Ocular and Orbital Trauma Correlated With an Increased Risk of Mortality in Female Patients With a History of Intimate Partner Violence.

Outcomes from a posttraumatic growth-oriented program among veterans: A quasi-experimental retrospective study.

Altered brain activity mediates the correlation between childhood trauma and aggression in youths with internet gaming disorder.

Treatment of immature permanent teeth with blunderbuss apices and thin dentinal walls remains an enigma for endodontists. Various treatment modalities have been used to manage immature teeth, such as non vital pulp therapy with calcium hydroxide or apexification using Mineral Trioxide Aggregate (MTA), Biodentine, or bioceramic putty. However, these methods fail to address the problem of thin dentinal walls, which often leads to tooth fracture and extraction despite successful initial treatment. Regenerative Endodontic Procedures (REPs) offer the best solution for such cases, with the potential to re-establish the dentin-pulp complex, thereby facilitating apexogenesis and root maturation. The development of second-generation platelet concentrates such as Platelet-Rich Fibrin (PRF) has made the success of REPs more predictable compared to procedures that rely solely on induced intracanal bleeding. A 25-yearold female patient presented with pain and swelling in the upper anterior region, with a history of childhood trauma 17 years earlier and recent incomplete dental treatment. Clinical and radiographic examination revealed tenderness on percussion and a well-defined periapical radiolucency (~10×12 mm) involving teeth #21 and #22. Tooth #21 exhibited an open apex and a necrotic pulp, while tooth #22 had previously undergone root canal treatment. A working diagnosis of periapical pathology secondary to pulpal necrosis was made. A Regenerative Endodontic Procedure (REP) was planned for tooth #21, while tooth #22 was left untreated due to satisfactory restoration and obturation. Following disinfection using 1.5% sodium hypochlorite and placement of an interim calcium hydroxide dressing over three visits, Platelet-Rich Fibrin (PRF) prepared from autologous blood was placed as a scaffold. A collagen plug was positioned over the PRF, followed by a 3 mm layer of MTA, and the tooth was sealed with resin-modified glass ionomer cement. Follow-ups at 3, 6, 12, and 24 months revealed complete resolution of the periapical radiolucency with apical closure of tooth #21. The tooth remained asymptomatic and functional, although no response to pulp vitality tests was observed. Regenerative endodontic treatment can be successfully performed alongside conventional endodontic therapy in managing immature permanent teeth with periapical radiolucency. Two teeth involved in the same lesion can be effectively treated using different treatment modalities, and prior conventional endodontic intervention does not hinder the future success of regenerative endodontics.

Childhood trauma and life history strategies - the moderating role of childhood socio-economic status and the dark triad traits

The Palato-Gingival Groove (PGG) is a rare developmental anomaly most frequently affecting maxillary incisors, predisposing the tooth to plaque retention, localised periodontal destruction, and combined endodontic-periodontal lesions. Owing to its complex anatomy, the diagnosis and management of PGG remain a significant clinical challenge. This case report describes the management of a severe PGG in a 26-year-old male who presented with mobility and a deep periodontal pocket in the maxillary right lateral incisor. Clinical and radiographic examination, including Cone-Beam Computed Tomography (CBCT), confirmed the presence of a deep PGG associated with periapical radiolucency. Root canal therapy was performed, followed by a full-thickness flap surgery. The groove was saucerised and sealed with mineral trioxide aggregate to prevent microleakage and promote healing. Bone grafting was performed to facilitate periodontal regeneration, and the flap was repositioned and sutured. Follow-up evaluations at one, three, and five months demonstrated a significant reduction in probing depth, radiographic evidence of bone fill, and restoration of periodontal stability. The second case involved a 35-year-old male with a history of trauma to the maxillary left central incisor and previous root canal treatment, who reported recurrent pain and swelling. Clinical and CBCT examination revealed a palatal radicular groove associated with periapical pathology. Nonsurgical endodontic retreatment was performed, followed by flap surgery. The groove was sealed with light-cured Glass Ionomer Cement (GIC) to achieve a smooth surface, prevent microleakage, and enhance periodontal healing. Bone grafting and periodontal dressing were placed to promote regeneration. Follow-up evaluations at three and five months showed complete resolution of symptoms, bone fill, and satisfactory gingival healing. This report of two cases emphasises the importance of early recognition of the PGG as an etiological factor in persistent endo-perio lesions. A comprehensive approach involving endodontic, periodontal, and restorative procedures was essential in achieving favourable outcomes. The novelty of this report lies in highlighting the role of multidisciplinary management in preserving a tooth with an otherwise poor prognosis, thereby reinforcing the need for awareness and timely intervention in such rare anatomical anomalies.

Nontraumatic neuropathies of the shoulder and brachium result from Pancoast tumors, brachial plexus neuritis, thoracic outlet syndrome, proximal compression of the radial nerve, and supracondylar compression of the median nerve. Although these pathologies often require multidisciplinary intervention, patients with these conditions often first present for orthopaedic evaluation. The surgeon should take care to elicit a history of trauma in their workup because this too can be an important cause of neuropathy. A practical description of the presentation, diagnosis, treatment, and prognosis of these pathologies is important for the orthopaedic surgeon.

Profiles of parental bonding and childhood trauma in a clinical sample: Implications for coping strategies in adulthood among Chinese young adults.

Complex post-traumatic stress disorder moderates functional connectivity in people with psychosis.

Nursing can be highly rewarding, but at the same time, overwhelmingly stressful or even traumatizing. Spirituality constitutes a central element of nurses' resilience, while personal trauma may be activated during exposure to patients' trauma. The aim of this study was to examine the impact of sociodemographic and work-related characteristics, spirituality, and personal trauma history on compassion fatigue and compassion satisfaction among Greek nurses. A cross-sectional survey study with a total of 210 nurses selected by convenience sampling and required to complete the Professional Quality of Life Scale (ProQOL V), the FACIT-Spiritual Well-Being Scale-12 nonillness scale, and the Traumatic Life Events Questionnaire (TLEQ). Thirty percent (30%) of the participants reported high compassion fatigue risk, while 76% expressed high to moderate potential for compassion satisfaction. Secondary traumatic stress (STS), as expected, was found to correlate positively with traumatic life events. Compassion satisfaction scores were found to correlate positively with spiritual well-being and the three aspects of meaning, peace, and faith. Nurses who reported good physical health, high levels of cooperation, respect for teamwork, and positive work climate also reported higher levels of Compassion Satisfaction and lower risk for compassion fatigue. The findings of this study shed light on the significant prevalence of compassion fatigue among nursing staff, highlighting the need for targeted interventions to improve the mental health of front-line healthcare professionals. Healthcare organizations must recognize the importance of fostering compassionate work environments that prioritize nurses' spiritual and psychological well-being.

Background Pregnancy and childbirth are vulnerable periods for women’s mental health, with common occurrences of postnatal depression (PPD), postpartum post-traumatic stress symptoms (PP-PTSS) and postnatal severe fear of childbirth (PP-FOC). While previous trauma is linked to higher rates of postpartum psychological difficulties, the mechanisms and variations by parity and sociodemographic factors remain poorly understood. The aim of this study was to compare the prevalence of PPD symptoms, postnatal post-traumatic stress disorder (PP-PTSD), PP-PTSS and PP-FOC between women with a history of trauma and those without. Additionally, the study aimed to analyse the prevalence of previous trauma and postnatal mental health problems in subgroups of primi- and multiparous women, and to investigate how trauma influenced mental health in relation to sociodemographic characteristics. Methods This was a cross-sectional study including 619 women who had given birth at five maternity clinics in Sweden. Data for the survey were collected online using validated instruments to measure PPD, PP-PTSD, PP-PTSS and PP-FOC. Data were analysed using Chi-squared tests, independent t-tests and uni- and multivariable regression. Results Women with a trauma history (n = 298) showed significantly higher rates of PPD (26% vs. 13%) and PTSD (5% vs. 2%) than those without a trauma history (n = 321). Previous trauma, age and parity significantly influenced postnatal outcomes, with trauma having the most substantial impact. Conclusions A history of trauma is correlated to higher risk of postpartum mental health problems, while previous births may offer some protection, especially against PP-PTSS and PP-FOC. Early identification and targeted support for women with trauma histories are recommended.

ABSTRACT Background: Complex posttraumatic stress disorder (cPTSD) was recently added to the ICD-11. Refugees might be particularly vulnerable to develop this disorder, due to key risk factors including trauma history, comorbid symptoms, and post-migration stressors. However, most prevalence estimates rely on self-report questionnaires, which are less reliable than clinical interviews. This study aimed to assess PTSDICD-11 and cPTSD prevalence in treatment-seeking refugees using clinician ratings, and to examine risk factors influencing diagnostic status and symptom severity. Method: N = 104 treatment-seeking refugees were assessed for cPTSD and PTSDICD-11, as well as symptom severity and single symptom endorsement using a new clinical interview, the Complex PTSD Item Set Additional to the CAPS. Trauma history, comorbid symptoms (dissociation, sleep problems, somatic symptoms, anxiety, depression, social impairment), and post-migration stressors were investigated as predictors for cPTSD diagnostic status and symptom severity using Wilcoxon Rank sum tests, logistic and linear regression. Results: Prevalences for cPTSD and PTSDICD-11 were 14.42% (n = 15) and 63.46% (n = 66), respectively. Participants with and without cPTSD did not differ regarding the frequency of traumatic events experienced. However, cPTSD symptom severity was significantly positively associated with the frequency of experienced traumatic events. In regression analyses, comorbid symptoms were significantly associated with cPTSD diagnostic status and symptom severity with depressive symptoms being a significant predictor. Post-migration stressors were associated with cPTSD diagnostic status and symptom severity, and the perception of the present financial situation was a significant predictor for cPTSD severity. Discussion: The prevalence of cPTSD was relatively low in this refugee sample. This discrepancy to earlier prevalence estimates could be due to the assessment since we used a clinical interview instead of a self-report questionnaire. More investigations into cPTSD diagnostic assessments are needed, and clinical interviews should be used more often.

Epigenetic changes affecting genes in the glucocorticoid pathway have been studied as biomarkers for major depressive disorder (MDD). The aim of this cross-sectional study was to evaluate glucocorticoid receptor (GR) gene promoter methylation levels in depressed workers exposed to occupational stress. Nuclear receptor subfamily 3 group C member 1 (NR3C1) promoter methylation levels were measured by methylation-sensitive high-resolution melting (MS-HRM) in 70 patients with MDD and 40 healthy controls. Occupational stress was evaluated in patients and controls using the Job Content Questionnaire (JCQ). NR3C1 promoter methylation levels were found to be significantly higher in MDD patients than in controls (p = 0.0001). A multiple regression analysis revealed a significant positive association between NR3C1 methylation levels and MDD diagnosis (r = 0.507, p < 0.0001), and a negative association with occupational stress (r = −0.218, p = 0.03). No differences in NR3C1 methylation levels were found between depressed patients exposed and non-exposed to previous traumatic events and the history of trauma was not a significant independent predictor of NR3C1 methylation levels. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation through GR gene hypermethylation could play a key role in the pathophysiology of occupational stress-related disorders. Occupational stress could independently contribute to the epigenetic mechanisms underlying vulnerability to psychopathology. Further research is needed focusing on biomarkers for stress-related disorders as a potential tool for the diagnosis and prevention of occupational diseases.

Purpose: o report and characterize malposition of the inferior oblique (IO) muscle observed during orbital surgeries for congenital and acquired pathologies. Study Design: Descriptive case series. Place and Duration of Study: Al- Shifa Trust Eye Hospital, Rawalpindi from June 2004 to June 2024. Methods: In this study, all the patients who underwent orbital surgery during the 20 years, by one experienced orbital surgeon, were reviewed. Out of 1200 cases of orbital surgeries four cases were identified for the study. In all four cases, IO mal position was directly observed during orbital surgery. Pre-operative orbital imaging studies could not find the malposition. All surgeries were performed by the same surgeon under general anesthesia. In addition to the planned surgical procedure, an attempt was also made to re-position the abnormal-origin IO. Results: Out of the four patients with IO malposition, there were two females and two males. Two patients presenting with congenital dermoid cysts had a normal birth history with no history of any surgery or trauma. The other two patients with acquired malposition had a history of trauma and previous surgery. Conclusion: IO malposition is a rare entity. It is difficult to predict pre-operatively so while performing orbitalor strabismus surgeries, one should be very careful and watchful to prevent damage to ectopic muscles.

ABSTRACT Hemophilia is a bleeding disorder characterized by recurrent bleeding into muscles and joints. Many people with hemophilia experience multiple traumatic painful bleeding episodes, meaning that pain is often a significant problem for people with hemophilia, with a potentially high prevalence of posttraumatic stress and posttraumatic stress disorder symptoms. Current pain treatments are often ineffective and do not consider pain memories, which are experienced by almost half of people with posttraumatic stress disorder and which has not been explored in people with hemophilia. To fill this gap, 14 semistructured interviews with men with hemophilia were completed between November 2022 and January 2023 to explore their lived experiences of pain relating to their hemophilia. Data were analyzed using reflexive thematic analysis. Three overarching themes were constructed from the data: “trauma histories,” “pain management,” and “impact on the present.” Findings show that pain experienced by people with hemophilia is complex and does include a memory element for many individuals. Pain memories are clear and vivid and include visual, somatic, and emotional elements in intricate detail. Pain can also be experienced in the present when experiencing a pain flashback, and pain in the present can be a trigger to recalling and re-experiencing pain memories from the past. Self-taught active dissociation from pain, imagery, and distraction were described as useful pain management strategies. Findings from this study have implications for clinicians and service providers because current pharmacological and physical pain management techniques may be ineffective when pain memory is involved. Future interventions should consider how pain management is advanced for people with hemophilia and how hemophilia services become trauma informed.

Purpose: To determine visual outcomes and pattern of injuries among patients presented with Ocular Trauma in three major tertiary care centers of Karachi. Study Design: Cross sectional study. Place and Duration of Study: Mross-sectional study conducted at three tertiary care centers of Karachi, over a 3-month period. Methods: Patients with history and signs of recent ocular and adnexal trauma were included in the study and those with any other ocular or systemic disease were excluded from the study. Data was collected on a self-designed proforma for history and the relevant ocular and adnexal examination details. Majority of the patients presented to the Accident and Emergency department and referred to Eye clinics. Ocular Trauma Scores (OTS) were calculated with the help of OTS chart. Results: In a sample of 343 patients, 44% were presented at Jinnah Postgraduate Medical Centre (JPMC), 45% at Isra Postgraduate Institute of Ophthalmology (IPIO), and 11% at Dow International Medical College (DIMC). Most injuries occurred in males (76.7%). Accidental injuries were the commonest injuries found in DIMC, (52.63%) and IPIO, (64.52%)(n=100). Whereas in JPMC, assault was the most common (31.75%). Commonest sign of ocular trauma was lid swelling (26.23%) found in DIMC and lid tear (16.76%) in JPMC. Conclusion: Ocular trauma patterns in Karachi are closely linked to the nature of surrounding environments, including traffic density, occupational hazards, and access to emergency services. Public education, protective gear enforcement, and workplace safety policies are needed to reduce the burden of preventable vision loss.

This article examines Richard Flanagan’s Question 7 (2023) as a transformative work of postmemorial literature that fuses personal, historical, and ecological trauma within a metamodern framework. Drawing on the theories of Marianne Hirsch, Martin Heidegger, and Charlene Spretnak, the analysis traces how the novel expands postmemory beyond familial inheritance to encompass planetary crisis and ecological interconnectedness. Through narrative fragmentation, ethical self-reflection, and a poetics of care, Flanagan’s text models a reconstructive metamodernism that resists nihilism and affirms the profound communion of all life. Ultimately, Question 7 offers an ethics of love and responsibility, inviting readers to dwell authentically and respond to contemporary crises with renewed relationality and hope.

Background: In the contemporary digital era, smartphones have become indispensable tools for communication, education, and entertainment. However, their excessive and prolonged use has given rise to behavioral dependency, particularly among students and young adults who are frequent users. Extended use of smartphones often involves maintaining forward head or flexed neck postures, which may gradually lead to musculoskeletal strain, posture alterations, and functional limitations. Objective: To examine the association between prolonged smartphone use and its impact on neck posture, pain intensity, and functional disability among young adults. Methodology: This analytical cross-sectional study was conducted from March to August 2025 at the Department of Rehabilitation Sciences, Shifa Tameer-e-Millat University, Islamabad. A sample of 400 participants was enrolled utilizing a non-probability purposive sampling. Eligible participants were healthy males and females aged 18 to 25 years. Patients with a history of cervical trauma, fractures, or any neurological or vascular pathology were excluded. Ethical clearance for the study protocol was secured from the Institutional Review Board and Ethics Committee of Shifa International Hospital. The primary outcome measures included cervical range of motion, the Numeric Pain Rating Scale for pain intensity, the Neck Disability Index for functional status, and the Occiput-to-Wall Distance test for posture. Participants self-reported their average daily smartphone usage duration. Postural assessment was conducted via the Occiput-to-Wall Distance test, while cervical range of motion was evaluated using a bubble inclinometer. The pain score and Neck Disability Index were employed to quantify neck pain and its impact on daily activities, respectively. For statistical analysis, Spearman's correlation test was applied. Results: The findings revealed a weak but statistically significant positive correlation between smartphone use and both neck posture (p=0.01, r=0.11) and functional disability (p=0.00, r=0.13). However, no significant association was found with neck pain intensity (p=0.31, r=0.05). Conclusion: The study underscores that extended smartphone use is associated with postural deviations and functional impairment of the neck, though its direct link to neck pain remains statistically inconclusive. These findings highlight the need for awareness and preventive strategies to mitigate posture-related complications among young adults.

Research suggests autistic people experience greater post-traumatic stress disorder symptom severity than non-autistic people following traumatic events. Post-trauma appraisals are fundamental in cognitive models of post-traumatic stress disorder, but have not been explored in autistic people. We aimed to explore whether we could replicate effects of heightened trauma exposure and post-traumatic stress disorder symptom severity in autistic adults, and examine how post-traumatic appraisals affect the association between autism and post-traumatic stress disorder symptom severity. Two hundred forty-two autistic (n = 148) and non-autistic adults (n = 94) completed a survey measuring trauma exposure, post-traumatic stress disorder symptom severity and post-trauma appraisals. Exposure to types of traumatic events did not differ significantly between the groups, but the autistic group endorsed more events that 'happened to me' directly. Post-traumatic stress disorder symptom severity and endorsement of negative post-traumatic appraisals were significantly higher in the autistic group, specifically alienation, shame and fear appraisals. These appraisals mediated the association between autism and post-traumatic stress disorder symptom severity. Therefore, as in the general population, greater endorsement of negative post-traumatic appraisals may be a risk factor for post-traumatic stress disorder symptom development in autistic adults, particularly appraisals of shame, fear and alienation. Longitudinal designs are required to confirm the direction of these effects and to elucidate factors underlying these negative appraisals in autistic people.Lay SummaryMany people experience intrusive memories and anxiety after a traumatic event. However, for some, these symptoms last longer and they might be diagnosed with post-traumatic stress disorder. Research suggests that autistic people might be more likely to develop post-traumatic stress disorder and experience more severe symptoms compared to non-autistic people after traumatic events. One factor that is important in post-traumatic stress disorder development is how people think about the trauma. These might be thoughts like 'It was my fault', 'I'm not safe', 'I'm disconnected from other people'. There has not been research into how autistic people think about traumatic events compared to non-autistic people, and this could be important for making post-traumatic stress disorder treatments more effective for them, as many of these focus on thoughts. In this study, we asked 148 autistic people and 94 non-autistic people in the United Kingdom to complete an online survey about their trauma history, post-traumatic stress disorder symptoms and thoughts about a traumatic event. We found that autistic people experienced more types of traumatic events directly (it happened to them), but they did not experience more types of traumatic events overall. Interestingly, both groups reported events like bullying or the death of a loved one as traumatic, but these events would not meet the official diagnostic criteria for post-traumatic stress disorder. As expected, autistic people reported worse post-traumatic stress disorder symptoms than non-autistic people and were more likely to meet the cut-off for post-traumatic stress disorder diagnosis. Autistic people also reported more negative thoughts about the trauma, especially feeling unsafe, disconnected, ashamed or that the trauma was their fault. Having more thoughts like this was associated with being autistic and experiencing more severe post-traumatic stress disorder symptoms. Our findings suggest that therapies focusing on these negative thoughts could be helpful for autistic people with post-traumatic stress disorder. Future research should explore why autistic people have more of these thoughts after traumatic events and should use longitudinal or experimental designs to explore how these factors influence one another over time. Efforts to prevent negative experiences, challenge negative attitudes in society towards autism and support positive autistic identity and well-being will be helpful for changing this in the future. It is also important that mental health services offer support for post-traumatic stress disorder even when events do not meet the current diagnostic criteria, as this might prevent autistic and non-autistic people who need support with post-traumatic stress disorder getting help.

Introduction: Gout stands out as the predominant form of inflammatory arthritis caused by the accumulation of monosodium urate (MSU) crystals within joints and connective tissues. The classic manifestation of gout typically involves repeated acute episodes impacting the first metatarsophalangeal joints. However, sometimes the unusual occurrence of cyst can be happened and sometimes lead to misdiagnosis or be mistaken for other conditions. This will be the first case report about the unusual occurrence of gout arthritis in calcaneocuboid joint. Case presentation: A-30-years old male came with pain on his left foot which was worsen by walking and relieved by resting since 6 months ago. History of trauma was denied. Patient underwent for x-ray and did not show any significance abnormality. Then, patient was treated as osteoarthritis metatarsal cuboid. He was given intraarticular injection of sodium hyaluronate 25 mg for twice in the period of one month. However, the symptoms were not significantly relieved. Patient underwent for CT-Scan 3D reconstruction. Then, it was found there was subchondral cyst in the lateral aspect of distal cuboid. Uric acid test showed increasement up to 12.8 mg/dL. Patient underwent for debridement and bone graft to evacuate the cyst. After the surgery, patient showed good functional and pain result. Conclusion: Unusual presentation of gout arthritis is rarely happening and may lead to misdiagnosis. In this case, we presented a 30-year-old male with gout arthritis cyst inside the cuboid joint. Patient was successfully diagnosed with comprehensive approach although it is a rare occurrence. Keywords: calcaneocuboid joint, foot, gout arthritis, osteoarthritis, uric acid.