Local Restrictions Research Articles

Subtitling profanity into Malay: Balancing formal and creative taboo expressions

Introduction: Translation of swearwords has unceasingly gained traction in audiovisual translation. In subtitling, swearing does not only warrant linguistic consideration but other multimodal elements, such as intonation and body movement. Apart from subtitling technicalities, the difficulties of swearword translation are also impeded by their explicit and implicit forms, as well as the linguistic-cultural differences in source-target texts. This study aims to deliberate on the Malay translation of English swearwords of ‘fuck’ and ‘shit’ in two episodes of Netflix TV series The History of Swearwords.Methods: To this end, it employs a comparative and descriptive analysis by developing a parallel corpus by utilising AntConc and AntPConc software. The selection of Netflix posits no local law or policy restrictions and censorship.Results: The comparative analysis found a linkup between creative and formal subtitling of the swearwords, which signals a prevalent pragmatic and cultural foundation in the translation, especially vis-à-vis the deletion and neutralisation procedures. The study also raises other notable concerns, such as the identification and semantic comprehension of swearwords by the series subtitlers.Conclusions: Overall, the study posits that the socio-pragmatic factors, among others are still central for the English-Malay translation strategies of the swearwords in maintaining both linguistic accuracy and cultural appropriateness for target audience

My body my choice: The hostile appropriation of feminist cultural memory in American anti-vaccine movements.

This article discusses how the reproductive rights slogan 'my body my choice' - which functions as a carrier of feminist cultural memory - was weaponised when it gained traction in anti-vaccine movements that appropriated it. During the global Covid-19 pandemic, transnationally coordinated groups associated with the far right and characterised by nationalist and pro-life values started using the protest slogan to politicise their resistance to local lockdown restrictions and vaccine and mask mandates. The article shows that their use of the slogan was a hostile form of mnemonic appropriation and analyses the discursive mechanisms used to discredit the reproductive rights movement. It demonstrates that when slogans become carriers of cultural memory, they can be used in claim-making by movements on opposing sides of the political spectrum. It concludes that protest memories can be used politically both in the advancement of social movement causes as well as in the backlash against those causes.

Injury risks for different road users in Nepal: a secondary analysis of routinely collected crash data

Background Road traffic injuries are the 12th leading cause of mortality globally. Nepal, one of the least developed countries in the world, has a rapidly rising rate of road traffic-related morbidity and mortality. There is incomplete reporting of traffic crashes in Nepal in the last three World Health Organization global status reports on road safety. Together with poor-quality coding of crashes, essential information to inform prevention interventions or make international comparisons is lacking. Objectives The study aimed to critically analyse routinely collected traffic police data in Makwanpur district, Nepal, to identify the road user groups most likely to be involved and injured in traffic crashes in this part of the country. Design Secondary data analysis. Setting Makwanpur district, Nepal. Data sources Road traffic crash records from the District Traffic Police Office, Makwanpur, over 2 years (April 2017–March 2018 and May 2019–April 2020). Data were extracted from paper-based records onto an electronic database, and the data were analysed descriptively using the Statistical Package for the Social Sciences version 24.0 (IBM Corporation, USA). Results There were 291 crashes recorded in 2017–8 and 435 crashes in 2019–20. Two-wheeled vehicles (motorcycles/scooters) were the most frequently involved in police-reported crashes (35.5%). For most crashes (419/726, 58%), no cause was documented in the police record. Road users involved in crashes were mostly riders or passengers of motorised two-/three-wheelers (33.4%), four-wheeled vehicles (19.9%) or buses (16.7%). Of fatal injuries, 31.2% were riders or passengers of motorised two-/three-wheelers, and 24.8% were pedestrians. Limitations The data used represent crashes reported to the traffic police and therefore underestimate the true number of crashes and injuries. At the end of the second period of study, local movement restrictions associated with the COVID-19 pandemic lockdown limited the traffic on the roads, resulting in fewer crashes in March and April 2020. In most crash records, there were missing data, limiting the ability to determine contributory factors with confidence. Conclusion This study contributes to the evidence gap by describing crashes and mortality data by vehicle type and road user category. The findings suggest that the number and rates of crashes may be increasing over time. Action to improve the quality and completeness of data routinely collected by the traffic police is needed; a piloted web-based Road Accident Information Management System has the potential to support improved routine data collection. Future work The data indicate crashes occurring in one district over 2 years. To better understand the apparent increase in crashes, an analysis over a longer period, and over multiple districts, would be necessary. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 16/137/49.

Exploring infectious disease spread as a function of seasonal and pandemic-induced changes in human mobility.

Community-level changes in population mobility can dramatically change the trajectory of any directly-transmitted infectious disease, by modifying where and between whom contact occurs. This was highlighted throughout the COVID-19 pandemic, where community response and nonpharmaceutical interventions changed the trajectory of SARS-CoV-2 spread, sometimes in unpredictable ways. Population-level changes in mobility also occur seasonally and during other significant events, such as hurricanes or earthquakes. To effectively predict the spread of future emerging directly-transmitted diseases, we should better understand how the spatial spread of infectious disease changes seasonally, and when communities are actively responding to local disease outbreaks and travel restrictions. Here, we use population mobility data from Virginia spanning Aug 2019-March 2023 to simulate the spread of a hypothetical directly-transmitted disease under the population mobility patterns from various months. By comparing the spread of disease based on where the outbreak begins and the mobility patterns used, we determine the highest-risk areas and periods, and elucidate how seasonal and pandemic-era mobility patterns could change the trajectory of disease transmission. Through this analysis, we determine that while urban areas were at highest risk pre-pandemic, the heterogeneous nature of community response induced by SARS-CoV-2 cases meant that when outbreaks were occurring across Virginia, rural areas became relatively higher risk. Further, the months of September and January led to counties with large student populations to become particularly at risk, as population flows in and out of these counties were greatly increased with students returning to school.

Sexually Transmitted Infections in Italian Young and Adult People: A Worrying Positive Trend Hidden by COVID-19 Epidemic.

Recent European data show an increase in sexually transmitted infections (STIs), particularly N. gonorrhoeae, among young heterosexuals, surpassing pre-pandemic numbers. Italy's varied local health restrictions during the COVID-19 pandemic likely affected STI management and reporting. To evaluate COVID-19's impact on STI spread in Italy, we analyzed microbiological data from before and during the pandemic in an area with minimal restrictions on clinical services. This retrospective study (2017-2022) included 5503 subjects: 2586 from STI clinics (STD group) and 3687 diagnosed with primary infertility (ART group). Samples were tested for Mycoplasmas/Ureaplasmas, C. trachomatis, N. gonorrhoeae, and T. vaginalis by a multiplex PCR. During the pandemic, overall STI prevalence increased significantly (p < 0.01). U. parvum was the most frequent microorganism in the STD group (26.1% vs. 23.9%), with a notable increase in women (52.1% vs. 32.7%) (p < 0.001). C. trachomatis and M. hominis positive rates decreased significantly (p < 0.001 and p < 0.01, respectively). N. gonorrhoeae cases rose among young people (19-29), predominantly heterosexual, with high ciprofloxacin resistance. In the ART group, U. parvum was the most common infection, particularly in young infertile women (p = 0.01). This study indicates a notable rise in STIs among young people, including heterosexuals, despite social restrictions. The long-term impact of this trend requires further evaluation.

Who Benefits? A Mixed Methods Study Assessing Community Use of a Major Metropolitan Park During the COVID-19 Pandemic.

By providing spaces for recreation, physical activity, social gatherings, and time in nature, urban parks offer physical, mental, and social benefits to users. However, many urban residents face barriers to park use. The COVID-19 pandemic introduced new potential barriers to urban park access and use, including changes to daily life and employment, closure of park amenities and restrictions to public movement, and risk from the coronavirus itself. The mixed-methods PARCS study measured use and perceptions of a large urban park in St. Louis, Missouri before, during, and after local COVID-19 contingency measures and restrictions. We examine data from 1,157 direct observation assessments of park usership, an online survey of park users (n=561), interviews with key stakeholders (n=27), four focus groups (n=30), and a community-based participatory research sub-study (n=66) to comprehensively characterize the effects of the COVID-19 pandemic on park use. Park users who felt unsafe from the coronavirus experienced 2.65 higher odds of reducing park use. However, estimated park visits during COVID-19 contingency measures (n=5,023,759) were twice as high as post-contingency (n=2,277,496). Participants reported using the park for physical activity, recreation, time in nature, and socializing during the contingency period. Black, Hispanic/Latino, and young people were less likely to visit the park than others, suggesting an additional, disproportionate impact of the pandemic on minoritized and socioeconomically disadvantaged communities. This study highlights the role of public spaces like parks as resources for health and sites where urban health inequities can be alleviated in times of public crisis.

Cycles of length 3 and 4 in edge-colored complete graphs with restrictions in the color transitions

Let G be a graph and H a graph possibly with loops. We will say that a graph G is an H-colored graph if and only if there exists a function c:E(G)⟶V(H)\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$c:E(G)\\longrightarrow V(H)$$\\end{document}. A cycle (v1,…,vk,v1)\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$(v_1,\\ldots ,v_k,v_1)$$\\end{document} is an H-cycle if and only if (c(v1v2),…,c(vk-1vk),\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$(c(v_1 v_2),\\ldots ,c(v_{k-1}v_k),$$\\end{document}c(vkv1),c(v1v2))\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$c(v_kv_1), c(v_1 v_2))$$\\end{document} is a walk in H. Whenever H is a complete graph without loops, an H-cycle is a properly colored cycle. In this paper, we work with an H-colored complete graph, namely G, with local restrictions given by an auxiliary graph, and we show sufficient conditions implying that every vertex in V(G) is contained in an H-cycle of length 3 (respectively 4). As a consequence, we obtain some well-known results in the theory of properly colored walks.

A Prospective Quality Improvement Program to Reduce Prolonged Postoperative Antibiotic Prophylaxis in Ethiopia.

Introduction: Although postoperative antibiotic prophylaxis has not been shown to prevent surgical site infections, prolonged antibiotic administration is common in low- and middle-income countries. We developed a quality improvement program to reduce unnecessary postoperative antibiotics through hospital-specific guideline development and the use of a brief, multidisciplinary discussion of antibiotic indication, choice, and duration during clinical rounds. We assessed reduction in the number of patients receiving ≥24 h of antibiotic prophylaxis after clean and clean-contaminated surgery. Methods: We piloted the program at a referral hospital in Ethiopia from February to September 2023. After a 6-week baseline assessment, multidisciplinary teams adapted international guidelines for surgical prophylaxis to local disease burden, medication availability, and cost restrictions; stakeholders from surgical departments provided feedback. Surgical teams implemented a "timeout" during rounds to apply these guidelines to patient care; compliance with the timeout and antibiotic administration was assessed throughout the study period. Results: We collected data from 636 patients; 159 (25%) in the baseline period and 477 (75%) in the intervention period. The percentage of patients receiving ≥24 h of antibiotic prophylaxis after surgery decreased from 50.9% in the baseline period to 40.9% in the intervention period (p = 0.027) and was associated with a 0.5 day reduction in postoperative length of stay (p = 0.047). Discussion: This antibiotic stewardship pilot program reduced postoperative antibiotic prophylaxis in a resource-constrained setting in Sub-Saharan Africa and was associated with shorter length of stay. This program has the potential to reduce unnecessary antibiotic use in this population.

A chromatic vanishing result for TR

In this note, we establish a vanishing result for telescopically localized topological restriction homology TR. More precisely, we prove that T ( k ) T(k) -local TR vanishes on connective L n p , f L_n^{p,f} -acyclic E 1 \mathbb {E}_1 -rings for every 1 ≤ k ≤ n 1 \leq k \leq n and deduce consequences for connective Morava K-theory and the Thom spectra y ( n ) y(n) . The proof relies on the relationship between TR and the spectrum of curves on K-theory together with fact that algebraic K-theory preserves infinite products of additive ∞ \infty -categories which was recently established by Córdova Fedeli [Topological Hochschild homology of adic rings, Ph.D. thesis, University of Copenhagen, 2023].

Balanced Federated Semisupervised Learning With Fairness-Aware Pseudo-Labeling.

Federated semisupervised learning (FSSL) aims to train models with both labeled and unlabeled data in the federated settings, enabling performance improvement and easier deployment in realistic scenarios. However, the nonindependently identical distributed data in clients leads to imbalanced model training due to the unfair learning effects on different classes. As a result, the federated model exhibits inconsistent performance on not only different classes, but also different clients. This article presents a balanced FSSL method with the fairness-aware pseudo-labeling (FAPL) strategy to tackle the fairness issue. Specifically, this strategy globally balances the total number of unlabeled data samples which is capable to participate in model training. Then, the global numerical restrictions are further decomposed into personalized local restrictions for each client to assist the local pseudo-labeling. Consequently, this method derives a more fair federated model for all clients and gains better performance. Experiments on image classification datasets demonstrate the superiority of the proposed method over the state-of-the-art FSSL methods.

Neural network adaptive switched fault-tolerant control of uncertain nonlinear systems with full state constraints

This paper studies the neural network adaptive fault-tolerant control (NNAFTC) for a class of uncertain nonlinear systems with full state constraints. It is the first time to introduce switched adaptive fault compensation strategy for the controller design process. On the one hand, the proposed method overcomes the limitation needed to be given a prescribed local restriction region of the traditional state constraint schemes, such as log-type, tan-type and integral-type. On the other hand, the full-state constraint and switched fault-tolerant problem is effectively solved even if the existence of actuator failures. Concomitantly, the novel switched tuning functions, the NN approximation technique and the integral barrier Lyapunov functions (IBLF) are combined to construct the backstepping controllers and adaptation laws. It can be proved that all the closed-loop states are restricted in the proper compact sets for any given initial values. Finally, A simulation is shown to demonstrate the validity and advantages of the presented control approach.

Local restrictions, population movement, and spillovers during the pandemic: Evidence from Japan's restaurant restriction.

We investigate how a local restaurant restriction aimed at containing the COVID-19 pandemic influenced population movement and COVID-19 prevalence within and outside the restricted districts. Using data on restaurant location and hourly population at the 500-m-mesh level and on COVID-19 prevalence at both prefecture and municipality level in Japan, we employ a triple-difference approach and a difference-in-differences approach with fixed effects. While the policy decreased population movement to restaurant areas in the restricted districts, it caused spillovers of increasing population movement to restaurant areas in the neighboring nonrestricted districts. Consequently, COVID-19 prevalence worsened in the neighboring nonrestricted districts but improved in the restricted districts. Our findings suggest that imposing such local restrictions in the context of the pandemic may contain the pandemic only in the restricted districts while sacrificing economic activities within these districts and public health in neighboring nonrestricted districts.

Identification in general equilibrium

This survey covers the developments in the theory of the recoverability of unobserved fundamentals from observable variables in general equilibrium models. Concretely, suppose one observes equilibrium prices that vary with the profiles of individual endowments. What inferences can be made about individuals’ preferences? What are the local restrictions on the map, from profiles of endowments to prices? Suppose one only has finitely many observations. What inferences about individuals’ preferences can be made as the number of observations becomes large?

EFFECTS OF THE COVID-19 PANDEMIC ON INGUINAL HERNIA SURGERY IN A SINGLE CENTER IN PORTUGAL: ANALYSIS OF EMERGENCY CASES AND TREATMENT PATTERNS

Abstract Background The COVID-19 pandemic triggered substantial shifts in healthcare priorities, redirecting resources to address unprecedented emergency needs. Concerns about how COVID-19 might affect surgical outcomes prompted our investigation, given the complex interplay of factors across diverse healthcare settings. Our study sought to understand the impact of emergency declarations on the treatment of inguinal hernias, examining changes in elective versus emergent surgeries, as well as variations in surgical techniques and care settings. Method Analyzing five years of data (2019–2023) from a single institution in Almada, Portugal, we collected demographic and procedural information, comparing patients treated during the pandemic's confinement period (March 18, 2020, to April 30, 2021) with those treated before and after this period. Results Of the 1764 identified patients, 1004 underwent surgery elsewhere, leaving 760 for analysis. While only 2.9% required emergency surgery, some elective cases were labeled as "delayed urgencies" or "high priority," suggesting potential influences of emergencies on elective treatment decisions. Before the pandemic, 4.3% underwent emergency surgery, dropping to 1.1% during the emergency period, and rising to 3.1% afterward, though these changes lacked statistical significance. Laparoscopic surgeries increased gradually, while ambulatory procedures decreased, likely due to local restrictions rather than COVID-19. Conclusion Our findings echo previous research indicating a decrease in emergency surgeries contrary to expectations. However, data biases may exist, highlighted by an uptick in patients receiving surgery within 15 days, possibly reflecting shifts in healthcare accessibility rather than direct COVID-19 effects.

The advancement of artificial intelligence in biomedical research and health innovation: challenges and opportunities in emerging economies

The advancement of artificial intelligence (AI), algorithm optimization and high-throughput experiments has enabled scientists to accelerate the discovery of new chemicals and materials with unprecedented efficiency, resilience and precision. Over the recent years, the so-called autonomous experimentation (AE) systems are featured as key AI innovation to enhance and accelerate research and development (R&D). Also known as self-driving laboratories or materials acceleration platforms, AE systems are digital platforms capable of running a large number of experiments autonomously. Those systems are rapidly impacting biomedical research and clinical innovation, in areas such as drug discovery, nanomedicine, precision oncology, and others. As it is expected that AE will impact healthcare innovation from local to global levels, its implications for science and technology in emerging economies should be examined. By examining the increasing relevance of AE in contemporary R&D activities, this article aims to explore the advancement of artificial intelligence in biomedical research and health innovation, highlighting its implications, challenges and opportunities in emerging economies. AE presents an opportunity for stakeholders from emerging economies to co-produce the global knowledge landscape of AI in health. However, asymmetries in R&D capabilities should be acknowledged since emerging economies suffers from inadequacies and discontinuities in resources and funding. The establishment of decentralized AE infrastructures could support stakeholders to overcome local restrictions and opens venues for more culturally diverse, equitable, and trustworthy development of AI in health-related R&D through meaningful partnerships and engagement. Collaborations with innovators from emerging economies could facilitate anticipation of fiscal pressures in science and technology policies, obsolescence of knowledge infrastructures, ethical and regulatory policy lag, and other issues present in the Global South. Also, improving cultural and geographical representativeness of AE contributes to foster the diffusion and acceptance of AI in health-related R&D worldwide. Institutional preparedness is critical and could enable stakeholders to navigate opportunities of AI in biomedical research and health innovation in the coming years.

On the existence of cycles with restrictions in the color transitions in edge-colored complete graphs

Consider the following edge-coloring of a graph G. Let H be a graph possibly with loops, an H-coloring of a graph G is defined as a function c:E(G)→V(H).\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$c : E(G) \\rightarrow V(H).$$\\end{document} We will say that G is an H-colored graph whenever we are taking a fixed H-coloring of G. A cycle (x0,x1,…,xn,x0),\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$(x_0,x_1,\\ldots ,x_n,x_0),$$\\end{document} in an H-colored graph, is an H-cycle if and only if (c(x0x1),c(x1x2),…,c(xnx0),\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$(c(x_0x_1),c(x_1x_2),\\ldots , c(x_nx_0),$$\\end{document}c(x0x1))\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$c(x_0x_1))$$\\end{document} is a walk in H. Notice that the graph H determines what color transitions are allowed in a cycle in order to be an H-cycle, in particular, when H is a complete graph without loops, every H-cycle is a properly colored cycle. In this paper, we give conditions on an H-colored complete graph G, with local restrictions, implying that every vertex of G is contained in an H-cycle of length at least 5. As a consequence, we obtain a previous result about properly colored cycles. Finally, we show an infinite family of H-colored complete graphs fulfilling the conditions of the main theorem, where the graph H is not a complete k-partite graph for any k in N.\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathbb {N}}.$$\\end{document}

A Retrospective Analysis of Indoor CO2 Measurements Obtained with a Mobile Robot during the COVID-19 Pandemic.

This work presents a retrospective analysis of indoor CO2 measurements obtained with a mobile robot in an educational building after the COVID-19 lockdown (May 2021), at a time when public activities resumed with mandatory local pandemic restrictions. The robot-based CO2 measurement system was assessed as an alternative to the deployment of a net of sensors in a building in the pandemic period, in which there was a global stock outage of CO2 sensors. The analysis of the obtained measurements confirms that a mobile system can be used to obtain interpretable information on the CO2 levels inside the rooms of a building during a pandemic outbreak.

Constrained Local Approximate Ideal Restriction for Advection-Diffusion Problems

Constrained Local Approximate Ideal Restriction for Advection-Diffusion Problems

It's Not Just: Evaluation of a Media Campaign to Motivate Action Around Targeting of Menthol Tobacco in Black Communities.

For more than 60 years, tobacco companies have aggressively marketed menthol tobacco products in Black communities. In 2021, New York State Department of Health-funded grantees launched a media campaign aimed toward civically engaged New York adults to educate and mobilize community action to prevent targeted marketing of menthol tobacco. This study examined audience reactions to the campaign and associations between campaign awareness and key outcomes. Following campaign implementation, we administered 2 online, cross-sectional surveys to 2,000 civically engaged New York adults to assess campaign awareness, audience reactions, and campaign-related attitudes and behaviors. We examined sociodemographic differences in audience reactions and assessed multivariate associations between campaign awareness and key outcomes. Overall, 40% of respondents were aware of the campaign. Perceived advertisement (ad) effectiveness was higher among Black, Hispanic, and nonsmoking respondents and those aware of the campaign. Negative reactions to ads were higher at wave 1, among non-Hispanic White and male respondents, and among current smokers. Campaign awareness was positively associated with campaign-related beliefs. The association between campaign awareness and support for a menthol ban varied by survey wave and race, with positive associations at wave 2 and among non-Hispanic White respondents only. Among wave 2 respondents only, campaign awareness was positively associated with actions to reduce the targeting of menthol in Black communities. Media campaigns can play an important role in raising awareness of menthol tobacco product targeting in Black communities and building public support for local and statewide menthol restrictions that may be implemented before federal product standards are in place.

Paliperidone LAI-Induced Leukocytopenia: A Case Report

IntroductionAntipsychotics effectively manage psychotic symptoms but may have side effects. Patients with schizophrenia often lack insight into their condition, leading to nonadherence. Long-acting injectable (LAI) antipsychotics aim to overcome this, reducing relapse risks. Paliperidone LAI, a second-generation antipsychotic, has a lower side effect profile when compared to first-generation counterparts. Blood dyscrasias, like neutropenia and lymphopenia, increase infection susceptibility. This case report describes an instance of leukocytopenia arising during paliperidone LAI treatment, which quickly resolved after the discontinuation of the medication.ObjectivesThis case report describes an instance of leukocytopenia arising during paliperidone LAI treatment, which quickly resolved after the discontinuation of the medication.MethodsResultsCASEA 42-year-old female with schizophrenia, nonadherent to previously prescribed medication was admitted to our acute psychiatric department. She experienced positive symptoms (paranoid delusions), as well as disorganized thinking and behavior. Oral risperidone 4 mg two times a day was recommenced and titrated with mild improvement in her psychotic symptoms with the idea of switching to paliperidone LAI and eventually ceasing oral medication. Oral paliperidone was unavailable for prescription due to local restrictions. At admission her routine laboratory tests showed no abnormalities, but 5 days after receiving paliperidone LAI, routine laboratory tests showed a strong decrease in her WBC and absolute neutrophilic and lymphocytic count ( Lkc 2.89x109/L, Neut 1.57x 109/L, Lym 0.88x 109 /L ). Antipsychotic-induced blood dyscrasia was suspected and paliperidone depot was discontinued. The patient had rapid improvement in her WBC reaching the reference range in 10 days ( Lkc 4.23 x 109/L, Neut 2.51x10 9/L, Lym 0.98x 109/L). Sertindole was introduced consdering her history of a good therapeutic response to the drug, with improvement in psychotic symptoms. She is currently stable taking sertindole 16 mg/day, clonazepam 2 mg/day and alprazolam 0.5 mg/day.DISCUSSIONThe onset of neutropenia and lymphopenia post-paliperidone LAI initiation, resolving in 10 days,, indicate a direct association. Few cases report to date describe paliperidone-induced leukocytopenia, with rapid recovery post-discontinuation. Proposed mechanisms include bone marrow suppression and peripheral WBC destruction. It has been proposed that drug-induced neutropenia is often dose-dependent, which could explain why our patient exhibited tolerability to risperidone but developed cytopenia upon transitioning to depot paliperidone.ConclusionsWhile cases of agranulocytosis have been reported in association with the use of other antipsychotics these antipsychotics do not require the same monitoring as clozapine. Our case emphasizes the need for vigilant blood dyscrasia monitoring during antipsychotic therapy.Disclosure of InterestNone Declared