ABSTRACT Background and Aims Children with cerebral palsy (CP) are vulnerable to respiratory infections and chronic airway inflammation, which leads to diminished respiratory function. This decline is exacerbated by muscle tone abnormalities and reduced strength, worsening as CP progresses. Traditional lung function tests are often impractical for those with severe cognitive and motor impairments. Diaphragm evaluation through ultrasound imaging emerges as a non‐invasive, easy‐to‐apply technique for assessing respiratory function in CP children. This study aimed to evaluate diaphragm function in CP and typically developing (TD) children using ultrasound, focusing on diaphragm thickness and excursion parameters. The study also explored factors influencing respiratory function, particularly the number of lower respiratory tract infections (LRTI). Methods The study included 10 CP (11.2; range 4–17 years) and 12 TD children (8.9 years; range 4–13 years). M‐mode ultrasound assessed diaphragm thickness, thickening fraction (TF), and inspiratory slope (IS). Additionally, data on demographics, anthropometrics, medical history, and physical examination were collected. Results The intra‐operator reliability for diaphragm ultrasound measurements showed good to excellent consistency (over 0.86). Significant differences were found between CP and TD children; CP children exhibited lower excursion and IS, with a non‐significant trend towards reduced diaphragm thickness. LTRI were associated to decreased excursion and IS, and increased TF in CP children. Conclusions Diaphragmatic ultrasound is a non‐invasive, reproducible tool for assessing respiratory function in both CP and TD children, even in cases of severe cognitive and motor impairment. It effectively identifies diaphragm dysfunction associated with LRTI.
ABSTRACT Objectives This study aims to explore the correlation of psychological domains and behavioural engagement with ChatGPT among undergraduate dental students. Material and Methods A cross‐sectional study was conducted using a self‐administered questionnaire (supporting material) distributed to 130 undergraduate dental students of a dental school in Karachi, Pakistan. The questionnaire assessed the frequency and purpose of ChatGPT usage across academic domains and specific learning contexts. It also evaluated students’ attitudes, perceptions, and behaviors using a Likert scale. Descriptive statistics were used for analysis, while Spearman's correlation tests were applied to examine subgroup differences and relationships between attitudes and behaviors. Results Most participants reported learning about ChatGPT through peers or friends ( n = 53) and social media ( n = 38). The mean composite scores for the psychological domains [Perception(3.27), behaviour (3.21) and Attitude (3.19)] indicate a generally neutral‐to‐moderately positive inclination toward ChatGPT. The primary area of usage was basic dental sciences ( n = 73). A strong positive correlation was observed between trust in ChatGPT for dental explanations and behavioral engagement ( rs = 0.86, 95% CI [0.88, 0.95], p = 0.003, Holm–Bonferroni adjusted p = 0.006), while doubts regarding its accuracy were negatively correlated with engagement ( rs = −0.91, 95% CI [−0.97, −0.76], p = 0.002, adjusted p = 0.006). Students who used ChatGPT for staying updated with dental knowledge ( rs = 0.90, 95% CI [0.68, 0.91], p = 0.004, adjusted p = 0.004) and those willing to recommend it to peers ( rs = 0.95, 95% CI [0.88, 0.98], p = 0.001, adjusted p = 0.004) also demonstrated significantly higher behavioural engagement. Conclusion Undergraduate dental students showed cautious but receptive attitudes toward ChatGPT, with psychological factors such as trust and perceived usefulness significantly shaping behavioral engagement. While the tool was mainly used for foundational learning, these findings support the need for structured, faculty‐guided integration of AI in dental education.
ABSTRACT Background and Aims This study aimed to examine the prevalence of menstrual cycle characteristics and lower limb injuries among elite female team sport athletes, and to identify factors influencing injury risk. Methods Data were collected from 301 female team athletes across the German 1st and 2nd division in basketball, field hockey, football, handball, and volleyball using an online questionnaire. Information was gathered on gynaecological health and lower extremity injuries in the past 12 months. Results Forty‐two percent used hormonal contraceptives, while among non‐users, 81% were naturally menstruating and 19% had a menstrual dysfunction (MD). Of those naturally menstruating, 46% experienced dysmenorrhea in every menstrual cycle, and 18% took painkillers during each menstruation. Regarding injuries, 42% reported at least one lower limb injury in the past 12 months, with 44% classified as severe. The most commonly affected regions were the knee (44%), ankle (31%), and upper thigh (9%). MD was associated with lower anterior cruciate ligament (ACL) injury rates ( p = 0.04, Cramer's V = 0.199, 95% CI: −∞ to −0.09), while regular periodic health examinations (PHE) were associated with higher injury rates ( p = 0.05, Cramer's V = 0.121, 95% CI: −0.98 to −0.01), particularly knee cartilage injuries ( p = 0.001, Cramer's V = 0.241, 95% CI: −3.19 to −0.59). No significant associations were found between injury rates and dysmenorrhea or premenstrual syndrome. Conclusion This study highlights the complex relationship between menstrual cycle characteristics and injury risk in female athletes, showing MD's unexpected association with lower ACL injury rates. Further, it emphasizes the need for targeted injury prevention programs, regular PHE, and enhanced medical support structures to reduce injury risks in elite female team sports.
ABSTRACT Background and Aims Obstructive sleep apnea (OSA) is a prevalent sleep disorder linked to cardiovascular diseases and is highly prevalent, especially in the elderly population. This study aimed to investigate the association between OSA severity and arterial stiffness, as measured by pulse wave velocity (PWV), in patients with moderate to severe OSA. Methods This cross‐sectional study included 60 adults with moderate‐to‐severe OSA, confirmed by polysomnography (PSG). Arterial stiffness was measured by brachial artery oscillometry. Polysomnographic parameters, including the apnea–hypopnea index (AHI), minimum oxygen saturation (SpO2), and sleep efficiency, were analyzed to determine their correlation with PWV. Correlations between PWV and PSG parameters were performed using Spearman's correlation coefficient. Additionally, multivariate regression analysis was conducted to adjust for confounders, including age, sex, BMI, hypertension, diabetes, and medication use. Results The mean age of participants was 62.07 ± 8.83 years, with 55% being male. A significant positive correlation was found between PWV and AHI ( r = 0.4724; 95% CI = 0.2438 to 0.6512; p < 0.001), indicating that arterial stiffness increases with OSA severity. Additionally, an inverse relationship was observed between PWV and minimum SpO 2 ( r = ‐0.2995; 95% CI = –0.5234 to –0.03684; p = 0.02), as well as between PWV and sleep efficiency ( r = –0.2702; 95% CI = −0.4999 to –0.004971; p = 0.04). However, when adjusted for age and other potential confounders using multivariate regression, these associations between PSG parameters and arterial stiffness lost statistical significance. Age emerged as the primary independent predictor of PWV in this population. Conclusion The study confirms a significant initial association between the severity of OSA, as indicated by AHI and minimum SpO 2 , and arterial stiffness. The subsequent analysis highlights that the relationship between sleep parameters and PWV is primarily age‐dependent, emphasizing the importance of rigorous cardiovascular risk assessment in aging OSA patients.
ABSTRACT Background and Aims Edentulism significantly affects oral function and quality of life, particularly among mandibular complete denture wearers, where reduced retention and stability remain common clinical challenges. Denture adhesives are frequently recommended as adjuncts to improve denture performance; however, limited randomized controlled trials have compared different adhesive forms using standardized control conditions. This study aimed to evaluate and compare the short‐term subjective effects of cream, powder, and strip‐type denture adhesives on satisfaction and functional outcomes in mandibular complete denture wearers. Methods This randomized controlled trial included 240 completely edentulous participants aged 40–70 years with moderately resorbed mandibular ridges. Participants were randomly allocated into four groups ( n = 60 each): cream‐type adhesive, strip‐type adhesive, powder‐type adhesive, and a control group using 0.9% saline solution without adhesive. Subjective outcomes, including general satisfaction, chewing ability, speaking ability, denture cleanliness, retention, and comfort were assessed after 1 week using a five‐point Likert scale. Data were analyzed using χ 2 tests with Bonferroni correction, and a p value ≤ 0.05 was considered statistically significant. Results All adhesive types demonstrated significantly higher satisfaction, improved chewing ability, greater retention, and enhanced comfort compared with the control group ( p < 0.001). Speaking ability was improved with cream and strip adhesives ( p < 0.001), whereas the powder adhesive showed no significant improvement ( p > 0.05). The proportion of participants reporting high satisfaction ranged from 26.7% with powder to 50% with strips, effective chewing from 33.3% with powder to 63.3% with strips, and improved speaking ability from 23.3% with powder to 60% with strips. No significant differences in denture cleanliness were observed between the control and adhesive groups ( p > 0.05). Conclusion All adhesive types significantly improve short‐term satisfaction, mastication, retention, and comfort in mandibular complete denture wearers. Improvements in speaking ability were observed with cream and strip adhesives only, while denture cleanliness or adhesive removal from dentures remained comparable across all groups. Trial Registration The study was registered at clinicaltrials.gov (first submitted date: June 24, 2021; identifier number: NCT05063422) and approved by the ethical review committee of Altamash Institute of Dental Medicine, Pakistan (AIDM/RDRC/01/2021/03).
ABSTRACT Background and Aims Late diagnosis of chronic hepatitis B and C, often identified by the presence of advanced disease such as hepatocellular carcinoma or decompensated cirrhosis at the time of initial hepatitis diagnosis, is associated with high rates of hospitalization and mortality. This review aimed to synthesize published evidence regarding factors associated with late diagnosis of viral hepatitis. Methods This review was conducted in accordance with the PRISMA guidelines. We conducted a search of four biomedical databases up to January 2025. Eligible studies included articles that explored factors associated with the late diagnosis of chronic hepatitis B and C. Due to heterogeneity across the studies, we conducted a narrative synthesis to summarise the identified barriers and facilitators. Results Of 5131 studies, 22 were eligible, with most from the USA (27%) and Australia (14%). The proportion of late diagnosis ranged from 11% to 70% (hepatitis C) and 15% to 51% (hepatitis B). Key barriers included older age, being male, history of alcohol misuse, HCV/diabetes comorbidity, and fewer physician visits; and facilitators were being female, history of injection drug use, higher number of physician visits and HCV/HIV comorbidity. Conclusions To promote the early detection of viral hepatitis, interventions targeting men, older individuals, diabetic patients and those with a background of alcohol abuse are required. Undiagnosed individuals should be sought out and linked to treatment programs.
ABSTRACT Background and Aims The objective of this study was to explore the short‐term impact of a brief, curated exposure to social networking site content on facial and smile dissatisfaction and face‐related self‐discrepancy among young adults. Additionally, the study aims to compare these effects with the use of appearance‐neutral Instagram images. Methods A randomized control trial was conducted at Altamash Institute of Dental Medicine for a duration of 1 month. Freshly inducted students with a Bachelor of Dental Surgery (first year) with no prior knowledge of smile parameters were asked questions about their satisfaction with their smiles. They were then divided into groups of 2 where both of the groups were shown images from social media. Half of the group was shown images of an idealized smile (#hollywoodsmile), whereas the other group was kept as control and shown images of nature (#nature). Both groups were asked to fill out the same questionnaire again to note down any difference this experiment made in their perceptions. Results The study comprised predominantly female participants in both the experimental (74.1%) and control (70.4%) groups, with a mean age of 19.61 ± 1.86 and the majority (70.9%) spending one to 2 h on Instagram daily. Both groups maintained relatively stable OES scores from pre‐ to post‐exposure, with no significant differences observed. Whereas the experimental group exhibited higher mean SACS scores (4.74 ± 1.75) than the control group (3.28 ± 2.07). Lastly, the SDI analysis of the experimental and control group post‐exposure showed similar results. Conclusion Our study suggests that despite frequent engagement with social media, individuals tend to report satisfaction with their smiles. Trial Registration The study was registered at clinicaltrials. gov, date: 03/23/2023; identifier NCT05798650.
ABSTRACT Background and Aim Evolutionary principles offer critical insights into pandemic dynamics but have been largely overlooked in contemporary responses to COVID‐19. Relaxed natural selection, increased global mobility, and lifestyle mismatches have contributed to human vulnerability to infectious diseases in modern societies. This study investigated the relationship between healthcare development, measured by the Biological State Index (I bs ), and cumulative COVID‐19 infection rates across different countries and regions. Methods Data from 189 countries were analysed to assess the association between the Biological State Index and COVID‐19 infection rates, defined as the cumulative percentage of the population contracting COVID‐19. Correlation analyses (Pearson's r and Spearman rho), partial correlations adjusting for aging, economic affluence, urbanization, and vaccination coverage, and multiple linear regressions were performed. Countries were further stratified by income level, development status, and WHO regions to explore group‐specific patterns. Results Higher Biological State Index values were strongly associated with higher COVID‐19 infection rates globally (Pearson's r = 0.734, p < 0.001). Partial correlation analyses confirmed that this association remained significant after adjusting for key demographic and economic variables. Multiple regression models identified economic affluence and population aging as strong independent predictors, with the addition of the I bs further improving model fit. Stratified analyses demonstrated consistently stronger correlations in developing and low‐ to middle‐income countries compared to high‐income and developed nations. Conclusions Healthcare system advancement is strongly associated with higher reported COVID‐19 infection rates, likely reflecting greater susceptibility, improved detection capabilities, demographic shifts, and broader exposure opportunities. These findings highlight the importance of integrating evolutionary perspectives into pandemic preparedness strategies, recognizing that modern healthcare developments, while reducing mortality, may inadvertently alter infection patterns and pathogen‐host dynamics over time.
ABSTRACT Background and Aim Non‐adherence to diabetes medication treatment is a recognized public health problem that can lead to unfavorable clinical, humanistic, and economic outcomes. This study aimed to analyze adherence to insulin treatment in people with type 1 diabetes or type 2 diabetes in primary health care in a Brazilian municipality. Methods This cross‐sectional study was developed with 152 participants and a simple probability sample. We collected blood and urine samples, performed ophthalmological fundus examinations using a portable retinal camera on a smartphone, and conducted face‐to‐face interviews. Adherence was measured using the Insulin Treatment Adherence Measure, a version validated in Brazil. Results A higher proportion of women (63.2%), without private health plan (84.2%), with a medically diagnosed type 2 diabetes (93.3%), inadequate glycemic control (76.9%), and without diabetic retinopathy (71.7%) was observed. The prevalence of insulin therapy adherence was estimated at 47.4% (95% CI 39.4–55.3). Higher insulin therapy adherence was observed among males, self‐reported Nonwhite race/ethnicity, and those diagnosed with systemic arterial hypertension. A negative association was observed with alcohol abuse, amputation, and among those with private health plan ( p < 0.05). Conclusion Adherence to insulin treatment was low, and this scenario can lead to complications with various impacts, including increased healthcare costs. The associated variables evidenced the need for drug therapy management, incorporating multidimensional care for people with diabetes, to enable disease control in primary health care.