Early Detection Treatment Research Articles

Association of contraception use and pregnancy intention with perinatal depression risk among Omani mothers—a longitudinal cohort study

BackgroundUnplanned pregnancy is significantly associated with an increased risk of perinatal depression (antenatal and postnatal depression), emphasizing its prevalence and its potentially detrimental effects on both maternal and child health. This study aimed to investigate the association of contraception use and pregnancy intention with the risk of perinatal depression among Omani mothers.MethodsA prospective longitudinal study design was employed to investigate perinatal depression risk in mothers attending antenatal health care services in Oman. Perinatal depression risk was assessed using the Edinburgh Postpartum Depression Scale during the third trimester and postpartum visits. Multiple linear regression analyses were utilized to explore relationships between the risk of perinatal depression and pregnancy-related factors, contraception use, and sociodemographic variables.ResultsThe study involved 300 participants with a mean age of 30.8 years (SD = 5.47). The majority of participants reported planned pregnancy (74.0%), no use of contraception (66.0%), and being multiparous (72.7%). A significantly higher proportion (87.8%) of women with planned pregnancies were primiparous (p < 0.001). Besides family structure (core family, p = 0.025) and monthly income (1,000 OMR or below, p = 0.021), mothers who were pregnant for the first time (p < 0.001), and those who were primiparous (p < 0.001) did not use contraception. The regression models showed a significant association between the antenatal and postnatal depression scores (p < 0.001, 95% CI 0.401–0.603) according to the Edinburgh Postpartum Depression Scale.ConclusionsThe findings suggest that women with unplanned pregnancies warrant attention for early detection and preventive interventions, irrespective of their emotional stance. Incorporating routine mental health screening into perinatal care can facilitate early detection, and targeted interventions, contributing to improved maternal mental well-being.

What is the pathophysiology of inflammation-induced cortical injury in the perinatal brain?

Perinatal exposure to infection/inflammation is highly associated with neural injury, and subsequent impaired cortical growth, disturbances in neuronal connectivity, and impaired neurodevelopment. However, our understanding of the pathophysiological substrate underpinning these changes in brain structure and function is limited. The objective of this review is to summarize the growing evidence from animal trials and human cohort studies that suggest exposure to infection/ inflammation during the perinatal period promotes regional impairments in neuronal maturation and function, including loss of high-frequency electroencephalographic activity, and reduced growth and arborization of cortical dendrites and dendritic spines resulting in reduced cortical volume. These inflammation-induced disturbances to neuronal structure and function are likely to underpin subsequent disturbances to cortical development and connectivity in fetuses and/or newborns exposed to infection/inflammation during the perinatal period, leading, in the long term, to impaired neurodevelopment. The combined use of early electroencephalography monitoring with neuroimaging techniques that enable detailed evaluation of brain microstructure, and the use of therapeutics that successfully target systemic and central nervous system inflammation could provide an effective strategy for early detection and therapeutic intervention.

Unravelling ATTR Cardiac Amyloidosis in Iceland: A Nationwide Epidemiological Study

Introduction: Cardiac amyloidosis (CA) arises from the deposition of misfolded amyloid proteins in the heart's extracellular matrix, leading to significant cardiac disease. Recent data suggest that CA is under recognised and advances in treatment have increased focus on this condition with the intention of implementing treatment earlier to improve prognosis. There is limited knowledge regarding the prevalence of Transthyretin-CA (ATTR-CA) on a national level, particularly in Iceland. Therefore, this study represents the first nationwide effort to evaluate the baseline characteristics, diagnostics, and treatment of ATTR-CA in Iceland. Methods: A retrospective study of all patients diagnosed with ATTR-CA in Iceland from 6 May 2013 to 11 March 2024 were identified in the Icelandic Cardiac Amyloid Registry (ICE-CAR) created in 2023 by heart failure (HF) specialists at Landspitali University Hospital in Reykjavik, Iceland. Diagnosis was based on different combinations of transthoracic echocardiography (TTE), an elevated Perugini score on bone scintigraphy and heart biopsies, as well measurements of free light chains, M-component measurements in blood and urine. Patients were grouped according to the National Amyloidosis Centre (NAC) prognostic staging system for ATTR-CA. Results: In total, 65 patients with ATTR-CA were identified (males n=60, females n=5, median age 81.4 years [IQR 75.5-85.5 years]), all wild-type and no mutant variant. Diagnosis was made with myocardial biopsy in 7 cases. Upon diagnosis, 83% of the patients had an interventricular septum thickness of ≥15mm and 92% showed a posterior wall thickness of ≥12mm. Approximately 57% of patients belonged to New York Heart Association (NYHA) functional class I-II. The HF phenotypes according to left ventricular ejection fraction (LVEF) were distributed as follows: reduced (HFrEF) n=24 (37%), mildly reduced (HFmrEF) n=9 (14%), preserved (HFpEF) n=29 (44.5%), and unknown LVEF n=3 (4.5%). A total of 54 patients had reported NAC stage: Stage I 23 (35.4%), Stage II 20 (30.8%), Stage III 11 (16.9%). Around 32% received disease modifying treatment. Conclusion Despite the low NYHA class observed in the study population, our findings in Iceland's nationwide assessment of ATTR-CA indicate more advanced age and lower LVEF at diagnosis compared to other studies. This highlights the critical need for early detection and appropriate therapeutic interventions in managing ATTR-CA.

Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments.

Diabetes-related cognitive impairment is increasingly recognized as a significant complication, profoundly impacting patients' quality of life. This review aims to examine the pathophysiological mechanisms, clinical manifestations, risk factors, assessment and diagnosis, management strategies, and future research directions of cognitive impairment in diabetes. A comprehensive literature search was conducted using PubMed, Medline, and other medical databases to identify, review, and evaluate published articles on cognitive impairment in diabetes. The search focused on studies examining pathophysiology, clinical presentations, risk factors, diagnostic approaches, and management strategies. The review of current literature revealed that chronic hyperglycemia, insulin resistance, and vascular factors are major contributing factors to cognitive deficits in diabetes. Clinical manifestations include impairments in attention, memory, executive function, visuospatial abilities, and language. Risk factors encompass disease duration, glycemic control, presence of complications, age, education level, and comorbidities. Assessment tools include cognitive screening instruments, neuropsychological testing, and neuroimaging techniques. Management strategies involve glycemic control optimization, lifestyle modifications, cognitive training, and pharmacological interventions. This review highlights the significant prevalence and impact of cognitive impairment in diabetes, resulting from complex metabolic and vascular disturbances. Early detection and multifaceted interventions are crucial for preserving cognitive function and improving patient outcomes. Future research should focus on neuroprotective strategies, biomarker identification, and personalized approaches. Collaborative efforts between clinicians and researchers are essential to effectively address this growing healthcare challenge and enhance the quality of life for individuals with diabetes-related cognitive impairment.

Unveiling the Interplay Between the Human Microbiome and Gastric Cancer: A Review of the Complex Relationships and Therapeutic Avenues.

The human microbiota plays a crucial role in maintaining overall health and well-being. The gut microbiota has been implicated in developing and progressing various diseases, including cancer. This review highlights the related mechanisms and the compositions that influence cancer pathogenesis with a highlight on gastric cancer. We provide a comprehensive overview of the mechanisms by which the microbiome influences cancer development, progression, and response to treatment, with a focus on identifying potential biomarkers for early detection, prevention strategies, and novel therapeutic interventions that leverage microbiome modulation. This comprehensive review can guide future research and clinical practices in understanding and harnessing the microbiome to optimize gastric cancer therapies.

P4HA3 depletion induces ferroptosis and inhibits colorectal cancer growth by stabilizing ACSL4 mRNA.

Colorectal cancer (CRC) is a malignancy with high global incidence and mortality rates, posing a serious threat to human health. Despite favorable outcomes following early detection and surgical intervention, the asymptomatic nature of CRC often results in delayed diagnoses, limiting surgical treatment options. Furthermore, effective therapeutic drugs for CRC remain lacking in clinical practice, highlighting an urgent need to identify novel therapeutic targets. In this study, we identified that prolyl 4-hydroxylase subunit alpha 3 (P4HA3) is significantly upregulated in CRC and is associated with poor prognosis in patients. Both in vitro and in vivo experiments demonstrated that knockdown of P4HA3 induces ferroptosis, thereby inhibiting tumor growth. This ferroptosis induction is closely linked to increased lipid peroxidation, and P4HA3 knockdown promotes ferroptosis by upregulating acyl-CoA synthetase long-chain family member 4 (ACSL4), which regulates polyunsaturated fatty acid-containing phospholipids (PUFA-PLs) biosynthesis. Mechanistically, P4HA3 knockdown stabilizes ACSL4 mRNA by downregulating AUF1, an important RNA-binding protein (RBP) that binds to AU-rich elements (AREs) in the ACSL4 mRNA 3' untranslated region (UTR), thereby preventing its degradation. Additionally, given the lack of research on P4HA3 inhibitors, we employed virtual screening and identified Tubuloside A as a potential therapeutic agent. Tubuloside A promotes the ubiquitin-proteasome degradation of P4HA3, exerting anti-CRC effects. In summary, our findings demonstrate that P4HA3 protects CRC cells from ferroptosis by regulating ACSL4 mRNA stability via AUF1, and Tubuloside A serves as a potential P4HA3 degrader, offering a promising therapeutic strategy for CRC treatment.

MRI imaging characteristics of brainstem and midbrain aqueduct in patients with iNPH

Idiopathic normal pressure hydrocephalus (iNPH) is frequently difficult to diagnose due to the absence of specific symptoms, yet early detection and surgical intervention are essential for preventing sequela such as irreversible dementia. This study explores the specific magnetic resonance imaging (MRI) features of the brainstem and mesencephalic aqueduct in patients with iNPH. Head MRI data of 50 iNPH patients and 30 healthy matched controls were compared for mesencephalic aqueduct length, diameter, and angle, structural features of the brainstem at the sagittal plane, brainstem component volume ratios, angle between the brainstem and spinal cord, and the area and morphology of the pontine cisterns. Compared to healthy individuals, iNPH patients exhibited significant dilation of the mesencephalic aqueduct diameter, a reduced aqueduct angle, and a decrease in the sagittal plane area of the brainstem, with the most pronounced reduction in the midbrain region. Notably, the CSF spaces surrounding the brainstem were dilated, resulting in the prepontine cistern presenting a “hammer-like” shape on the sagittal plane. The prevalence of this hammer shape was positively correlated with prepontine cistern area in patients with iNPH. These unique imaging characteristics may facilitate the clinical recognition of iNPH for early diagnosis and treatment.

Electronic Health Records-Based Data-Driven Diabetes Knowledge Unveiling and Risk Prognosis

In the healthcare sector, the application of deep learning technologies has revolutionized data analysis and disease forecasting. This is particularly evident in the field of diabetes, where the deep analysis of Electronic Health Records (EHR) has unlocked new opportunities for early detection and effective intervention strategies. Our research presents an innovative model that synergizes the capabilities of Bidirectional Long Short-Term Memory Networks-Conditional Random Field (BiLSTM-CRF) with a fusion of XGBoost and Logistic Regression. This model is designed to enhance the accuracy of diabetes risk prediction by conducting an in-depth analysis of electronic medical records data. The first phase of our approach involves employing BiLSTM-CRF to delve into the temporal characteristics and latent patterns present in EHR data. This method effectively uncovers the progression trends of diabetes, which are often hidden in the complex data structures of medical records. The second phase leverages the combined strength of XGBoost and Logistic Regression to classify these extracted features and evaluate associated risks. This dual approach facilitates a more nuanced and precise prediction of diabetes, outperforming traditional models, particularly in handling multifaceted and nonlinear medical datasets. Our research demonstrates a notable advancement in diabetes prediction over traditional methods, showcasing the effectiveness of our combined BiLSTM-CRF, XGBoost, and Logistic Regression model. This study highlights the value of data-driven strategies in clinical decision-making, equipping healthcare professionals with precise tools for early detection and intervention. By enabling personalized treatment and timely care, our approach signifies progress in incorporating advanced analytics in healthcare, potentially improving outcomes for diabetes and other chronic conditions.

Public awareness and knowledge about colorectal cancer screening in Saudi Arabia

Background: Colorectal cancer (CRC) is a significant global health concern, ranking second among women and third among men in cancer diagnoses worldwide. In Saudi Arabia, CRC has been the most prevalent cancer in men since 2002. Despite rising incidence rates, public awareness and understanding of CRC screening remain critical for early detection and effective intervention. This study assesses public awareness and knowledge regarding CRC screening in Saudi Arabia. Methods: A cross-sectional, questionnaire-based study was conducted using Google forms to gather data from Saudi Arabia's overall population from 5th December 2023 to 20th December 2023. The online questionnaire included demographic information and assessed participants' knowledge, awareness, and attitudes toward CRC screening. Data analysis was performed using SPSS version 26. Results: Of the 461 participants, 61.4% were female, 38.6% were male, and 53.1% were 50 or older. Only 13.1% of participants aged 50 and above had undergone CRC screening. A significant proportion (55.1%) in other age groups remained undecided about future screening. Lack of awareness (51.9%) was the primary reason for refusal or hesitation. Participants exhibited limited awareness of CRC's global prevalence (50.3%) and the recommended screening age (36.4%). Significant associations were found between awareness levels, gender, education, and age groups. Conclusions: The study highlights a substantial need for more awareness and knowledge about CRC screening in Saudi Arabia, particularly among specific demographic groups. Targeted awareness campaigns are crucial, focusing on increasing knowledge about risk factors, symptoms, and the importance of early screening.

Systemic and Cardiac Microvascular Dysfunction in Hypertension.

Hypertension exerts a profound impact on the microcirculation, causing both structural and functional alterations that contribute to systemic and organ-specific vascular damage. The microcirculation, comprising arterioles, capillaries, and venules with diameters smaller than 20 μm, plays a fundamental role in oxygen delivery, nutrient exchange, and maintaining tissue homeostasis. In the context of hypertension, microvascular remodeling and rarefaction result in reduced vessel density and elasticity, increasing vascular resistance and driving end-organ damage. The pathophysiological mechanisms underlying hypertensive microvascular dysfunction include endothelial dysfunction, oxidative stress, and excessive collagen deposition. These changes impair nitric oxide (NO) bioavailability, increase reactive oxygen species (ROS) production, and promote inflammation and fibrosis. These processes lead to progressive vascular stiffening and dysfunction, with significant implications for multiple organs, including the heart, kidneys, brain, and retina. This review underscores the pivotal role of microvascular dysfunction in hypertension-related complications and highlights the importance of early detection and therapeutic interventions. Strategies aimed at optimizing blood pressure control, improving endothelial function, and targeting oxidative stress and vascular remodeling are critical to mitigating the systemic consequences of hypertensive microvascular damage and reducing the burden of related cardiovascular and renal diseases.

Complications in interventional radiology: early detection and effective intervention strategies.

This narrative review provides a comprehensive overview of complications in interventional radiology (IR), focusing on their aetiology, recognition, and management. As IR procedures continue to evolve and expand, understanding potential adverse events is crucial for improving patient safety and outcomes. The review will summarise various common complications associated with IR-based procedures, including their presentation, aetiology, and management. By consolidating current knowledge on these issues, the review offers valuable insights into minimising risks and enhancing procedural success. This synthesis will aid practitioners' knowledge and ultimately try and ensure safer IR practices and aftercare of patients.

Engaging Australian healthcare consumers to determine priorities and consensus for precision medicine approaches to detect non-communicable disease in early life: a modified Delphi study

ObjectivesResearch to develop early screening tools to determine an individual’s risk of developing adult-onset disease is a growing field. Expectant parents may find themselves with an option in the future...

Identification and verification of feature biomarkers associated with choline metabolism in sepsis-induced cardiomyopathy.

Background: Sepsis-induced cardiomyopathy (SIC), one of the most common complications of sepsis, seriously affects the prognosis of critically ill patients. Choline metabolism is an important biological process in the organism, and the mechanism of its interaction with SIC is unclear. The aim of this study was to reveal the choline metabolism genes (CMGs) associated with SIC and to provide effective targets for the treatment of SIC.Methods: Through a comprehensive analysis of the microarray dataset GSE79962 (comprising 20 SIC patients and 11 healthy controls) from the GEO database, suspected co-expression modules and differentially expressed genes (DEGs) in SIC were identified. Hub CMGs were obtained by intersecting choline metabolism database with DEGs and key model genes. Afterward, hub CMGs most significantly involved in prognosis were further analyzed for the verification of major pathways of enrichment analysis. Finally, the expression of hub CMGs in in vivo and in vitro SIC model was verified by immunohistochemistry staining and quantitative real-time polymerase chain reaction analysis (qPCR).Results: WGCNA identified 1 hub gene panel and 3867 hub genes, which were intersected with DEGs and CMGs to obtain the same 3 hub CMGs:HIF-1α, DGKD and PIK3R1. Only HIF-1α shows significant association with mortality (P = 0.009). Subsequent differential analysis based on the high and low HIF-1α expression yielded 63 DEGs and then they were uploaded into Cytoscape software to construct a protein-protein interaction (PPI) network and 6 hub genes with the highest priority were obtained (CISH, THBS1, IMP1, MYC, SOCS3 and VCAN). Finally, a multifactorial COX analysis revealed a significant correlation between HIF-1α and survival in SIC patients, which was further validated by in vitro and in vivo experiments.Conclusion: Our findings will provide new insights into the pathogenesis of SIC, and HIF-1α may have important applications as a potential biomarker for early detection and therapeutic intervention in SIC.

Establishing a telemedical supported trans-sectoral collaboration network from community support to emergency care for outpatient care recipients: study protocol of a prospective non-randomized complex intervention study with a pragmatic approach, Stay@Home – Treat@Home

BackgroundDemographic changes in Germany are increasing the number of outpatient care recipients, who often resort to emergency care due to difficulties accessing timely outpatient medical care. Previous studies suggest that early detection and telemedical interventions could reduce unnecessary hospitalizations. The new form of healthcare aims to provide continuous, flexible healthcare for outpatient care recipients using digital technologies to detect health deteriorations and facilitate interventions at home. The goal of our study is to evaluate, whether the number of emergency situations and hospital stays will be reduced, and health outcomes will be improved compared to standard care.MethodsIn this prospective non-randomized complex intervention study with a pragmatic approach, we aim to evaluate a new form of healthcare focused on establishing an interdisciplinary network for outpatient care in the homes of care-dependent individuals. Utilizing a digital interactive health diary, health data will be gathered from participants, caregivers, and healthcare providers, covering both stable primary care and acute situations. A telemedical network will coordinate measures, including non-medical aid, nursing care, and medical assistance. A total of 1,500 participants will be recruited for the intervention group, matched with a control group from health insurance data. A second control group with n=300 will provide self-reported measures. The study is planned to span eight quarters, with data collected from the digital interactive health diary and health insurance records. Evaluation perspectives include health insurance, patients, and healthcare providers, assessing utilization and costs compared to standard care, health status, health-related quality of life, care dependency, interdisciplinary cooperation, and usability of the new technology.DiscussionDemographic change results in a larger older people population, exacerbating mobility issues and care dependency, worsened by the shortage of medical personnel. Stay@Home – Treat@Home aims to enable home health monitoring and care, reducing hospitalizations. The digital interactive health diary supports direct communication, allows remote monitoring, and empowers patients and caregivers to manage health changes. Nursing aid personnel and physicians can access entries for informed interventions. The development of the digital interactive health diary aims to improve the situation of care-dependent individuals. Evaluating its effectiveness and efficiency is crucial for the development and implementation of new technologies.Trial registrationGerman Clinical Trials Register, ID: DRKS00034260, registered on May 14, 2024 (retrospectively registered): https://drks.de/search/de/trial/DRKS00034260 and https://who.int/clinical-trials-registry-platform/network/who-data-set.

Vascular Inflammatory Genes as Predictors of Preeclampsia: A Systematic Review

ABSTRACT Background: Preeclampsia, a condition causing new-onset hypertension and proteinuria after 20 weeks of gestation, is a significant cause of maternal and fetal morbidity and mortality. The pathogenesis of preeclampsia is complex, involving an interplay of vascular inflammation and angiogenic imbalance. This systematic review and meta-analysis aims to elucidate the role of key vascular inflammatory candidate genes—VEGF, TNF-α, IL-10, and LPL—in the onset of preeclampsia. Methodology: We conducted a comprehensive literature search across PubMed, Embase, and Cochrane databases, identifying case-control and cohort studies that examined the association between these genetic variants and preeclampsia. Results: Our meta-analysis reveals significant associations between preeclampsia and polymorphisms in the VEGF, TNF-α, IL-10, and LPL genes, with pooled odds ratios indicating increased risk for the VEGF -2578C>A, VEGF -1154G>A, TNF-α -308G>A, IL-10 -819C>T, and LPL Ser447Ter variants. Conclusion: These findings suggest that genetic predispositions in vascular inflammatory pathways may contribute to the development of preeclampsia, offering potential targets for early detection and therapeutic intervention. Further research is warranted to explore the molecular mechanisms by which these genetic variants influence the pathogenesis of preeclampsia and to develop targeted prevention strategies.

Rhabdomyolysis in Severe Fever With Thrombocytopenia Syndrome: Associations With Acute Kidney Injury and Mortality.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging zoonosis caused by a novel bunyavirus. Until recently, rhabdomyolysis in SFTS was not elucidated. The objective of this study was to investigate the prevalence and clinical characteristics of rhabdomyolysis and its association with AKI and prognosis in patients with SFTS. A total of 231 consecutive patients diagnosed with SFTS were enrolled, including 144 (62.3%) patients in the no rhabdomyolysis group and 87 (37.7%) patients in the rhabdomyolysis group. Clinical characteristics and laboratory parameters of SFTS patients were compared between the no rhabdomyolysis and rhabdomyolysis groups. Patients with rhabdomyolysis had more frequency of confusion, cough, sputum, chest distress, abdominal pain, petechia and ecchymosis, headache, myalgia, and myasthenia than those without rhabdomyolysis. Compared with patients in the no rhabdomyolysis group, patients in the rhabdomyolysis group had higher serum levels of laboratory parameters referring to liver, kidney, pancreas, heart, coagulation system injury, and higher viral load. The cumulative survival rate of patients with rhabdomyolysis was significantly lower than that of patients without rhabdomyolysis. Furthermore, univariate and multivariate binary logistic regression analyses demonstrated that rhabdomyolysis was an independent predictor for acute kidney injury and mortality in patients with SFTS. Rhabdomyolysis may be an important contributing factor to adverse outcomes and its effects on mortality may be mediated by acute kidney injury in SFTS. The early detection and effective intervention of rhabdomyolysis may decrease the mortality of patients with SFTS.

Digital Elder Abuse Intervention for Early Detection of Abuse in Older Adults Living with Dementia

Digital Elder Abuse Intervention for Early Detection of Abuse in Older Adults Living with Dementia

Targeting the JAK-STAT pathway in colorectal cancer: mechanisms, clinical implications, and therapeutic potential.

Colorectal cancer (CRC) remains one of the most prevalent and fatal malignancies worldwide, consistently ranking among the top three in terms of incidence and mortality. Despite notable advancements in early detection and therapeutic interventions, survival outcomes for advanced-stage CRC are still dismal, largely due to issues such as drug resistance and metastasis. Recent research has increasingly implicated the JAK-STAT signaling pathway as a pivotal contributor to CRC pathogenesis. This evolutionarily conserved pathway plays a key role in transmitting extracellular signals to the nucleus, thereby modulating gene expression involved in numerous fundamental biological processes. In CRC, dysregulation of the JAK-STAT pathway is frequently observed and is strongly associated with tumor progression, including processes such as cellular proliferation, apoptosis, metastasis, immune evasion, and the sustenance of cancer stem cells. Given its integral role in CRC advancement, the JAK-STAT pathway has gained recognition as a viable therapeutic target. Extensive evidence from preclinical and clinical models supports the efficacy and safety of targeting components of the JAK-STAT pathway, presenting new therapeutic possibilities for patients with CRC, particularly in addressing drug resistance and enhancing treatment outcomes. This review offers a detailed exploration of the JAK-STAT pathway, focusing on its regulatory mechanisms in CRC-related malignancies. Moreover, it examines the association between JAK-STAT protein expression, clinical features, prognosis, and its therapeutic potential in CRC management.

Upper Limb Therapy for Infants and Young Children with Unilateral Cerebral Palsy: A Clinical Framework.

Early detection and rehabilitation interventions are essential to optimise motor function in infants and young children with unilateral cerebral palsy. In this paper we report a clinical framework aimed at enhancing upper limb therapy for infants and young children with unilateral cerebral palsy during a sensitive period of brain development. We describe two major therapeutic approaches based on motor learning principles and evidence: constraint-induced movement therapy and bimanual therapy. These two therapies have demonstrated efficacy in older children and emerging evidence is available for their application to infants younger than 2 years of age. To provide clinicians with guidance as to when to implement these therapies, we discuss the key consideration when undertaking upper limb therapy programs. In addition, we describe the factors to consider when choosing which approach may be suitable for an individual child and family. Detailed strategies for implementing these therapies in infants and young children of different ability levels are given.

Eventration of Right Hemidiaphrgm – A Post Covid -19 Infection Complication

Introduction and Significance: Diaphragmatic eventration is an uncommon disorder marked by partial or complete thinning of the diaphragm's muscle tissue. In this condition, the diaphragm, which is normally flexible and moves downward during inhalation, instead moves upward in a paradoxical manner. This abnormal movement leads to restricted lung function. The condition can be congenital or acquired, with acquired cases often resulting from trauma to the phrenic nerve, either from mechanical or surgical causes, compression by thoracic space-occupying lesions, or various infectious or inflammatory conditions impacting the phrenic nerve. Many individuals with this condition may remain asymptomatic for long periods, leading to frequent underdiagnosis. Clinical suspicion should prompt chest X-rays, and the diagnosis can be confirmed with chest computed tomography (CT).  Case Presentation: We report the case of a 65-year-old male who exhibited right-sided hemi-diaphragmatic eventration and experienced dyspnea over the past two years. The patient underwent a multilayer surgical plication of the right hemidiaphragm, which resulted in a successful outcome.  Clinical Discussion: The choice to proceed with surgical intervention for diaphragmatic eventration is influenced by the severity of associated complications. Patients who are symptomatic and exhibit compromised respiratory, cardiovascular, or gastrointestinal function generally require diaphragmatic plication.  Conclusion: Despite its rarity, diaphragmatic eventration is a condition that warrants careful evaluation by clinicians. Early detection and surgical intervention are key to managing and repairing this condition effectively.