Respiratory Issues Research Articles

Assessing the impact of natural ventilation on indoor air quality and CO2 concentration in residential apartments

This study investigates the impact of natural ventilation on indoor air quality (IAQ) and CO₂ concentration in residential buildings in Dhaka, Bangladesh, focusing on kitchen environments. Poor IAQ, particularly elevated CO₂ levels, poses significant health risks, including respiratory issues and cognitive impairments. In Dhaka, inadequate ventilation exacerbates these issues, especially in kitchens where cooking activities generate pollutants like CO₂ and particulate matter. The study aims to assess how variations in window size and ventilation influence CO₂ levels in kitchens and compare CO₂ concentrations before and after cooking. Additionally, it explores natural ventilation strategies to enhance IAQ in residential apartments. Using an experimental approach, CO₂ levels were monitored in various kitchens and living rooms over a one-week period, employing HOBO CO₂ sensors and temperature-humidity loggers. Cooking activities like grilling, frying, and boiling were analyzed to determine the effect on CO₂ concentrations. Results showed that CO₂ levels significantly increased during cooking, with kitchens exhibiting the highest concentrations. Notably, open windows contributed to lower CO₂ levels, particularly in living rooms and dining areas, emphasizing the role of natural ventilation. However, kitchens still experienced substantial CO₂ buildup, indicating the need for additional ventilation solutions. The study concludes that while open windows improve IAQ, enhanced ventilation systems and strategic airflow management are essential to reduce CO₂ levels and ensure healthier living environments in residential buildings.

Work Related Health Problems and Healthcare Seeking Among Tea Garden Worker

Background: Tea, derived from the Camellia sinensis plant, is a globally consumed beverage with a rich history. Despite its widespread production, smaller gardens produce unique teas highly valued by enthusiasts. The tea industry in Bangladesh, particularly in Sylhet, plays a pivotal role in the economy but is plagued by challenges such as work-related health issues among its predominantly marginalized and tribal labor force. This study aimed to explore the health and lifestyle challenges faced by tea workers in Sylhet. Methods: A cross-sectional study was conducted in three tea gardens in Sylhet, focusing on socio-demographic characteristics, work-related health problems, and healthcare-seeking behaviors. Data were collected from 255 participants using a semi-structured questionnaire, and statistical analyses, including Chi-Square test, were performed using SPSS version 26. Results: The socio-economic profile revealed a predominantly female, Hindu, and illiterate workforce with low income. Musculoskeletal disorders (MSDs) were prevalent, affecting 77.6% of participants, with lower back pain being the most common. Common diseases, injuries, and respiratory issues were reported. Allopathic treatment was preferred by 78% of respondents. Significant associations were found between MSDs and age, education, smoking, and drug use. Job-related factors like nature of work and weekly working hours also showed significant associations (p<0.05). Conclusion: The study highlights the multifaceted challenges faced by tea garden workers, emphasizing the need for targeted interventions considering socio-demographic and occupational factors. Insights from this research can inform policies and healthcare strategies to improve the well-being of this vulnerable population. Further research and collaborative efforts are warranted to address the complexities of the tea industry and promote the health and rights of its workforce. JOPSOM 2023; 42(2): 36-42

Use of the structured emergency nursing framework HIRAID® improves patient experience: A stepped-wedge cluster randomised control trial in rural, regional and metropolitan Australia.

Emergency departments have high levels of uncertainty, long wait times, resource shortages, overcrowding and a constantly changing environment. Patient experience and patient safety are directly linked, yet levels of patient experience are stagnant. To improve emergency nursing care and patient experience, an emergency nursing framework HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) was implemented in 29 Australian emergency departments. To evaluate HIRAID® on patient experience in the emergency department. This modified stepped-wedge cluster randomised control trial was conducted in 29 Australian rural, regional and metropolitan emergency departments and involved over 1300 emergency nurses. A total 2704 (1456 control, 1248 intervention) surveys were completed. We hypothesised implementation of HIRAID® would result in an at least 5% increase in patient experience per Schmidt's Perceptions of Nursing Care Survey and Australian Hospital Patient Experience Question Set. Patients (of all ages) and/or their carers completed a phone interview. Data were analysed using descriptive statistics and Generalized Estimating Equations approaches. Median (IQR) participant age was 54 (31-67) years. The most common presenting problems were abdominal, chest and respiratory issues. Greater than 5% improvement in all categories of the Schmidt's Perceptions of Nursing Care Survey, and 10 out of 12 Australian Hospital Patient Experience Question Set was achieved. The implementation of the HIRAID® emergency nursing framework in Australian emergency departments significantly improved patient experience with emergency care. Demand for emergency care is increasing. Evaluating what methods work to effectively translate evidence to emergency practice, improve patient experience in the complex emergency setting is crucial. We present how a behaviour change informed implementation strategy enabled maximum, sustained uptake of an intervention that improved patient experience in a variety of emergency settings despite the COVID-19 pandemic and catastrophic flooding. ANZCTR, ACTRN12621001456842. 25.10.2021.

CFAP65 is essential for C2a projection integrity in axonemes: implications for organ-specific ciliary dysfunction and infertility

Defects in motile cilia and flagella lead to motile ciliopathies, including primary ciliary dyskinesia (PCD), which manifests as multi-organ dysfunction such as hydrocephalus, infertility, and respiratory issues. CFAP65 variants are a common cause of male infertility, but its localization and function have remained unclear. In this study, we systematically evaluated CFAP65’s role using Cfap65 knockout mice and human patients with CFAP65 variants. The knockout mice displayed severe sperm flagellar defects (MMAF), high hydrocephalus incidence, but no significant impact on respiratory cilia. Similarly, the patients exhibited MMAF and infertility without respiratory symptoms. CFAP65 was found to anchor at the base of the C2a projection of the axoneme, interacting with proteins such as CFAP70 and MYCBPAP. Loss of CFAP65 caused disorganization of the sperm head-shaping microtubule structure and impaired protamine precursor removal, leading to nuclear condensation defects and poor assisted reproductive outcomes. Importantly, the assembly of CFAP65 was unaffected in mice with defects in the radial spokes (RSs) and nexin-dynein regulatory complex (N-DRC), indicating that CFAP65 assembly is independent of these components. However, CFAP65 deficiency led to the disintegration of the C2a projection, compromising ciliary and flagellar integrity. These findings establish CFAP65 as an essential component of the C2a projection, critical for the structure and function of sperm flagella and ependymal cilia, but not respiratory cilia, underscoring the organ-specific consequences of C2a projection defects in PCD.Graphical abstract

Indoor air quality and human health risk assessment in selected high-altitude villages of Gilgit-Baltistan, Pakistan.

This research marks the inaugural endeavor in Gilgit-Baltistan (GB) to identify the primary sources of household energy and indoor air pollutants (IAPs) during the winter and additionally, to evaluate the health impacts associated with IAPs within specific high-altitude communities in Gilgit-Baltistan, Pakistan. Using the convenience sampling method, 20 households were continuously monitored to assess IAPs based on standards time-weighted average. The study found that 90% of the population relied primarily on animal dung as their main energy source, with wood, agricultural residues, electricity, and gas as other sources. The average levels of PM2.5 were five times greater, and CO levels were three times higher than the National Environmental Quality Standards (NEQS). Among the samples examined, 65% of homes were found to have inadequate ventilation and did not comply with ASHRAE standards for living rooms. Households using animal dung and wood as fuel showed elevated PM2.5 and CO levels. Health data indicated increased winter illness, with high rates of respiratory and cardiovascular issues such as morning cough (17%), eye irritation (15%), bronchitis (14%), wheezing (13%), chest tightness (12%), heart disease (11%), morning phlegm (10%), and shortness of breath (8%). The findings indicate that socioeconomic and geographic factors play a significant role in choosing solid fuels. Recommendations include raising awareness of stove maintenance and the harmful impacts of IAPs and proper ventilation, promoting cleaner fuels, and upgrading heating systems. The government should provide health screenings and subsidies for cleaner energy such as hydropower, LPG, and solar power, reducing reliance on dung and wood, and improving health in high-altitude communities.

Altered immune surveillance of B and T cells in patients with persistent residual lung abnormalities 12 months after severe COVID-19

BackgroundPost-COVID-19 respiratory sequelae often involve lung damage, which is called residual lung abnormalities, and potentially lead to chronic respiratory issues. The adaptive immune response, involving T-cells and B-cells, plays a critical role in pathogen control, inflammation, and tissue repair. However, the link between immune dysregulation and the development of residual lung abnormalities remains unclear.Methods109 patients discharged with residual lung abnormalities after a critical COVID-19 were followed for 12 months and divided as full recovery patients (FRG, n = 88) and persistent lung abnormalities (PLAG, n = 21). Cell profiling analysis was done using flow cytometry at 24 h of not antigen-specific in vitro stimulation. Plasma or supernatant levels of IFN-g, IL-4, IL-10, IgM, and IgG were assessed, and 10 patients (5 FRG, 5 PLAG) were randomly selected for detailed immune cell phenotyping and functional analysis of peripheral blood mononuclear cells using flow cytometry.ResultsCompared to the FRG group, PLAG exhibited an increase of unswitched (p = 0.0159) and decreased double-negative activated B-cells (p = 0.0317), systemic IL-10 levels were lower, displayed reduced frequency of total B-cells, and impaired spontaneous IgM (p = 0.0357) and IgG (p = 0.0079) release in culture. Regarding T-cells, PLAG patients showed a reduction in effector memory CD4 + cells (p = 0.0159) and an increase in CD4 + TEMRA cells (p = 0.0079) following in vitro stimulation. Notably, the PLAG group also exhibited higher frequencies of central memory CD4 + Th2 (GATA3+) T-cells in response to activation than the FRG group (p = 0.0079).ConclusionsPatients with residual lung abnormalities 12 months post-critical COVID-19 exhibit impaired B-cell function, increased unswitched B-cells, and higher frequencies of CD4 + TEMRA T-cells following in vitro activation. These immune imbalances may contribute to ongoing lung dysfunction and warrant further investigation as a potential mechanism in residual lung abnormalities. Larger studies are necessary to confirm these findings.

Subcutaneous Pectoral Edema After Arthroscopic Labral Repair Despite Normal Irrigation Fluid Usage and Surgery Duration.

Edema after shoulder arthroscopic surgery poses concerns due to its potential complications such as compartment syndrome, nerve damage, and respiratory issues. This study aimed to investigate the acute accumulation of subcutaneous fluid after shoulder arthroscopy. A prospective cohort study, providing Level III evidence was conducted on 50 patients undergoing arthroscopic shoulder surgery under interscalene block anaesthesia from September to December 2023. The patients were divided into two groups: rotator cuff repair (RCR, n = 29) and labral repair for shoulder instability (LR, n = 21). Subcutaneous fluid levels were measured preoperatively, postoperatively, and at discharge (24 h postsurgery) using the MoistureMeterD Compact at the neck, pectoral region, deltoid area, cubital fossa, and carpal tunnel. Data on surgery duration and irrigation fluid volume were documented. In the statistical analysis, repeated measures ANOVA and the independent-samples t-test were applied to compare parametric data, while the Friedman test and Mann-Whitney U test were used for nonparametric data. The average operation time was 29.0 ± 12.1 min for RCR and 30.0 ± 10.9 min for LR, with average irrigation fluid use of 3.8 ± 0.9 and 4.0 ± 0.7 L, respectively (both p > 0.05). There was no increase in subcutaneous edema in the neck and deltoid region in both groups. At discharge, the percentage of subcutaneous fluid increased in the cubital fossa (p = 0.04 for RCR; p < 0.001 for LR) and carpal tunnel (both p < 0.001) in oth groups, whereas pectoral edema increased only in the labral repair group (p = 0.04). Subcutaneous pectoral edema can occur following arthroscopic labral repair, and increased fluid levels in the cubital fossa and carpal tunnel were observed in both rotator cuff and labral repairs, even in the absence of prolonged surgery or excessive irrigation fluid use. These findings highlight the need for careful postoperative management of edema after shoulder arthroscopy, particularly for labral repairs, with special attention to the pectoral region, cubital fossa, and carpal tunnel to prevent potential complications. The registry is sponsored by the United States National Library of Medicine (www. gov); Registry Name: Examination of Edema After Arthroscopic Shoulder Surgery ID: NCT06014203.

FHIR PIT: a geospatial and spatiotemporal data integration pipeline to support subject-level clinical research

BackgroundEnvironmental exposures such as airborne pollutant exposures and socio-economic indicators are increasingly recognized as important to consider when conducting clinical research using electronic health record (EHR) data or other sources of clinical data such as survey data. While numerous public sources of geospatial and spatiotemporal data are available to support such research, the data are challenging to work with due to inconsistencies in file formats and spatiotemporal resolutions, computational challenges with large file sizes, and a lack of tools for patient- or subject-level data integration.ResultsWe developed FHIR PIT (HL7® Fast Healthcare Interoperability Resources Patient data Integration Tool) as an open-source, modular, data-integration software pipeline that consumes EHR data in FHIR® format and integrates the data at the level of the patient or subject with environmental exposures data of varying spatiotemporal resolutions and file formats. We applied FHIR PIT to generate “integrated feature tables” containing patient- or subject-level EHR data integrated with environmental exposures data on two cohorts: one on patients with asthma and related common pulmonary disorders; and a second on patients with primary ciliary dyskinesia and related rare pulmonary disorders. The data were then exposed via the open Integrated Clinical and Environmental Exposures Service, which was then queried to explore relationships between exposures to two representative airborne pollutants (particulate matter and ozone) and annual emergency department or inpatient visits for respiratory issues. We found that hospitalizations for respiratory issues were more common among patients exposed to relatively high levels of particulate matter and ozone and were higher overall among patients with primary ciliary dyskinesia than among patients with asthma.ConclusionsOur manuscript describes a major release of FHIR PIT v1.0 and includes a technical demonstration use case and a clinical application on the use of FHIR PIT to support research on environmental exposures and health outcomes related to asthma and primary ciliary dyskinesia. For application of the tool to common data models (CDMs) other than FHIR, we offer open-source conversion tools to map from the PCORnet, i2b2, and OMOP CDMs to FHIR.

Long COVID in Children and Adolescents: Mechanisms, Symptoms, and Long-Term Impact on Health-A Comprehensive Review.

Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is increasingly recognized as a condition affecting not only adults but also children and adolescents. While children often experience milder acute COVID-19 symptoms compared to adults, some develop persistent physical, psychological, and neurological symptoms lasting for weeks or months after initial infection. The most commonly reported symptoms include debilitating fatigue, respiratory issues, headaches, muscle pain, gastrointestinal disturbances, and cognitive difficulties, which significantly impact daily activities, schooling, and social interactions. Additionally, many children with long COVID experience psychological symptoms, such as anxiety, depression, mood swings, and irritability, likely exacerbated by prolonged illness and lifestyle disruptions. Risk factors for long COVID in children include pre-existing health conditions such as asthma, obesity, and neurological disorders, with adolescents and females seemingly more affected. Hypothesized mechanisms underlying long COVID include chronic immune dysregulation, persistent viral particles stimulating inflammation, autonomic nervous system dysfunction, and mitochondrial impairment, which may collectively contribute to the variety of observed symptoms. Long-term outcomes remain uncertain; however, long COVID can lead to school absenteeism, social withdrawal, and psychological distress, potentially affecting cognitive development. Severe cases may develop chronic conditions such as postural orthostatic tachycardia syndrome (POTS) and reduced exercise tolerance. This review synthesizes the existing literature on long COVID in children, examining its prevalence, symptomatology, risk factors, and potential mechanisms, with an emphasis on the need for further clinical studies. While existing research largely relies on surveys and self-reported data, clinical assessments are essential to accurately characterize long COVID in pediatric populations and to guide effective management strategies.

Use of Antibiotics in Companion Animals from 133 German Practices from 2018 to 2023.

Background/Objectives: While antibiotic usage in farm animals has been systematically monitored and reduced in many countries, including Germany, data on companion animals such as dogs and cats remain scarce. To address this gap, a study was conducted in Germany to analyze patterns of antibiotic use in dogs and cats. Methods: Antibiotic usage data were obtained from debevet, a cloud-based veterinary practice management software based in Berlin, Germany. Practices with fewer than 100 patients were excluded, and data from 2018 to 2022 were analyzed. Results: The analysis included 477,310 consultations of 78,381 dogs and 241,532 consultations of 55,729 cats across 133 veterinary practices. Antibiotics were used in 12.9% of dog consultations and 22.5% of cat consultations, with substantial variation across practices. Aminopenicillins, particularly amoxicillin, were the most commonly used antibiotics, while the highest-priority critically important antibiotics (HPCIAs) accounted for 12.4% of treatments. Follow-up treatments led to changes in antibiotic substances in 9.3% of cases, often within the first two days. Indications varied by species, with respiratory issues more frequent in cats and orthopedic problems in dogs. Body weight and breed characteristics influenced the likelihood of antibiotic treatment, with short-nosed breeds showing higher odds. Conclusions: The routine data analysis provided valuable insights into antibiotic use in dogs and cats, enabling tracking trends across species and indications over time. While some specific information was missing, the invoicing data's completeness, the cost-effectiveness of their use, and their unbiased nature make them a robust tool for monitoring and informing legislative changes.

Investigating the effectiveness of whole-virus, protein-based, and vector-based SARS-CoV-2 vaccines on the rates of COVID-19 infection, hospitalization, and mortality: a historical cohort study in Iran

BackgroundEach of the Coronavirus disease 2019 (COVID-19) vaccines has its characteristics that can affect their effectiveness in preventing hospitalization and patient mortality. The present study aimed to determine the effectiveness of COVID-19 vaccines, including whole-virus, protein-based, and vector-based on COVID-19 infection, hospitalization, and mortality.MethodsThe current cohort study was conducted using the data of all people who received at least two doses of each type of COVID-19 vaccine from March 2020 to August 2022 in Khorasan Rzavi province. Quantitative data were characterized using measures of central tendency and dispersion, while the risks of infection, hospitalization, and mortality were assessed for each type of vaccine. Logistic regression was employed to evaluate the effect of various vaccine types on infection rate, hospitalization, and mortality while adjusting for other independent variables.ResultsIn this study, over 2 million vaccinated individuals had received at least two doses of the COVID-19 vaccine. Whole-virus vaccines, which had an infection rate of 3%, a hospitalization rate of 1.4%, and a mortality rate of 0.2%, were the most effective vaccines. The study also identified several factors associated with an increased risk of COVID-19 infection, hospitalization, and mortality, including kidney disease, cardiovascular disease, respiratory issues, age, sex, diabetes, olfactory dysfunction, fever, chills, body mass index (BMI), and the type of vaccine.ConclusionThis study highlights the substantial impact of COVID-19 vaccination in reducing infection, hospitalization, and mortality rates in Iran. The results support the use of whole-virus and vector-based vaccines as more effective options for preventing COVID-19 outcomes. The study also emphasizes the importance of considering various factors, including medical history and side effects, when evaluating the effectiveness of different vaccine types. The findings of this study can inform public health policy and vaccination strategies in Iran and other countries.

Surgical Treatment of Pectus Excavatum: The Boundary Between Pathologic and Aesthetic Need.

Background: Pectus excavatum, also known as sunken chest or funnel chest, is a structural deformity of the anterior chest wall, characterized by an inward sternum. This condition can lead to respiratory and cardiovascular issues, although it is often addressed for aesthetic reasons. This perspective article reviews the experiences of multiple centers in treating pectus excavatum, to explore whether a clear boundary exists between pathological and aesthetic needs. Methods: The research was conducted on PubMed, using the following targeted search queries to identify relevant studies: "pectus excavatum and surgery", and "pectus excavatum and conservative treatment." Additional searches were performed for articles related to the psychological and emotional state of patients with pectus excavatum. Results: Over 2000 articles related to the topic were identified in the literature. Only primary studies from the past 20 years were included, with a focus on centers reporting a minimum of 30 to 50 cases annually. Nearly 60% of these centers perform the Nuss procedure, exclusively. Major complications occurred in 1-2% of cases, particularly when the procedure was performed without videothoracoscopy. Post-surgery, improvements in lung function and exercise capacity were reported, along with significant reductions in depression and anxiety. Conclusions: The decision to pursue surgical correction of pectus excavatum requires a thorough evaluation of both therapeutic and aesthetic factors. A patient-centered approach, considering both the physical and emotional aspects of the condition, is essential for achieving the best possible outcome.

Polycyclic Aromatic Hydrocarbons (PAHs): Environmental Persistence and Human Health Risks

Polycyclic aromatic hydrocarbons (PAHs) are a class of organic compounds generated during the incomplete combustion of organic materials, such as coal, oil, and biomass. PAHs are highly persistent in the environment and pose significant health risks due to their genotoxic, mutagenic, and carcinogenic properties. This review provides an overview of PAH formation, environmental accumulation, and the main human exposure pathways, including inhalation, ingestion, and dermal contact. It highlights the toxicological effects of PAHs on various systems of the human body, such as the nervous, respiratory, reproductive, immune, and cardiovascular systems. Acute exposure to PAHs can cause symptoms such as eye irritation, nausea, vomiting, and diarrhea, while chronic exposure is associated with cancer, cardiovascular diseases, respiratory issues, and reproductive dysfunction. Although most research relies on animal studies, the findings suggest that PAHs may cause severe harm to humans through mechanisms like DNA damage. Due to the limitations of extrapolating animal-based studies to human health, future researches should more thoroughly explore the specific mechanisms by which PAHs affect human health to address the challenges posed by PAH pollution.

Traffic-related air pollutants (TRAP) in relation to respiratory symptoms among security guards

Traffic-related air pollutants (TRAP) comprises emissions from moving vehicles and secondary pollutants formed in the atmosphere. Security guards are among the outdoor workers exposed to TRAP pollutants, mainly particulate matter 2.5 (PM2.5), which can lead to chronic respiratory diseases. Occupational lung disease is a significant health concern in Malaysia, which, relatively little research on respiratory issues among Malaysian security personnel. The objective of this study is to evaluate the exposure level of TRAP PM2.5 and respiratory symptoms among security guards. The study utilized environmental monitoring to assess the concentration of TRAP PM2.5 and a questionnaire adopted from the American Thoracic Society Division of Lung Diseases questionnaire (ATS-DLD-78A) was administered to eligible respondents to observe symptoms of cough, phlegm, wheezing, and shortness of breath. Approximately 45% of the respondents reported experiencing cough as a respiratory symptom when exposed to high levels of TRAP PM2.5. Factors of smoking status and the number of cigarettes smoked per day have been identified as potential risk factors correlated with respiratory symptoms. Given this, implementing job rotations for security guards could minimize their exposure to pollutants over the long term, rather than solely focusing on raising awareness about the proper use of personal protective equipment.

Prediction of Non Invasive Ventilation Failure in Critically Ill COVID 19 Patients

Background: Non-invasive ventilation (NIV) is recognized as a practical and effective method for assisting selected patients with respiratory issues. The HACOR scoring system evaluates heart rate, acidosis, consciousness, oxygenation, and respiratory rate and has proven to be predictive of NIV failure in critically ill patients like COVID-19 patinets. Aim: To determine the predictibility of HACOR score to identify NIV failure early in patients with respiratory failure linked to COVID-19. Methods: This cross-sectional study was carried out at the ICU of Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital over a one-year period. It involved 40 patients who were administered NIV via a conventional ventilator in spontaneous mode and selected based on specific inclusion and exclusion criteria. Informed written consent was obtained from each patient’s guardians. Upon admission to the ICU, the HACOR score of each patient was measured after one hour of NIV treatment, assessing factors such as heart rate, pH levels for acidosis, and oxygenation through the PaO2/FiO2 ratio, along with respiratory rate. Analysis was performed with both manual methods and software SPSS version 24. Results: NIV failure occurred in 33 (82.5%) patients with only 7 (17.5%) achieving psuccessful NIV. Older patients experienced NIV failure significanly higher compared to those with successful outcomes (average ages 61.79±17.28 vs. 47.57±11.92 years, p=0.045), and male patients were predominant (66.66%). The predominating comorbidities were diabetes mellitus (57.5%). The HACOR scores were significantly higher in patients who failed NIV compared to those who succeeded (8.18±2.18 vs. 4.71±1.5, p=0.002). Receiver operating characteristic (ROC) curve analysis established a HACOR score cutoff value of 5 after one hour of NIV treatment for predicting NIV failure in the study population, demonstrating a sensitivity of 93.9% and a specificity of 57.1% (AUC: 0.905). Conclusion: Despite the study's limited sample size, findings suggest that the HACOR score may serve as an early indicator of NIV failure in critically ill patients with COVID-19-related respiratory failure. Future research on a larger scale is anticipated to validate and expand upon these important insights.

Toddler feeding, WASH conditions, and clinical complaints during the 2024 flash flood disaster in Jorong Galuang, Sungai Pua District, Agam Regency, West Sumatra

This study focuses on the impact of flash floods in Jorong Galuang, Sungai Pua, particularly on toddler nutrition, water, sanitation, hygiene (WASH), and clinical health. A qualitative study conducted through interviews and direct observation, data were collected from mothers of toddlers, health officers, midwives, and NGO representatives AIMI. Despite the absence of dedicated MPASI kitchens during the disaster, toddlers did not experience significant difficulties with feeding due to aid from NGOs and the availability of undamaged kitchens in some homes. Water access remained sufficient through local springs and additional supplies from the PMI ( Palang Merah Indonesia), although hygiene practices, particularly handwashing, were inadequate. Clinical complaints among toddlers were predominantly respiratory issues, including coughs and colds, with a few cases of diarrhea reported.

Efficacy and safety of long-acting muscarinic antagonists in COPD: a meta-analysis and meta-regression with a focus on aging.

The increasing global elderly population, projected to reach 20% of individuals aged 65 and over by 2030, faces significant pulmonary challenges, including chronic obstructive pulmonary disease (COPD). Aging is associated with a natural decline in lung function and structural changes that exacerbate respiratory issues. COPD, characterized by chronic respiratory symptoms and airflow obstruction, presents a unique challenge in older patients due to the accelerated decline in lung function. Acetylcholine plays a pivotal role in airway dynamics through muscarinic acetylcholine receptors, particularly M3 subtype, which mediates bronchoconstriction. The efficacy of long-acting muscarinic antagonists (LAMA) may differ in older adults, with evidence suggesting that these patients can respond favorably to LAMA treatment. This study utilized meta-analysis and meta-regression to explore the efficacy and safety of LAMA in treating COPD, while considering aging as a potential modifier. A meta-analysis of Phase III randomized controlled trials highlighted significant improvements in trough forced expiratory volume in the 1st second when LAMA were compared to placebo (PCB). Furthermore, the meta-regression revealed a trend suggesting older adults may experience enhanced benefits from LAMA therapy, particularly with once-daily regimens. Safety outcomes, including serious adverse events (SAE), cardiovascular SAE, and mortality, were not modulated by age when comparing LABA to PCB. Overall, these findings support the use of LAMA in elderly COPD patients and underscore the need for tailored treatment strategies to improve clinical outcomes in this vulnerable population.

STATE OF THE ART REVIEW ON THE DIFFERENT TYPES OF FREON AND THEIR EFFECTS

Freon is viewed as a vital component in the cooling process. Nevertheless, it poses significant risks to human health and plays an indirect role in environmental degradation. The expanding hole in the ozone layer has severe repercussions for living organisms today. Research indicates that refrigerants commonly utilized in air conditioning significantly contribute to the depletion of the ozone layer, potentially rendering habitats uninhabitable due to its deterioration. Moreover, Freon itself presents direct threats through its adverse effects on human health inhaling this gas can lead to serious respiratory issues and disrupt overall bodily functions. Additionally, it may inflict damage at the genetic level and weaken the immune system due to harmful cosmic radiation, increasing susceptibility to various illnesses. Therefore, its crucial to implement prevention strategies and establish first aid procedures when exposure occurs. A comparison will also be made regarding refrigerants employed in air conditioning systems.

Right Aortic Arch in Pediatric: Experience of a Center

Background: Congenital aortic arch anomalies encompass various malformations, which can range from asymptomatic to presenting with severe respiratory or gastrointestinal issues. These anomalies may occur alone or alongside other congenital heart defects. Imaging is crucial for identifying these conditions and guiding accurate preoperative decisions. Objectives: This study aimed to assess the frequency of these abnormalities in patients with a right aortic arch, explore the reasons for their referral, and evaluate patient outcomes. Methods: This cross-sectional study was conducted on children under the age of 20 who visited the Congenital Heart Diseases Clinic at Imam Reza Hospital, Iran. We collected data from 277 records of patients with right aortic arch from 2002 to 2022. Data were gathered using a checklist, including echocardiographic results, angiography findings, and other diagnostic modalities for the patients. Statistical analysis was performed using IBM SPSS software, Version 25. Results: In this study, 118 (29.8%) patients had heterotaxia, of which 106 (26.8%) had dextrocardia and were excluded [82 (20.7%) with situs inversus, 21 (5.3%) with situs solitus, and 15 (3.7%) with situs ambiguous]. Among the 277 patients with a right aortic arch, 7 (2.3%) had an aberrant left subclavian artery branch. There were 141 (50.9%) female patients. The trachea and esophagus were compressed. Respiratory symptoms were commonly present in patients with a compressive right arch and aberrant left subclavian artery (Kommerell’s diverticulum), which showed a significant relationship. Congenital major heart anomalies were found in 261 (94.2%) patients, with the most common being right obstructive lesions related to tetralogy of fallot (TOF), seen in 115 (41.5%) patients. Complex congenital heart disease was present in 75 (27.1%) patients. Septal defects were observed in 44 (15.9%) patients, including ventricular septal defect in 39 (14.0%). Nine (3.2%) patients had left obstructive lesions, including coarctation of the aorta. Arterial anomalies, such as patent ductus arteriosus, were present in 14 (5.0%) patients. Sixteen patients had normal heart structures or minor cardiac anomalies. The most common non-cardiac abnormality was musculoskeletal. Finally, 189 (68.2%) patients underwent surgery, and 16 (5.8%) died. Conclusions: More detailed examinations during patient visits, attention to clinical symptoms, and modern imaging can hasten the identification of cardiac abnormalities in children, which plays an important role in the diagnosis and prognosis of patients.

Computational Simulation Study-Based Formulation Development and Characterization of MethylprednisoloneLoaded Nanoparticles Containing Chitosan and Pectin to Treat Nocturnal Asthma.

Nocturnal asthma (NA) is a high-prevalence disease that causes severe respiratory issues, leading to death from early midnight to early morning. In this research, nanoparticulate drug delivery system of methylprednisolone (MP) was developed using chitosan (CH) and pectin (PEC). MP is a synthetic corticosteroid medication widely used for its potent anti-inflammatory activity. Computational simulation study (AI-based blend analysis algorithm) was used to identify a better-mixing polymer with MP. MP nanoparticles were formulated by the ionic gelation method with the combination of CH and PEC. To modify the drug release properties, the formed beads were coated with chitosan succinate (CSSC). The morphological characteristics of the beads were determined by SEM analysis. The X-ray radiographic imaging study was used to observe the intactness of MP beads. Histopathological studies were also carried out to find out the toxicity of the beads in the organs of rats. Pectin and chitosan polymers were selected based on the computational simulation study. SEM analysis revealed that the beads had a spherical shape with a rough outer surface. CSSC-coated beads achieved sustained drug release for up to 24 h. X-ray imaging demonstrated the stability of the beads in acidic pH conditions. In vivo pharmacokinetic studies showed that CSSC-coated beads were more stable in the gastrointestinal tract (GIT) than PEC-CH beads and the pure drug. Histological evaluation confirmed that the beads are nontoxic and safe for use in rats. Based on the findings, it was concluded that CSSC-coated beads of MP exhibited superior release properties, making them suitable for a chronomodulated drug delivery system.