To highlight our experience in the management of patients with severe subglottic and/or upper tracheal stenosis associated with neurological co-morbidities. Effective tips and tricks in the surgical technique were emphasised.

This study included 33 patients with neurological co-morbidities who underwent tracheal and/or cricotracheal resection anastomosis. To decrease the anastomotic tension, suprahyoid release was performed and trachea-hyoid detensioning stitches were placed. Surgiflo® was applied over the anastomosis to enhance healing. Surgical and functional outcomes were evaluated.

The decannulation rate was 90.9 per cent. Regarding the functional outcomes, significant improvement of voice and swallowing was noticed after surgery. None of the patients experienced deterioration in their pre-existing neurological conditions following surgery.

Patients with severe subglottic and/or upper tracheal stenosis associated with neurological co-morbidities are challenging. Certain refinements in the surgical technique such as tailored suprahyoid release, tracheo-hyoid detensioning stitches and the application of Surgiflo are crucial to enhance healing, decrease anastomotic tension and improve outcomes.

Radiotherapy (RT) is a highly effective breast cancer treatment. However, RT can deliver radiation dose to the healthy tissues of the shoulder, increasing the potential for long-term shoulder morbidity. This study compared the dose delivered to key shoulder muscles between common RT techniques and patient positioning.

The treatment plans of 54 patients were analysed, including those treated in the prone and supine positions. Eight shoulder muscles were contoured on each patient’s computer tomography scan. The following breast treatment techniques were analysed: hybrid-intensity-modulated RT (hybrid IMRT), wedged field, two partial arcs volumetric-modulated arc therapy (VMAT), hybrid VMAT, and 3-field supraclavicular technique. Moreover, the effect of patient positioning was also evaluated (supine versus prone). Muscle radiation exposure was compared for the mean dose and the percent muscle volume exposed to V15 Gy and V30 Gy.

The mean dose and exposed volume for the pectoralis major and pectoralis minor were similar between hybrid IMRT, wedged field, VMAT, and hybrid VMAT. VMAT and hybrid VMAT delivered a greater mean dose to most posterior shoulder muscles compared to hybrid IMRT, though overall exposure remained generally low for these muscles. The 3-field supraclavicular technique increased radiation exposure to all shoulder muscles, particularly to the pectoralis major, the pectoralis minor and the supraspinatus. Prone positioning significantly reduced V15 Gy and V30 Gy exposure for both anterior and posterior shoulder muscles.

Shoulder muscle exposure was similar between hybrid IMRT, wedged field, VMAT and hybrid VMAT. The anterior shoulder muscles were consistently exposed to radiation with all RT techniques investigated in this study. In comparison, the 3-field supraclavicular technique substantially increased the radiation exposure to the posterior shoulder muscles. Lastly, delivering radiation in the prone position spared the anterior and posterior shoulder muscles. These findings inform treatment planning decisions aimed at mitigating the risk of long-term shoulder dysfunction.

The current study examined perceptions of and experiences with Flint Families Cook, a virtual cooking and nutrition programme for youth and families.

Families were invited to participate in virtual focus groups after completing the 5-week Flint Families Cook programme. The research study was guided by Social Cognitive Theory. Researchers used thematic analysis to examine the transcribed focus groups, identify patterns across transcripts and develop emerging themes.

Families living in Flint and surrounding Genesee County, Michigan, USA, engaged in virtual focus groups via Zoom.

Youth (n 32; 59 % female, 53 % African American) and adult caregivers (n 31; 90 % female, 39 % African American) participated in focus groups between October 2020 and February 2022.

Five themes were generated from the focus group discussions: (i) general cooking challenges; (ii) class format; (iii) family support; (iv) provision of food; and (v) instruction and learning.

In addition to perceived positive impacts on cooking skills and nutrition education, many participants shared that Flint Families Cook encouraged family cohesion and support. Most caregivers felt the programme, which included instruction by a chef and dietitian as well as ingredient box delivery, had important impacts on the emotional health of youth and family resilience. Flint Families Cook, and similar virtual scalable programmes, could broadly reach children and families to support physical and psychosocial health, especially in low-resource communities where such interventions may be most beneficial.

End-of-life dreams and visions (ELDVs) and delirium frequently occur near death but differ in core features. Clinical differentiation becomes challenging when they co-occur. This case report illustrates the interplay between ELDVs and delirium, examines the limits of current diagnostic criteria in mixed cases, and outlines a nuanced approach to distinction.

We report the case of an elderly Brazilian woman with metastatic cancer who exhibited both ELDVs and delirium. Mental status was serially assessed using the Confusion Assessment Method (CAM). ELDV accounts were prospectively triangulated across patient, family, and clinician reports to enhance reliability and contextual understanding.

The patient’s experiences showed ELDV hallmarks – vivid, realistic encounters with deceased relatives, biographical relevance, and preparatory themes – yet many were affectively distressing and occurred alongside fluctuating attention and consciousness consistent with delirium. CAM effectively identified delirium but could not, on its own, distinguish ELDVs within delirious states. When co-occurring, ELDVs often emerged during “windows of lucidity” marked by preserved autobiographical context, intact recall with subsequent coherent narration, and insight, despite intense emotional valence. Distress alone was not discriminatory, probably being shaped by psychosocial and cultural factors. These observations indicate the need to supplement CAM with qualitative and phenomenological criteria, including content, vividness, biographical meaning, insight, cultural fit, and acuity/recall.

To our knowledge, this is the first case to map evolving end-of-life mental status using serial CAM while prospectively documenting ELDVs via triangulated reports. The findings highlight the complexity of differentiating co-occurring ELDVs and delirium and challenge the sufficiency of CAM alone. An integrated approach – combining CAM screening with structured ELDV assessment – may prevent misclassification and support holistic, dignified palliative care. As a single case in an underexplored domain, these insights require confirmation in larger, prospective studies to assess generalizability.

This study aimed to evaluate the characteristics, difficulties, and outcomes of patients who underwent transcatheter ablation treatment due to arrhythmia with a diagnosis of CHD.

A total of 166 patients (189 substrates) with CHD who underwent catheter ablation between November 2013 and 2023 were evaluated retrospectively. EnSite™ (St Jude Medical Inc., St Paul, MN, USA) was used in all patients.

The mean age was 14.8 ± 7.9 years (2.9–43 years). The most common CHD’s were Ebstein anomaly (n: 40), tetralogy of Fallot (n: 31), atrial septal defect (n: 25), ventricular septal defect (n: 22), great artery transposition (D/L TGA, n: 12), and complex CHD in single ventricle physiology (n: 9). The most common arrhythmia mechanisms were Wolf-Parkinson-White syndrome (WPW, n: 50), intraatrial reentrant tachycardia (IART, n: 39), typical atrioventricular nodal reentrant tachycardia (AVNRT, n: 37), and ventricular tachycardia-ventricular extrasystoles (VT/VES, n: 23). There was more than one arrhythmia in 23 patients and multiple manifest accessory pathways in 10 patients. The average procedure time was 174 ± 69.3 minutes, and the average fluoro time was 8.3 minutes. While successful ablation was performed in 176/189 (acute success 93.1%) substrates, the procedure was unsuccessful in five patients and suboptimal in eight patients. Recurrence was observed in 11 patients (6.4%) during a mean follow-up period of 49.2 ± 30.1 months. A second ablation was performed on 13 patients. Acute success was achieved in all except one patient. A total of 11 patients are being followed up with medical treatment.

Despite the complex anatomy, age, operations, and limited vascular access possibilities in patients diagnosed with CHD, transcatheter ablation treatment with advances in electrophysiology, the introduction of different energy types, special ablation catheters, multipolar mapping catheters, and 3D nonfluoroscopic mapping systems seems to be a safe and effective option.

Overweight and obesity have become a global public health concern, with prevalence rising sharply in low- and middle-income countries. This study analysed temporal trends in overweight and obesity among schoolchildren in the largest capital city of Brazil, from 2006 to 2024.

Repeated cross-sectional.

Schoolchildren aged 6 to 19 years from Porto Velho, Rondônia, Brazil.

A total of 12 646 participants were evaluated. To assess the BMI z-score, standardised body mass and height measurements were used, stratified by sex (male and female) and age group (6–10 and 11–19 years). Temporal trends were assessed using joinpoint regression analysis.

Overall, 17·8 % of participants were classified with overweight, and 8·6 % were classified with obesity. The study also found that obesity prevalence was consistently higher among younger age groups compared to adolescents. The results revealed a significant increase in obesity prevalence among girls (annual percentage change (APC) = 5·81 %; 95 % CI = 1·03–10·81; P-value = 0·021) and children aged 6 to 10 years (APC = 5·20 %; 95 % CI = 1·17–9·39; P-value = 0·017), while no significant trends were observed for overweight or for male adolescents or adolescents aged 11 to 19 years.

Our findings indicate rising obesity among girls and children aged 6–10 years and support the need for urgency. We recommend targeted action, including implementing mandatory quality physical education and school nutrition standards, enforcing restrictions on marketing to children and prioritising municipal policies that increase access to healthy foods.

A better understanding of calcitonin gene-related peptide (CGRP) inhibitor use is in migraine treatment needed.

A retrospective, observational, population-based cohort study was conducted using administrative data. Adults (≥18 years) who received ≥1 prophylactic CGRP inhibitor in Canada (six provinces) between 2018 (first approved) and 2023 were identified. CGRP inhibitor use was described; migraine-related acute medication and healthcare use were compared pre–post CGRP inhibitor initiation (independent and paired t-tests).

12,851 adults were identified. CGRP inhibitor use increased from 11.8 (incident/prevalent) to 22.4 (incident) and 57.3 (prevalent) per 100,000 adults. Erenumab use decreased over time, as use of newer agents increased. During the 1-year period after CGRP inhibitor initiation, 57.4% had concomitant use with a different prophylactic migraine medication class (onabotulinumtoxinA injection: 23.2%; oral non-CGRP inhibitor: 34.2%), and 30.4% stopped use (21.3% switched to a different prophylactic migraine medication class; 9.1% discontinued all prophylactic migraine medication). During the 1-year period after CGRP inhibitor initiation (versus before), days of supply for migraine-related acute medication was lower (mean [standard deviation]: 129 [191] versus 145 [197] days; mean difference [95% confidence interval]: −16: [−22, −11] days), as were the number of healthcare visits (7.36 [8.70] versus 9.18 [10.10]; −1.82 [−2.06, −1.58]).

CGRP inhibitor use increased from 2018 to 2023. After CGRP inhibitor initiation, most patients had concomitant use with a different prophylactic migraine medication class, and some stopped use; migraine-related acute medication and healthcare use were lower (versus before). Findings provide a real-world description of the evolving landscape of CGRP inhibitor use in Canada.