS protocol. Adrenaline injection was administered and was connected to defibrillator shock. Conclusion: It is imperative for healthcare providers and pharmacists to recognize that, cephalosporins may result in fatal disorders such as Kounis Syndrome (KS) in order to appropriately prescribe the treatment and take preventative measures.

Understanding fire combustion characteristics and available safe egress time in underground metro trains: A simulation approach

Due to insufficient oxygen supply in the tunnel, incomplete combustion of the underground metro train fire easily produces toxic gases and smoke dust, causing difficulty in breathing for passengers and rescue. The experimental study of the fire combustion characteristics of metro trains in the tunnel is of great significance for designing metro fire extinguishing and fire prevention systems and providing reliable guidance for emergency evacuation in fire scenarios. A train fire model is established to study the effects of various factors on fire combustion characteristics and calculate the available safe egress time (ASET). The smoke spread characteristics under different conditions such as fire source power, fire source location, carriage layout, and train location are simulated. The simulation results show that the fire source power, location, and seat arrangement have a significant impact on the smoke spread characteristics of carriage fires and ASET.

Evaluation of the post-COVID multidisciplinary outpatient clinic at the Pulmonary Division of the Cantonal Hospital Winterthur from the patient's perspective: a mixed-methods study.

This prospective study, conducted with patients from the multidisciplinary post-COVID outpatient clinic at the Pulmonary Division of the Cantonal Hospital Winterthur, aimed to investigate changes in patients' main symptoms, elements that aided in coping with the condition and satisfaction with the consulting and therapeutic interventions. After obtaining ethical approval, fifty patients were consecutively included in this longitudinal study, which incorporated three survey times post-consultation: t1 (0-7 days), t2 (4-8 weeks) and t3 (4-6 months). The survey comprised standardised questionnaires, including the Hospital Anxiety and Depression Scale, the Post-COVID-19 Functional Status scale and the Chalder Fatigue scale, along with study-specific questions regarding symptoms and reasons for consulting the post-COVID outpatient clinic. Additionally, ten patients were invited to participate in qualitative individual interviews at t2 and t3. The study was conducted between November 2021 and February 2023. The median age of the 50 participants was 47 years (IQR: 36-55), with 66% (33/50) being female. Most participants (66% or 33/50) reported no pre-existing conditions prior to COVID-19 infection, and only six patients required hospitalisation during the acute phase of their infection. Visits to the multidisciplinary post-COVID clinic occurred approximately eight months post-infection, with referrals primarily made by primary care physicians (82% or 41/50). The majority of patients experienced persistent tiredness, exhaustion and fatigue (94% or 47/50), along with reduced physical performance (82% or 41/50), while pain or breathing difficulties were less frequently mentioned. At t1, around half of the patients were fully or partially unable to work, a proportion that reduced to around a third by t3. Symptoms generally decreased over time, with significant improvements observed between t2 and t3. However, subjectively perceived cognitive limitations worsened or were reported more frequently over time. Most patients (96% or 48/50) felt well cared for throughout their consultations. In qualitative interviews, patients highlighted the medical staff's attentiveness and the time dedicated to consultations, which made them feel that their complaints were taken seriously and that they received appropriate information. The results confirmed that the multidisciplinary post-COVID outpatient clinic met most respondents' expectations. Patients found that the attentive interprofessional coaching was most helpful in coping with their illness. However, participants also noted long waiting times and expressed a desire for earlier admission to the clinic.