Efficacy and safety of aspirin plus clopidogrel versus aspirin alone in ischemic stroke or high-risk transient ischemic attack: A meta-analysis of randomized controlled trials.

Background: Antiplatelet therapy plays an important role in reducing the risk of stroke recurrence in patients with mild ischemic stroke or high-risk transient ischemic attack (TIA). However, data regarding the effectiveness and safety of using aspirin plus clopidogrel in dual antiplatelet therapy (DAPT) compared to aspirin alone in mild ischemic stroke is limited. Methods: PubMed/MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) that compared DAPT to aspirin alone started within 72 hours in mild ischemic stroke or high-risk TIA. We used a random effects model to pool risk ratios (RRs) along with 95% CIs for clinical outcomes. Results: Four RCTs with 16,547 patients were included in this study. DAPT significantly reduced the risk of recurrent stroke by 26% (RR: 0.74; 95% CI: 0.67-0.83; p < 0.00001), ischemic stroke by 28% (RR: 0.72; 95% CI: 0.65-0.80; p < 0.00001), and major adverse cardiovascular events (MACE) by 24% (RR: 0.76; 95% CI: 0.68-0.84; p < 0.00001) compared to aspirin monotherapy. However, DAPT was associated with a significantly increased risk of moderate or severe bleeding (RR: 1.88; 95% CI: 1.10-3.23; p = 0.02) compared to aspirin alone. No significant differences were observed for hemorrhagic stroke (RR: 1.77; 95% CI: 0.96-3.29; p = 0.07), all-cause mortality (RR: 1.25; 95% CI: 0.87-1.80; p = 0.23), cardiovascular mortality (RR: 1.38; 95% CI: 0.81-2.33; p = 0.23), and myocardial infarction (RR: 1.63; 95% CI: 0.77-3.46; p = 0.20). Conclusion: DAPT involving aspirin plus clopidogrel reduces stroke recurrence and MACE but can lead to an increased risk of moderate or severe bleeding compared to aspirin monotherapy. (PROSPERO ID: CRD42024499310).

Compression-only versus standard cardiopulmonary resuscitation in out-of-hospital cardiac arrest: A meta-analysis of randomized controlled trials.

BACKGROUND: Bystander-initiated cardiopulmonary resuscitation (CPR) can improve survival rates in individuals with out-of-hospital cardiac arrest (OHCA). Two CPR approaches are commonly utilized, standard (S-CPR) with mouth-to-mouth breathing and compression-only (CO-CPR). We conducted a systematic review and meta-analysis to compare clinical outcomes associated with S-CPR versus CO-CPR in OHCA. METHODS: A systematic literature search was conducted using PubMed, EMBASE, and the Cochrane Library. Eligible studies included randomized controlled trials (RCTs) focused on adult OHCA patients receiving CO-CPR or S-CPR. Forest plots were generated for pooled data analysis using Review Manager version 5.4. Random-effect analyses were used, and statistical significance was set at p < .05. RESULTS: Four randomized controlled trials were included in the final analysis, encompassing a total sample size of 4987 patients (2482 in the CO-CPR group and 2505 in the S-CPR group). CO-CPR was associated with significantly improved 1-day survival compared with S-CPR (OR = 1.15; 95% CI: 1.02-1.31; p = .03) and survival to hospital discharge (OR = 1.25; 95% CI: 1.01-1.55; p = .04). No heterogeneity was observed among the studies for either outcome. CONCLUSION: CO-CPR emerges as a promising strategy for improving outcomes in OHCA compared to S-CPR. However, further large-scale RCTs are required to generate more robust evidence.

Deep Infiltrating Endometriosis: A Pictorial Essay.

Deep infiltrating endometriosis (DIE) is a subperitoneal intrusion of endometrial tissue. Resulting endometrial nodules may develop on the uterosacral ligament, urinary tract, rectovaginal, and retrocervical areas, and less commonly in the urinary bladder, thoracic, and neural regions. Genetics, age, and environmental factors determine the progression of the disease. DIE manifests with numerous symptoms, which are similar to unrelated diseases, namely dysmenorrhea, dyspareunia, urinary tract infections, and infertility. Transvaginal ultrasound, magnetic resonance imaging, computed tomography, and physical examination may detect and differentiate endometriosis lesions from other diseases. Its clinical management typically involves laparoscopic surgery and hormonal therapy. These are designed to improve the quality of life and to address individual reproductive goals. This pictorial essay aims to provide clinical cases to highlight the characteristic radiological findings in each diagnostic modality and in addition to elucidate the current clinical management of DIE.

Cutaneous Larva Migrans (CLM) may not be easy to diagnose: a case report and narrative review.

BACKGROUND: Cutaneous Larva Migrans (CLM) is one of the most common zoonotic dermatoses in subtropical and tropical regions and some European countries. It is caused by different types of hookworm, such as Ancylostoma braziliense, Ancylostoma caninum, and Uncinaria stenocephala. It is usually easy to diagnose, but the atypical presentation may occasionally mimic other dermatoses. CASE REPORT: A 32-year-old man presented with an extensive eczematous rash that developed during a recent vacation in Thailand. He didn't respond to antihistamines and systemic steroids. Finally, he was diagnosed with an atypical presentation of CLM and treated successfully with anthelminthic therapy. CONCLUSION: The report of an atypical presentation of CLM is crucial to increase awareness among healthcare workers, helping in early diagnosis and reducing potential psychological distress that patients may face.

Efficacy of Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Acute Myocardial Infarction: A Meta-Analysis of Randomised Controlled Trials.

BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular (CV) outcomes in patients with or without Type 2 diabetes and heart failure (HF). However, studies have shown conflicting evidence regarding their efficacy in patients following acute myocardial infarction (MI). We conducted a pilot systematic review and meta-analysis to synthesise the available evidence regarding the effectiveness of SGLT2 inhibitors in MI. METHODS: A systematic literature search was conducted using PubMed/MEDLINE, the Cochrane Library and Embase databases to identify randomised controlled trials (RCTs) that compared clinical outcomes of SGLT2 inhibitors with placebo following MI. We conducted the statistical analysis using RevMan, version 5.4 and pooled risk ratios (RRs) along the corresponding 95% confidence interval (CI) for all outcomes. RESULTS: Five RCTs reporting data for 11,211 patients were included in our study. The mean follow-up duration was 43.8 weeks. Our pooled analysis showed that SGLT2 inhibitors significantly reduced the risk of hospitalisations for heart failure (HHF) (RR = 0.76, 95% CI: 0.61-0.88, p = 0.001) in patients with MI. However, the risk of all-cause mortality (RR = 1.05, 95% CI: 0.78-1.41, p = 0.76), CV mortality (RR = 1.04, 95% CI = 0.84-1.29, p = 0.73) and all-cause hospitalisations (RR = 1.06, 95% CI: 0.96-1.17, p = 0.25) remained comparable across the two groups. CONCLUSION: SGLT2 inhibitors reduce HHF without affecting all-cause mortality, CV mortality and all-cause hospitalisations. However, further evidence is required to reach a definitive conclusion.

Intracranial intricacies: Comprehensive analysis of rare skull base meningiomas-A single-center case series.

This study paper's main goal is to report rare cases of skull base meningiomas that exemplify the complexities of diagnosis, therapy, and postoperative care. By describing these rare cases, we hope to advance knowledge of the clinical signs, difficulties, and prognoses of skull base meningiomas in a challenging anatomical setting. In the posterior cranial fossa, our investigation reveals a unique example of skull base meningioma that involved numerous cranial nerves and complex vasculature. A variety of visual abnormalities were present in the patient's clinical presentations, highlighting the wide range of symptoms that these tumors might cause depending on their precise positions. These cases highlight the critical importance of preoperative imaging, including high-resolution MRI and angiography, as well as the diagnostic difficulties these tumors pertain. By reporting these instances, our research adds to the body of knowledge about skull base meningiomas and offers insightful information about the nuances of their therapies. Our findings highlight the importance of individualized treatment plans, interdisciplinary cooperation, and the demand for continued study to better comprehend these convoluted tumors. Such studies are essential for advancing our knowledge of these enigmatic tumors, guiding clinical judgment, and eventually improving patient outcomes. These findings are important because they can fill information gaps, improve treatment plans, and encourage additional research in neuro-oncology. Abstract: This study presents a series of three rare cases of skull base meningiomas, emphasizing the complexities in diagnosis, treatment, and postoperative care. The patients' clinical presentations and imaging highlighted the diverse symptoms and challenges associated with these tumors, found in intricate anatomical locations. The cases underscore the crucial role of preoperative high-resolution imaging and angiography in diagnostic accuracy. Surgical intervention, guided by a multidisciplinary approach, is pivotal in managing these demanding cases. Histopathological examinations confirmed atypical meningiomas. The postoperative phases involved meticulous care to ensure optimal recovery and functional outcomes. Our findings contribute to the understanding of skull base meningiomas, emphasizing the need for personalized treatment plans and ongoing research to improve patient outcomes in neuro-oncology.

Enhancing WHO Prescription writing guideline adherence through an educational intervention - a quality improvement study of Azad Jammu and Kashmir.

BACKGROUND: Prescription writing is an important component of healthcare delivery and can directly influence patient safety and treatment outcomes. Prescription errors are common in developing countries because of the lack of national guidelines. This two-cycle clinical audit assessed the impact of educational interventions on improving prescription writing practices. METHODS: A cross-sectional prospective clinical audit was conducted in the Out Patients Department (OPD) of the District Head Quarters (DHQ) Hospital in Bhimber, Azad Jammu, and Kashmir. A total of 100 randomly selected prescriptions were reviewed for each cycle from July to August 2023. We recorded compliance with WHO guidelines for prescription writing before and after the educational intervention. Microsoft Excel and SPSS version 25.0 were used for statistical analysis. Categorical variables were analyzed using frequencies and percentages. RESULTS: An improvement in compliance was observed during the 2nd audit cycle, after the educational intervention. The greatest improvement was observed in documenting the allergic status of patients (62%) and the direction of drug administration (40%). We also observed improvements in the treatment duration (>10%), patient weight, physician registration number, diagnosis, and follow-up advice. The legibility of prescriptions also improved during the 2nd audit cycle. CONCLUSION: This study shows that integrating an educational intervention into a clinical audit can improve prescription writing practices and ultimately result in better quality of care for patients.

Potential for and challenges of menstrual blood as a non-invasive diagnostic specimen: current status and future directions.

Menstrual blood, which is often discarded as a waste product, has emerged as a valuable source of health information. The components of menstrual blood, such as endometrial cells, immune cells, proteins, and microbial signatures, provide insights into health. Studies have shown encouraging results for using menstrual blood to diagnose a variety of conditions, including hormonal imbalances, cervical cancer, endometriosis, chlamydia, diabetes, and other endocrine disorders. This review examines the potential of menstrual blood as a non-invasive diagnostic specimen, exploring its composition, promising applications, and recent advances. This review also discusses challenges to utilizing menstrual blood testing, including ethical considerations, the lack of standardized collection protocols, extensive validation studies, and the societal stigma around menstruation. Overcoming these challenges will open new avenues for personalized medicine and revolutionize healthcare for individuals who menstruate.

Noma in the WHO's list of neglected tropical diseases: A review of its impact on undeveloped and developing tropical regions.

Background: Noma is a neglected tropical disease and a global health concern. Objectives: To elucidate the epidemiology, management, prevention, and public health implications of Noma. Methods: PubMed, Scopus, and Web of Science, supplemented by Google Scholar and World Health Organization databases, were searched using keywords to gather both published and grey literature from 1970 to 2023 in English. Results: Approximately 30,000-40,000 cases occur annually, with varying incidences across various African countries, such as Nigeria, Niger, and Chad. Incidence in Nigerian and Ethiopian states range from 0.6 to 3300 and 1.64 to 13.4 per 100,000 population, respectively. Mortality is approximately 8.5% in Niger. Risk factors include malnutrition, immunocompromised status, poor dental hygiene, inadequate sanitation, gingival lesions, low socioeconomic status, chronic and infectious diseases, low birth weight, high parity, diarrhoea, and fever. Diagnosis is primarily made based on clinical signs/symptoms and accordingly staging of disease is done. Stage I, II and II presents with acute necrotizing gingivitis, facial edema with halitosis, and necrotizing stomatitis, respectively. If the patient survives acute stages, the progress to Stage IV and Stage V manifests as trismus, difficulty in deglutition and phonation, and facial disfigurement, with increased severity in last stage. Treatment encompasses antibiotic therapy (amoxicillin, metronidazole, chlorhexidine, ampicillin, gentamicin), surgical interventions, wound management (honey dressing, ketamine), and nutritional support. Prevention strategies include oral hygiene, vaccination, health education, and community-based interventions. Conclusion: Noma's recent inclusion in WHO list of neglected tropical diseases is a milestone in recognizing the importance of prevention and early intervention to globally enhance health outcomes.

Redefining Management in Hypertrophic Cardiomyopathy: The Role and Challenges of Exercise Rehabilitation.

Hypertrophic cardiomyopathy (HCM), a common genetic heart condition, is characterized by thickening of the left ventricle, which can result in a range of health issues, such as arrhythmias, heart failure, and sudden death. Despite traditional cautions against exercise in HCM patients due to potential exacerbation of symptoms and risk of sudden death, recent evidence suggests a paradigm shift toward the benefits of structured exercise rehabilitation. The pathogenesis of HCM, the physical and psychological effects of the illness on patients, and changing views on exercise as a therapeutic intervention are all covered in this review. Recent research shows that modest physical activity can considerably enhance functional ability, psychological health, and overall quality of life in individuals with heart failure without increasing the risk of unfavorable cardiac events, challenging earlier recommendations. Moreover, exercise rehabilitation has been shown to induce favorable myocardial remodeling and enhance cardiovascular fitness, suggesting a revaluation of exercise prescriptions tailored to individual patient profiles. Despite the promising role of exercise in managing HCM, this review also acknowledges the complexities of implementing rehabilitation programs, including the need for comprehensive patient assessment, personalized exercise regimens, and monitoring for potential complications. Future research should focus on optimizing exercise recommendations, understanding long-term outcomes, and integrating exercise rehabilitation into standard care protocols for HCM to foster a more holistic approach to patient management. Underscoring the necessity of a multidisciplinary strategy that balances the benefits of physical activity with the unique risks associated with HCM with the aim of improving patient outcomes through evidence-based, patient-centered care.

Outcomes of definite vs probable/presumed cardiac sarcoidosis: a systematic review and meta-analysis.

BACKGROUND: Diagnosing cardiac sarcoidosis (CS), which can be associated with arrhythmias and heart failure, remains challenging despite multiple advances over time. The 2014 Heart Rhythm Society (HRS) consensus statement recommends an endomyocardial biopsy (EMB) to establish a definite diagnosis of CS. In the absence of a positive EMB, a diagnosis of probable or presumed CS is made on the basis of clinical and imaging criteria. OBJECTIVE: To investigate whether there is any difference in outcomes between definite vs probable/presumed CS. METHODS: PubMed/MEDLINE, Embase, and the Cochrane Library databases were searched for relevant studies published after 2014. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using the random effects model and presented in forest plots. RESULTS: 6 studies involving 2,103 patients were identified. The cohort had a mean age of 56.8 years (SD:±13.6 years). The median duration of follow-up was 40.5 months. No statistically significant difference was observed between definite and probable/presumed CS for reduced risk of the composite endpoint (RR: 1.06, 95% CI: 0.66 to 1.72), all-cause death (RR: 1.03, 95% CI: 0.73 to 1.46), sudden cardiac death (RR: 1.59, 95% CI: 0.99 to 2.56), arrhythmias (RR: 0.80, 95% CI: 0.60 to 1.07), and HF-related hospitalizations (RR: 0.91, 95% CI: 0.59 to 1.38). CONCLUSION: This meta-analysis demonstrated the equivalence of clinical course and prognosis between definite and probable/presumed CS. This highlights the importance of a multi-disciplinary approach to CS care and emphasizes that histological confirmation should not be a prerequisite to diagnose or manage this condition.

Frequency of Severe Asthma and Its Clinical Phenotypes at the Asthma Clinic in One of the Largest Sudanese Tertiary Pediatric Hospitals: A Cross-Sectional Hospital-Outpatient-Based Study.

Background: Asthma is one of the most common non-communicable diseases. Childhood asthma has been increasing in Sudan, with a 13-16% prevalence among Khartoum school children. To achieve and maintain good asthma control, proper diagnosis, assessment of severity, and appropriate medication administration are crucial, with phenotyping being a key factor in determining patients' specific treatment. Objective: To study the frequency of severe asthma and the distribution of its different phenotypes and to investigate associations between age and gender and different phenotypes of asthma. Methodology: This descriptive cross-sectional hospital-based study was conducted in the Asthma Clinic of Mohamed Al-Amin Hamid Pediatrics Hospital. It included 229 patients who were presented to the clinic from September 2021 to April 2022. Data were collected from the patients and/or their caregivers using a modified validated standard questionnaire and were analyzed using SPSS version 26.0. A p-value of 0.05 or less was considered statistically significant. Results: In this study of 229 participants, 14.4% had severe asthma, with 44.5% and 41% exhibiting mild and moderate asthma, respectively. Most were effectively managed in steps 2 or 3. The cohort, primarily aged 5 or younger (40.2%) with a male majority (62%), showed a mean diagnosis age of 2.9 ± 2.8 years. Impressively, 90% maintained well-controlled asthma. Within severe asthma cases (87% atopic), 39.4% represented a severe allergic asthma phenotype. Elevated eosinophil counts were noted in 45.5% (serum) and 78.8% (sputum cytology), while 57.6% had normal serum IgE levels. The predominant symptom pattern in severe asthma was episodic multi-trigger wheezing (48.5%). Age and gender displayed no significant association with severe asthma phenotype. Conclusion: This study reveals a concerning rise in childhood asthma prevalence in Sudan, emphasizing the importance of tailored treatment strategies. Severe asthma, characterized by atopic eosinophilic involvement, necessitates targeted interventions in pediatric asthma care for specific phenotypes.

Rare occurrence of sagittal sinus thrombosis and haemorrhagic infarction with dengue fever: jumping from traditional symptoms to lethal neurological consequences.

Introduction and importance: Dengue virus (DENV) is an RNA virus transmitted by Aides mosquito causing dengue fever. There is growing recognition of neurological symptoms associated with DENV infection, some of which might be lethal if left untreated. Case reports describing sagittal sinus thrombosis, as a serious neurologic consequence of dengue infection, are rare. It is still unknown how often sagittal sinus thrombosis occurs and what variables increase the risk in dengue patients. Case presentation: Herein the authors presented an elderly Sudanese patient diagnosed with dengue fever. He was admitted, then 2 days after admission, the condition was complicated by atrial fibrillation, sagittal sinus thrombosis complicated by massive left temporal lobe infarction with haemorrhagic transformation and recurrent episodes of status epilepticus. After receiving the necessary care, his condition remained the same and no progress or deterioration was seen. Clinical discussion: Sagittal sinus thrombosis can happen due to several underlying causes. DENV can very rarely lead to such condition. The authors' patient developed this condition, which was later complicated by ischaemic stroke with haemorrhagic transformation and status epilepticus. In addition to a familial history of DVT and a history of myocardial infarction, our patient also acquired cardiac mural thrombus and DVT throughout his illness, which increased the suspicion of a protein C, protein S, or antithrombin 3 deficiency. Conclusion: Sagittal sinus thrombosis with haemorrhagic infarction associated with thrombocytopenia is a very rare kind of stroke that occurs in dengue. Dengue as a pathogenic mechanism of ischaemic stroke requires validation with further data.

Clinical outcomes with cardiac resynchronization therapy in patients with Cardiac Sarcoidosis: A systematic review and proportional meta-analysis.

BACKGROUND: Cardiac sarcoidosis (CS) is an inflammatory condition that can present with heart failure (HF). Cardiac resynchronization therapy (CRT) is known to improve clinical outcomes for patients with left bundle branch block in the general HF population. However, data about the outcomes of CRT in CS is limited. METHODS: A systematic literature search was conducted using PubMed/Medline, Embase, and the Cochrane Library from inception to February 2024 to identify studies that reported clinical outcomes following the use of CRT in patients with CS. Data for outcomes was extracted, pooled, and analyzed. OpenMetaAnalyst was used for pooling untransformed proportions along with the corresponding 95 % confidence intervals (CIs). RESULTS: Five studies with a total of 176 CS patients who received CRT were included. The pooled incidence for all-cause mortality was 7.6 % (95 % CI: -3 % to 18 %), for HF-related hospitalizations 23.2 % (95 % CI: 2 % to 43 %), and for major adverse cerebral and cardiovascular events 27 % (95 % CI: 8 % to 45 %) after a mean follow-up of 60.1 (±48.7) months. The pooled left ventricular ejection fraction (LVEF) was 34.28 % (95 % CI: 29.88 % to 38.68 %) demonstrating an improvement of 3.75 % in LVEF from baseline LVEF of 30.58 % (95 % CI: 24.68 % to 36.48 %). The mean New York Heart Association (NYHA) functional class was 2.16 (95 % CI: 1.47 to 2.84) after CRT as compared to the baseline mean NYHA of 2.58 (95 % CI: 2.29 to 2.86). CONCLUSION: Although improvements were observed in LVEF and mean NYHA, mortality was high in CS patients with CRT.

Healthcare workers' knowledge and risk perception regarding the first wave of COVID-19 in Khyber Pakhtunkhwa, Pakistan: an online cross-sectional survey.

Background: Increased COVID-19 transmission among the populace may be caused by healthcare workers (HCWs) who lack knowledge, awareness, and good preventive practices. Additionally, it may cause elevated stress levels, anxiety, poor medical judgement, and situational overestimation. Objectives: The present survey aimed to assess knowledge and risk perception regarding COVID-19 among HCWs in Khyber Pakhtunkhwa (KP), Pakistan. Methodology: A web-based online, pre-tested questionnaire comprising 26 items was circulated via social media in April 2020 amongst HCWs in major tertiary care facilities in KP. Results: The study's results, revealing both the commendable knowledge levels among HCWs about COVID-19 and their heightened risk perception, highlight the critical need for targeted interventions to address the potential impact on self-protective behaviour and mental health within this vital workforce. This insight is important for designing strategies that not only enhance HCWs' well-being but also ensure the continued effectiveness of healthcare delivery during pandemics. The percentage mean score (PMS) of COVID-19 knowledge was 85.14±10.82. Male HCWs and those with an age older than or equal to 32 years demonstrated a higher knowledge score (85.62±11.08; P=0.032 and 87.59±7.33, P=0.021, respectively). About 76% of HCWs feared contracting COVID-19. Nearly 82% of respondents were mentally preoccupied with the pandemic and also terrified of it. 'Of these, 81% were nurses, 87% had a job experience of 6-8 years and 54.45% were frontline workers. Feelings of panic and concern about the pandemic were found to be more in HCWs who were physicians above the age of 32, and who had 3-5 years of work experience. HCWs' overall risk perception was found to be significantly different between males (7.04±2.26) and females (8.01±1.97), job experience of 6-10 years (8.04±177) with 3-5 years and younger than or equal to 2 years job experience (7.18±2.43,6.93±2.22), respectively, and between frontline HCWs (7.50±2.10) and non-frontline HCWs (6.84±2.40). Conclusion: HCWs demonstrated good knowledge about COVID-19. As the risk perception of COVID-19 among HCWs is high, it can raise concerns about their self-protective behaviour, and mental health. These issues need to be addressed.

Infectious diseases following hydrometeorological disasters: current scenario, prevention, and control measures.

Natural disasters are catastrophic occurrences that can seriously harm infrastructure, inflict property damage, and even result in fatalities. Water supply and sanitation systems can be disrupted in flooded areas, raising the risk of infectious diseases. It is advised that public health responders do a disease risk assessment of such a catastrophic event to ascertain the disaster's consequences and the health requirements. This editorial provides an overview of the transmission of infectious illnesses after hydrometeorological disasters. It also discusses the effects of such catastrophes on individuals' psychological and physical health who live in disaster-prone locations.

Post-traumatic stress disorder following childbirth: a neglected cause.

Post-traumatic stress disorder (PTSD) following childbirth is a significant mental health risk for women globally. However, it remains a neglected cause, particularly in low-income countries like Pakistan. This paper explores the unique challenges faced by women in such settings, including limited access to healthcare and social support, cultural norms, and stigma surrounding mental health. The diagnosis and causes of postpartum PTSD are discussed, along with its effects on both mothers and their infants. The lack of awareness and training among healthcare professionals in recognizing and treating postpartum PTSD is highlighted as a major barrier to adequate care. To address these challenges, the paper proposes a comprehensive approach, including raising public awareness, providing mental health support and resources, and integrating postpartum mental health into medical education. Trauma-focused therapies are recommended for effective treatment. The paper concludes with the need for more research in low-income countries and emphasizes the importance of understanding and supporting women with postpartum PTSD to improve their well-being and maternal and child health.

A rare case of mandibular third molar displaced into submandibular space: A complication of mandibular third molar extraction.

Key Clinical Message: Accidental displacement of mandibular third molars or their roots into neighboring anatomical spaces, notably the submandibular region, during extraction, is a rare but significant complication. Comprehensive preoperative assessment, meticulous surgical techniques, and precise radiographic imaging play pivotal roles in successful management. Adhering to established protocols is imperative to mitigate potential complications and ensure optimal outcomes. Abstract: In this report, we emphasize the critical importance of comprehensive preoperative preparation to tailor surgical approaches and techniques in accordance with recognized surgical principles. Oral and maxillofacial surgery often involves the extraction of impacted lower third molars, a common surgical procedure. However, this procedure can present potential complications such as hemorrhage, tissue damage, infection, alveolar osteitis, paresthesia, and mandible dislocation. Unintentional displacement of a mandibular third molar or its root fragments into adjacent anatomical areas, such as the maxillary sinus or submandibular space, is a rare intra-operative exodontia complication that is seldom documented. A 44-year-old male patient presented with complaints of pain, discomfort, and limited mouth opening. He had previously attempted to have a tooth extracted, but the procedure resulted in a misplaced tooth. A painful, indurated swelling was observed at the patient's left mandibular angle. Radiographic analyses revealed a radiopaque lesion resembling the third molar tooth root. Utilizing orthopantomography and CT images, the misplaced root in the left submandibular region was accurately located. The tooth was successfully extracted following the elevation of a lingual flap. The patient was prescribed antibiotics and painkillers for 7 days, and he reported an uneventful recovery with no complications on the eighth postoperative day. Accidental displacement of lower third molars or root fragments into neighboring anatomical areas is a rare but potentially concerning complication. Common sites of displacement include the submandibular, sublingual, and pterygomandibular spaces. Risk factors for displacement encompass improper use of surgical instruments and variations in patient anatomical characteristics. The ease of extraction can be influenced by various factors, including the degree of impaction, root structure, and dental inclination. Recommended screening examinations include panoramic radiography, intraoral periapical (PA) radiography, and occlusal radiography. Precise diagnosis and localization necessitate radiographic assessments such as CT scans and panoramic radiography. Postoperative care involves administering analgesics, antibiotics, suturing, wound irrigation, and managing potential complications like swelling, discomfort, infection, and nerve damage. Accidental displacement of lower third molars or their roots into the submandibular region is an infrequent yet potential complication. Thorough case assessment and adherence to established protocols for appropriate access, judicious bone removal, and avoiding excessive force are imperative for clinicians in the field of oral and maxillofacial surgery.