Restriction Patterns Research Articles

Time Interval Between Right Ventricular Early Diastolic Velocity by Tissue and Pulse Wave Doppler: An Index of Right Atrial Pressure in Pulmonary Hypertension Patients

Background: A reversal of time difference between the onset of early diastolic velocity (e’) during tissue Doppler imaging and the onset of mitral inflow (E) has been observed in cases of elevated left atrial pressure. Whether this interval (Te’-E) may be useful to assess right atrial pressure has never been investigated, neither in healthy subjects nor in pulmonary hypertension patients. Methods: Right ventricular Te’-E was assessed in patients with pre-capillary pulmonary hypertension and compared with healthy volunteers who underwent comprehensive echocardiography examination. Te’-E is the difference between the interval from R wave at the superimposed electrocardiogram to the e’ wave during right ventricular tissue Doppler imaging and the interval from the R wave to transtricuspid E wave during pulsed wave Doppler imaging. Right atrial pressure was invasively measured in pulmonary hypertension patients. Results: Fifty-six patients were enrolled. Te’-E was prolonged in pulmonary hypertension subjects compared with healthy subjects (p < 0.001). Amongst the pulmonary hypertension patients, strong correlations were found between Te’-E and right atrial pressure (r = −0.885, p < 0.001), systolic pulmonary pressure (r = −0.85, p < 0.001) and the duration of tricuspid regurgitation (r = 0.72, p < 0.001). The area under the receiver operating characteristic curve of Te’-E in identifying right atrial pressure higher than 15 mm of mercury was 0.992 (sensitivity 100%, specificity 83%). Conclusions: In contrast to the left ventricle, there is a delay in the proto-diastolic filling in pulmonary hypertension patients, which correlates with the increase in systolic pulmonary arterial pressure, right atrial pressure, tricuspid regurgitation duration and restrictive diastolic pattern.

Optimising Transformation Efficiency in Borrelia: Unravelling the Role of the Restriction-Modification System of Borrelia afzelii and Borrelia garinii

Borrelia spp. are transmitted to humans by the bite of an infected tick. In Europe, Borrelia afzelii and Borrelia garinii are the main causative agents of Lyme borreliosis, one of the most prevalent tick-borne diseases in the northern hemisphere. In bacteria such as Borrelia spp., a restriction-modification system (RMS) protects against the harmful introduction of foreign DNA. The RMS comprises two activities: methyltransferase and endonuclease. This study is aimed to characterize the RMS of B. afzelii and B. garinii. First, we identified potential RMS genes. The predicted genes were cloned into a methylase-deficient Escherichia coli strain and digested with methylation-sensitive restriction enzymes to verify methyltransferase activity. Additionally, the RMS proteins were purified to evaluate endonuclease activity. Subsequently, methylated and unmethylated plasmids were used to investigate the effect of methylation on endonuclease activity and transformation efficiency. We identified four possible RMS genes in B. afzelii and four RMS genes in B. garinii. We analyzed the presence of these genes in patient isolates and observed a high degree of heterogeneity. The restriction pattern of DNA methylated by each of the four recombinantly expressed genes provided strong evidence that all encode adenine-specific methyltransferases. After 24 h of incubation with purified RMS proteins, we observed complete digestion of unmethylated plasmid DNA, demonstrating endonuclease activity. Finally, we proved that methylation protects against endonuclease activity and increases transformation efficiency.

Obstáculos para o diagnóstico e tratamento do transtorno do espectro autista

Objective: To understand the obstacles that reduce accessibility to the diagnosis and treatment of autism spectrum disorder (ASD). Literature review: ASD is a disorder characterized by difficulties in social interaction, impairments in communication and restricted patterns of behavior. Its diagnosis is clinical, based on behavioral observations and the patient's history and on criteria defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM – 5). Treatment includes pharmacological and behavioral approaches. However, the difficulties and challenges found in the literature include the symptomatological heterogeneity of ASD, the need for training health professionals and a more accurate assessment through a multidisciplinary team. Late diagnosis or its absence can lead to unfavorable outcomes in adult life, such as: anxiety, depression, and difficulty in interpersonal relationships. Recent studies include the use of specific biomarkers and innovative therapies that are not yet accessible. Final considerations: Early diagnosis and appropriate treatment are ideal for improving the quality of life of individuals with ASD. The importance of the doctor and new studies to improve therapeutic choice in ASD is also highlighted.

Abnormal spirometric patterns and respiratory symptoms in HIV patients with no recent pulmonary infection in a periurban hospital in Ghana.

Human immunodeficiency virus (HIV) infection is associated with chronic airway obstruction, even in patients who have achieved viral suppression from combination antiretroviral treatment (cART). Spirometry is a supplementary test that aids in diagnosing pulmonary dysfunction in people living with HIV. To compare the prevalence of spirometric abnormalities among cART-treated HIV patients and cART-naïve HIV patients with non-HIV controls with no recent history of pulmonary infection in a peri-urban hospital in Ghana. In a case-control design, spirometry was performed in 158 cART-treated HIV patients, 150 cART-naïve HIV patients and 156 non-HIV controls. Clinical, sociodemographic data and respiratory symptoms were collected using a structured questionnaire. Spirometric abnormalities were categorised as obstructive (OSP) or restrictive (RSP) spirometric patterns based on the Cameroonian reference equation. The prevalence of OSP was higher in the cART-treated and cART-naïve HIV patients compared to non-HIV controls (13.9% vs 10.7% vs 5.1% respectively, p = 0.026), whereas that of RSP was similar among the study groups. Respiratory symptoms were common among cART-treated and cART-naïve HIV patients compared to non-HIV controls (48.1% vs 40% vs 19.2% respectively, p < 0.001). The major factors associated with OSP were female gender [OR (95% CI) = 2.46 (1.09-5.13), p = 0.031], former cigarette smoking [1.92 (1.04-3.89), p < 0.001], exposure to medium-to-high levels of biomass [3.07 (1.16-8.73), p = 0.019], presence of a respiratory symptom [1.89 (1.11-5.08), p = 0.029] and unemployment [3.26 (1.19-8.95), p = 0.042]. The major determinants of RSP were age, female gender [1.74 (1.05-4.29), p = 0.041], former cigarette smoking [2.31 (1.27-6.77), p < 0.001] and medium-to-high biomass exposure [1.58 (1.06-5.37), p = 0.043]. In HIV patients without any recent pulmonary infection in a peri-urban area of Ghana, there was a higher prevalence of OSP among cART-treated and cART naïve HIV patients compared to the non-HIV control. However, the prevalence of RSP was similar among HIV patients and non-HIV controls.

Impact of SARS-CoV-2 viral load on restrictive spirometry patterns in mild COVID-19 recovered middle-aged individuals: a six-month prospective study

BackgroundLong term respiratory complications of Corona Virus Disease-2019 (COVID-19) are of great concern. Many studies have reported altered respiratory patterns in COVID-19 recovered individuals and most of them were from severe to critically ill patients. The association of viral load at the time of infection with symptoms of long COVID-19 specifically on pulmonary functions after months of recovery is still not known. This study was aimed to assess the impact of SARS-CoV-2 viral load during mild-moderate COVID-19 disease on pulmonary functions in middle-aged population after 6–8 months of acute infection.MethodsThis study included 300 (102 healthy controls and 198 COVID-19 recovered) individuals between age 30–60 of either gender. Mild-moderate COVID-19 recovered individuals were recruited between a period of 6–8 months post-acute infection. Spirometry was performed with MIR-Spirolab-III. The association of spirometry pattern was compared with SARS-CoV-2 viral loads during acute infection.ResultsWe observed up to 70% of the participants presented with either shortness of breath (11.5%), body aches (23.5%), recurrent cough (4.4%), recurrent respiratory infections (9.5%) and/or fatigue (33.3%) at follow up. In our study, 35.5% of COVID-19 recovered individuals had abnormal respiratory patterns (33.5% had restrictive and 2% had obstructive patterns). Viral load ≤ 20 CT value was associated with restrictive respiratory patterns (p = 0.004). No association was found between viral load and disease severity (p = 0.23).ConclusionIn this study, we found one third of mild-moderate COVID-19 recovered individuals have restrictive respiratory patterns after 6–8 months of recovery. These findings had a strong association with SARS-CoV-2 viral loads during acute infection which has been reported for the first time in our study. Studying the relationship between viral load and pulmonary functions can contribute to identifying potential risk factors for long COVID and developing preventive measures to mitigate the long-term impact on lung health.Clinical trial numberNot applicable.

The role of pulmonary rehabilitation in improving lung functions in patients with ankylosing spondylitis

Background Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by axial and peripheral entheseal inflammation and new bone production(1). The development of syndesmophytes, enthesophytes, and spinal fusion along the course of the disease is linked to chronic pain, functional impairment, and disability(2). Fibrosis of the upper lobes of the lungs (interstitial lung disease) and chest wall abnormalities are two of the emerging forms of pulmonary involvement in AS. (3). Pulmonary rehabilitation is a multifaceted program of education, counselling, breathing exercises, and other modalities that can increase the patient’s independence and ease of functioning(4). Aim To estimate the role of pulmonary rehabilitation in enhancing lung function in AS individuals in relation to disease activity, clinical, and functional parameters. Patients and methods This study was an interventional study: single-arm group (prospective randomized clinical study). Thirty people (30) participated in that study from those presented to Physical Medicine, Rheumatology and Rehabilitation inpatient and outpatient clinic at Ain Shams University hospitals, diagnosed as radiographic axial spondyloarthropathy (SPA) from 02/2022 to 12/2022. All patients underwent pulmonary rehabilitation program and were exposed to a detailed history, clinical, and pulmonary function testing. Disease activity was evaluated by Ankylosing Spondylitis Disease Activity Score C-reactive protein (ASDAS-CRP), Valuation of function by using Bath Ankylosing Spondylitis Functional index (BASFI), 6-Minute walk test (6MWT), the Modified Borg Dyspnoea Scale (MBS), and Timed Up and Go (TUG) test. All function and clinical scores were done at baseline and repeated after completing pulmonary rehabilitation program. Result The mean age of patients was 36.57 ± 7.83 years (23–45 years), with a median disease duration of (5 (3–9) years). In total, there were 19 out of the studied patients with restrictive pattern. With comparison between pre- and postintervention of pulmonary rehabilitation, there was a significant statistical difference in all, disease activity (ASDAS and BASFI) and functional (MBS, TUG, and 6MWT) parameters (P &lt;0.001), except for occiput to the wall. Regarding pulmonary function tests, including forced vital capacity (FVC), expiratory volume in one second (FEV1), and peaked expiratory flow (PEF), there was a statistically significant change at baseline and at the end of exercise (P &lt;0.001). Conclusion Improved respiratory function and disease activity and overall functional activity are possible outcomes of pulmonary rehabilitation programs in combination with other rehabilitation interventions.

Evolution and palaeoenvironmental migration of a Cambrian undermat miner

Microbial mats sealed the sea bottom, becoming the food supply of many early metazoans, which exploited this resource in multiple ways during the late Ediacaran and earliest Cambrian. The onset of highly penetrative bioturbation in shallow-marine environments later in the early Cambrian removed this seal, resulting in the protracted restriction of microbial mats to marginal- and deep-marine environments. In this study, we demonstrate that the undermat-miner trace fossil Oldhamia followed the pattern of matground restriction to deep-marine environments. This is shown by a dataset compilation of Cambrian Oldhamia based on a comprehensive review of the literature with addition of recently discovered Oldhamia in the Cambrian strata of North and South China. Oldhamia is one of the most distinctive and widely distributed ichnogenera in early to middle Cambrian siliciclastic successions. It consists of semi-permanent, very shallow-tier, undermat-miner structures produced by stationary vermiform organisms. Despite its importance, details of Oldhamia ichnodiversity trajectories at ichnospecies level, environmental trends, and potential palaeogeographic patterns have not been explored. Our results demonstrate that Oldhamia displays high diversification in Fortunian shallow- and deep-marine settings, representing a signal of the Cambrian Information Revolution. Oldhamia alata and O. geniculata only occurred in shallow-marine settings, O. curvata and O. flabellata were restricted to the deep sea, and O. antiqua and O. radiata ranged from shallow- to deep-marine settings. The producers of Oldhamia retreated into deep sea since the end of the Fortunian mirroring the restriction of matgrounds as a response of intense bioturbation in shallow-marine deposits during the Agronomic Revolution. The producers of Oldhamia originated from the Iapetus Ocean and then migrated into other oceans, most likely through dispersal assisted by ocean currents.

Impact of pectus excavatum deformity on the cardiopulmonary function: a literature review

BACKGROUND: Pectus excavatum deformity is the most common chest wall malformation. Currently, surgeons and researchers of this problem have no consensus on whether pectus excavatum is a purely aesthetic problem or whether pectus excavatum disturbs the function of the cardiopulmonary system. AIM: To analyze publications on the effect of pectus excavatum on the cardiorespiratory system and the functional features of the heart and lung after thoracoplasty in patients with pectus excavatum. MATERIALS AND METHODS: Data were searched in the scientific databases PubMed, Google Scholar, Cochrane Library, Crossref, and eLibrary without language limitation. In this article, the method of analysis and synthesis of information was used. Most of the studies included in the analysis were published in the last 20 years. RESULTS: In patients with pectus excavatum, severity of cardiorespiratory dysfunction depends on the degree of chest deformity. According to obtained data, the pulmonary function test in patients with pectus excavatum in the majority of cases revealed restrictive pattern (formed vital capacity 80% of the norm, with normal ratio of forced expiratory volume in 1 minute to forced lung capacity). In most cases, echocardiography showed compression of the right heart chambers. Comparative analysis of the pre- and postoperative study of cardiorespiratory system in most cases indicated improvement and adaptation of the cardiopulmonary system to stress after surgical intervention. CONCLUSIONS: Funnel chest is an aesthetic problem wherein a severe degree of deformity leads to impaired respiratory mechanics and dysfunction of the cardiovascular system. Surgical restoration of the volume of the retrosternal space allows improvement of the functional capabilities of the heart and lungs.

THE BENEFITS OF NON-BIOLOGICAL THERAPY IN CHILDREN WITH AUTISM SPECTRUM DISORDER (ASD)

Introduction – Autism Spectrum Disorders (ASD) are a group of neurodevelopmental disorders characterized by three main problems, namely the presence of communication disorders, impaired reciprocal social interaction with the surrounding environment, and restricted, repetitive, and stereotyped behavior patterns in the first 3 years of age. In Indonesia, there were around 112,000 ASD sufferers in 2012, while in 2015 it was estimated that 1 in 250 children had ASD, or around 134,000 people. Methods – The author used the literature review method by collecting the results of several kinds of literature on ASD, and non-biological therapy and their benefits in ASD children. The literature on non-biological therapy and its benefits in ASD children is limited to 2011-2021. Results – Autism is a lifelong disorder, so it is important to recognize it as early as possible, and parents need to understand the problem. It's important to remember that the cause of autism is unknown, and no single drug has been found that can cure ASD, but some therapies can suppress ASD symptoms that can help ASD lead a more productive life by reducing symptoms and improving skills. Discuss – There is no definitive therapy that can cure ASD, but therapy is aimed at improving ASD symptoms. Non-biological therapy which includes behavioral therapy (such as TEACCH or ABA) is currently used as first-line therapy for ASD. Conclusion – Symptoms that appear in ASD children vary widely, therefore the therapy given is individual and depends on the circumstances and symptoms that appear. There are many types of non-biological therapies for ASD, such as ABA, TEACCH, PECS, Caregiver-mediated Intervention, Parent-mediated Communication, SIT, and AIT. These therapies have been shown to have benefits in improving ASD symptoms such as communication skills, social interaction, and behavior, where each therapy has different benefits in each type. These therapies are given to everyone as needed. Keywords: non-biological, children, autism.

Radiological Insights into Acute Leukoencephalopathy with Restricted Diffusion (ALERD): A Case Series Analysis

Abstract Objectives The study aimed to investigate the clinical and radiological characteristics of acute leukoencephalopathy with restricted diffusion (ALERD) among pediatric patients presenting with acute encephalopathy, seizures, and fever. Methods A retrospective analysis was conducted on 48 pediatric patients who underwent magnetic resonance imaging (MRI) between April 2022 and August 2023 at Bapuji Hospital, J.J.M. Medical College, Davanagere, Karnataka, India. Inclusion criteria comprised acute-onset encephalopathy, fever, seizures, and MRI evidence of acute subcortical white matter involvement. Clinical and radiological data were collected and analyzed to delineate ALERD characteristics. Results Among the study cohort, 18.7% of cases met the diagnostic criteria for ALERD, predominantly affecting male children with a mean age of 32 months. Clinical presentations varied, including biphasic and monophasic courses. Two distinct patterns of brain involvement, diffuse and central-sparing, were identified. Laboratory abnormalities and differential diagnoses were elucidated, providing insights into distinguishing ALERD from other conditions. MRI, particularly diffusion-weighted imaging, emerged as a crucial tool for ALERD diagnosis, revealing characteristic restricted diffusion patterns. Conclusion The study underscores the importance of recognizing ALERD as a distinct clinical-radiological syndrome associated with infections, aiding in timely diagnosis and management. Understanding the varied clinical presentations and radiological patterns enhances diagnostic accuracy, emphasizing the role of MRI in ALERD diagnosis. These findings contribute to a comprehensive understanding of ALERD, facilitating improved patient outcomes and prognosis.

Diagnosis Dilemma; Patient with Breathlessness &amp; Befogged Appearing Cardiomegaly on Chest Xray

A sixty-year-old south Indian woman complained of dyspnoea on excretion, unexpected weight gain and other symptoms and signs of hypothyroidism that had been present over a year. When examined physically, the blood pressure was 110/70mmg. The heartbeat was regular at 82beats/min and oxygen saturation at room air was 96%. The point of highest impulse was found to be in the fifth intercostal space, 10 cm to the left of the midsternal line, on examination there was no murmur or friction rub audible, and the heart sounds were within normal limits. Ankle oedema, rales, or hepatomegaly were absent. Thyroid function test showed the following values FT3 1.2 pg/ml FT4 0.5 ng/dl TSH 10 micro IU/ml and patient was started on T. Thyroxine 50 mcg/day Chest Xray showed an expanded cardiac silhouette on the right side at the junction of diaphragm and heart (Fig. 1). At the time, differential diagnosis made were myocarditis, pericarditis, or pericardial cyst. The ECG showed no abnormalities. HRCT scan visualized a radiolucent border around a centrally located, normal-sized heart shadow measuring several centimetres in thickness. This radiolucency was indicative of a significant fat build-up in the tissues surrounding the heart. 2dEcho showed pericardial fat deposition with EF 62% and NRWM. Pulmonary Function Test (PFT) was done it showed restrictive pattern. Ultimately, the clinical impression was made that hypothyroidism was the cause of the patient's symptoms. It was suggested that the dyspnea was brought on by weakened muscle tone occurring as sequelae to hypothyroidism and the rapid increase in weight gain could have contributed to the increase in pericardial fat.

Microfacies and species richness analysis of upper Bartonian and Priabonian carbonate shelf deposits from the Thrace Basin (Tethyan Ocean, Greece): Paleoenvironmental evolution and species-richness hotspot revealed

Sediment, thin section, microfacies and foraminiferal analyses were conducted on middle-upper Eocene carbonate deposits to shed new light on the paleoenvironmental evolution and species richness of the Thrace Basin (Tethyan Ocean, Greece). Material from a total of 7 new sites, covering localities on the mainland and the north-eastern Aegean islands of Samothraki and Lemnos, was examined in order to analyze the general conditions and environmental evolution of the basin over as large a geographical area as possible. Analysis of the sedimentological and paleontological data allowed the identification of 5 microfacies types. These can be assigned to a sequence of interior to outer shelf environments and speak in favor of a model of a rimmed carbonate shelf with isolated platforms. Both open and restricted water circulation patterns have prevailed on and between the platforms. Triggered and driven by dynamic syn-rifting, topographic highs have developed in this area on which productive and species-rich reef structures could thrive. In the late Eocene carbonate deposits we found the highest documented species richness of larger symbiont-bearing foraminifers (LBF) to date, characterizing the Thrace Basin not only as a particularly species-rich and diverse area, but also as a LBF hotspot of diversity.

Correlation of spirometry findings and post-six-minute walk test oxygen desaturation in chronic simple silicosis patients with age, duration of silica exposure, smoking pack years, occupation and mean pulmonary artery pressure.

Silicosis is associated with preventable but irreversible lung damage. Early quantifiable assessment of silicosis workers would promote early interventional steps to reduce health deterioration. The objectives of this study were to correlate spirometry findings and post-six-minute walk test oxygen desaturation (post-6MWT OD) in chronic simple silicosis with age, duration of silica exposure (DSE), smoking pack years (SPY), occupation, and mean pulmonary artery pressure. Based on occupational exposure to silica and radiologic confirmation of chronic simple silicosis, 104 patients (all males) were enrolled and grouped based on SPY (nil, 1-10, 11-20, and >20) and occupation (drillers and dressers). They were further investigated with spirometry, post-6MWT OD, and transthoracic echocardiography (TTE), and findings were statistically analyzed. Abnormal spirometry findings were seen in 62.5% of total cases (65/104), with the highest percentage in the >20 SPY group (84%; 21/25) and drillers (68.3%; 28/41). The post-6MWT OD was seen in 50.96% of cases (53/104) with the highest percentage in the >20 SPY group (56%; 14/25) and drillers (63.4%; 26/41). Normal and restrictive patterns were predominant among <20 SPY groups, while obstructive and mixed patterns were prevalent in the >20 SPY group. Normal, obstructive, and restrictive patterns were predominant among dressers, while mixed patterns were in drillers. Mean age and mean DSE were higher for >20 SPY group and dressers; obstructive and mixed patterns; and patients with post-6MWT OD. Pulmonary hypertension was significantly associated with the presence of abnormal spirometry patterns (69.3%; 45/65) and post-6MWT OD (79.3%; 42/53). Mean forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) was significantly lower for the >20 SPY group. Mean FEV1 had an inverse relation with SPY, and mean FVC was lower for drillers than dressers. Spirometry, post-6MWT OD, and TTE assessment give a complete overview of the cardiopulmonary exercise capacity of chronic silicosis patients and facilitate early interventions with special consideration for workers involved in machine-based mining activity.

Effects of Different Caloric Restriction Patterns on Blood Pressure and Other Cardiovascular Risk Factors: A Systematic Review and Network Meta-Analysis of Randomized Trials.

All types of caloric restriction are preventive against cardiovascular risk factors, but the best restriction method and most affected factors have not been identified. The objective of this study was to explore the effects of different caloric restriction methods on various cardiovascular risk factors by horizontally comparing program advantages and disadvantages via network meta-analysis. The PubMed, Web of Science, Cochrane Library, and Embase literature databases were searched (October 2013 to October 2023). Eligible randomized controlled trials involving participants who underwent caloric restriction and systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), and high-density lipoprotein (HDL) cholesterol level measurements were included. Thirty-six of 13 208 records (0.27%) were included. Two researchers reviewed the articles, extracted data, and assessed article quality. Alternate-day fasting (ADF) reduced SBP (4.88 mmHg; CI, 2.06-7.15) and DBP (5.10 mmHg; CI, 2.44-7.76). Time-restricted eating reduced SBP (2.46 mmHg; CI, 0.16-4.76) but not DBP. Continuous energy restriction (CER) significantly reduced BMI (1.11 kg/m2; CI = 0.16, 2.06) and waist circumference (3.28 cm; CI, 0.62-5.94). This meta-analysis confirmed the preventive effect of CER and ADF on various cardiovascular risk factors. Additionally, CER is more likely to reduce obesity, and ADF is more likely to reduce blood pressure (BP). Based on this meta-analysis, CER is recommended to control obesity only for people who are obese and do not have elevated BP or other abnormal indicators. Additionally, ADF for early control or prevention is recommended for patients who have abnormal BP or other cardiovascular risk factors. PROSPERO registration no. CRD42023455889.

WP2.14 - Lung Mycetoma - Chronicles from the Pandemic

Abstract Introduction COVID-19 is a global pandemic which obeys no geographical borders. Post Covid pneumonia sequalae is still an unpredictable course especially with patients with a pre-existing lung compromise. In such scenario, a cohort of patients must also be looked for a fungal infection. Case Study A 31-year-old male presented with history of fever, hemoptysis, and weight loss for 1 month. He suffered from Covid-19 pneumonia 3 months back. He was also diagnosed with Pulmonary tuberculosis 4 years back. Examination revealed right sided tracheal deviation with dull percussion note on the upper and middle zones of the right side of chest. Pulmonary function tests showed a restrictive pattern with a FEV1/FVC ratio of 0.9 (FEV1=2.02, FVC=2.22). Transthoracic echocardiography revealed dextrocardia, moderate TR, and a pulmonary arterial systolic pressure of 25 mm Hg. Contrast enhanced CT scan of thoracic cavity showed reduced right hemithorax, well-defined thick-walled cavities in the upper and lower lobe of the right lung and a ground glass appearance in the bilateral lower lobes. A diagnosis of Lung mycetoma was made along with post covid-19 pneumonia changes. Right posterolateral thoracotomy and right pneumonectomy was performed. Per-operatively, a collapsed lower lobe and stony hard upper and middle lobes of right lung with associated fungal balls were found. Patient was clinically well after a 30-day follow-up period. Conclusion Covid-19 patients with pre-existing pulmonary co-morbidities should be followed with caution and pulmonary symptoms in the post pneumonia patient should raise the suspicion of fungal infections as well.

Development and Management of Avoidant/Restrictive Food Intake Disorder and Food Neophobia in Pediatric Patients with Food Allergy: A Comprehensive Review.

Avoidant/Restrictive Food Intake Disorder (ARFID) and food neophobia present significant challenges in pediatric healthcare, particularly among children with food allergies (FAs). These eating disorders, characterized by the persistent avoidance or restriction of food, can lead to severe nutritional deficiencies and psychosocial impairments. The presence of FAs further complicates these eating behaviors, as the fear of allergic reactions exacerbates avoidance and restrictive patterns. This comprehensive review synthesizes current knowledge on ARFID and food neophobia, focusing on their definitions, characteristics, and the unique challenges they present in the context of FAs. The review explores the critical role of healthcare professionals, especially nurses, in integrating psychological and clinical care to improve outcomes for affected children. A multidisciplinary approach, including Cognitive Behavioral Therapy (CBT) and Family-Based Therapy (FBT), is emphasized as essential in addressing the complex needs of these patients. The review also highlights the need for standardized treatment protocols and further research on the long-term outcomes of these disorders, aiming to enhance therapeutic strategies and family support systems. Effective management of ARFID and food neophobia in the context of FAs requires a holistic and integrated approach to mitigate the profound impacts on a child's growth, development, and overall well-being.

Lung Function Impairment Among Paint Factory Workers: A Cross-Sectional Analytical Study.

A paint factory or manufacturing is a vocation characterized by exposure to chemical hazards during production. Paint exposure plays a great role in the incidence of several health problems, particularly respiratory diseases. The study aims to assess the pattern of spirometric indices amongthe study population. This cross-sectional study of paint factory workers (PFWs)assesses their spirometric findings in Delta State, Nigeria. The participants for this study were divided into two groups; the PFWs and the non-PFWs (NPFW) which serve as the control group. Hundredand 200participants wererecruited for the study group and control, respectively. Among the participants in the paint worker cohort, 45 individuals (45.0%) had been employed for less than five years while 14 (14.0%) had worked over 10 years. Eighty-eight (88%) are aware of PPE; however, only 12 (12.0%) use them always.Findings show that 178(89.0%) vs. seven (7.0%) of NPFW and PFW had normal pulmonary function tests. The spirometric abnormalities within the PFW group were obstructive lung diseaseaffecting 59 (59.0%) of the cohort while 34 (34.0%) had restrictive lung patterns. Exposure to volatile organic compounds (VOCs) emitted from paint fumesis associated with spirometric abnormalities with obstructive patterns more predominant than restrictive patterns.

Stepwise Construction and Integration of Ecological Network in Resource-Based Regions: A Case Study on Liaoning Province, China

Ecological networks are an effective strategy to maintain regional ecological security. However, current research on ecological network construction in areas with large-scale resource extraction is limited. Moreover, classic ecological network construction methods do not perform satisfactorily when implemented in heavily damaged mining landscapes. Taking the example of Liaoning Province, China, a framework for stepwise renewal of ecological networks was proposed, which integrates basic ecological sources and other sources that include mining areas. The framework was based on multi-source ecological environment monitoring data, and all potential ecological sources were extracted and screened using an MSPA model and the area threshold method. Further, ecological sources were classified into two types and three levels based on the influence of abandoned mines and the characteristics of ecosystem services in the ecological sources. Ecological corridors were extracted using the MCR model. An ecological corridor optimization process based on combining the gravity model with addition and removal rules of corridors was proposed. The results indicated that the basic ecological network in Liaoning Province included 101 ecological sources and 162 ecological corridors, and the supplementary ecological network included 28 ecological sources and 67 ecological corridors. The ecological sources were divided into two types, and corridors were divided into three types. The basic ecological network exhibited a spatial distribution of discrete connections in the west and close connections in the east. Changes in ecological network topological indicators indicated that a supplementary ecological network strengthened the structural performance of the regional ecological network, expanding spatial coverage, filling hollow areas, and enriching local details of the regional ecological network. Regulation strategies were proposed for ecological sources with different connection modes. The number of ecological sources implementing restrictive development, pattern optimization, and protective development were 101, 12, and 16, respectively. This paper provides a constructing framework of ecological networks adapted for resource-based regions. This method can support decisions for the environmental governance of mines, thus contributing to a balance between resource exploitation and ecological protection in regions.

Lung function measurements in the Greenlandic Inuit population: results from the Greenlandic health survey 2017–2019

ABSTRACT Background Little is known about lung function in Inuit. The aim of this study was to describe lung function and the prevalence of obstructive and restrictive lung disease among Inuit in Greenland Methods During the 2017–2019 Health Survey, spirometry, with forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio in liters (L), and percent of predicted value (pred%) were recorded according to Global Lung function Initiative standard reference values (GLI). Smoking history was obtained. Obstructive spirometry was defined as FEV1/FVC <70%. Restrictive spirometry was proposed by FVC < 80% and FEV1/FVC >90%. Results Based on validated spirometries, 795/2084 persons were included in this cross-sectional, descriptive study. Of those, 54.6% were current- and 27.7% former smokers. In Inuit, normal lung function was higher than predicted GLI (FEV1 107.2 pred%/FVC 113.5 pred%). In total, 106 (13.3%) were found to have an obstructive lung function measurement and 11 (1.4%) had a restrictive pattern. Among current smokers, the prevalence of obstructive lung function was 16.4%. An accelerated decline in lung function was observed > 50 years old (y.o), compared to <50 y.o. Conclusion This study indicates that Inuit has higher absolute lung function values than standard GLI, despite the large proportion of smokers, which indicate a need for Inuit reference values in the daily clinical praxis. The high prevalence of obstructive lung function and rapid decline in lung function indicates the need for fucus on health issues that may affect lung health in Greenland.

Posttranslationally modified self-peptides promote hypertension in mouse models.

Posttranslational modifications can enhance immunogenicity of self-proteins. In several conditions, including hypertension, systemic lupus erythematosus, and heart failure, isolevuglandins (IsoLGs) are formed by lipid peroxidation and covalently bond with protein lysine residues. Here, we show that the murine class I major histocompatibility complex (MHC-I) variant H-2Db uniquely presents isoLG-modified peptides and developed a computational pipeline that identifies structural features for MHC-I accommodation of such peptides. We identified isoLG-adducted peptides from renal proteins, including sodium glucose transporter 2, cadherin 16, Kelch domain-containing protein 7A, and solute carrier family 23, that are recognized by CD8+ T cells in tissues of hypertensive mice, induce T cell proliferation in vitro, and prime hypertension after adoptive transfer. Finally, we find patterns of isoLG-adducted antigen restriction in class I human leukocyte antigens that are similar to those in murine analogs. Thus, we have used a combined computational and experimental approach to define likely antigenic peptides in hypertension.