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Objectives: To assess the efficacy and safety of polyethylene glycol 3350 plus electrolytes (PEG+E) for the treatment of chronic constipation in children. Design: Randomised, double blind, placebo controlled crossover trial, with two 2-week treatment periods separated by a 2-week placebo washout. Setting: Six UK paediatric departments. Participants: 51 children (29 girls, 22 boys) aged 24 months to 11 years with chronic constipation (lasting ⩾3 months), defined as ⩽2 complete bowel movements per week and one of the following: pain on defaecation on 25% of days; ⩾25% of bowel movements with straining; ⩾25% of bowel movements with hard/lumpy stools. 47 children completed the double blind treatment. Main outcome measures: Number of complete defaecations per week (primary efficacy variable), total number of complete and incomplete defaecations per week, pain on defaecation, straining on defaecation, faecal incontinence, stool consistency, global assessment of treatment, adverse events and physical examination. Results: The mean number of complete defaecations per week was significantly higher for children on PEG+E than on placebo (3.12 (SD 2.05) v 1.45 (SD 1.20), respectively; p<0.001). Further significant differences in favour of PEG+E were observed for total number of defaecations per week (p = 0.003), pain on defaecation (p = 0.041), straining on defaecation (p<0.001), stool consistency (p<0.001) and percentage of hard stools (p = 0.001). Treatment related adverse events (all mild or moderate) occurred in similar numbers of children on PEG+E (41%) and placebo during treatment (45%). Conclusions: PEG+E is significantly more effective than placebo, and appears to be safe and well tolerated in the treatment of chronic constipation in children.

Background and Objectives: Clonidine is a common additive to local anesthetics for various regional and local nerve blocks. However, its effectiveness in dentistry has not yet been fully explored. Thus, this study was performed to evaluate the quality of anesthesia, vasoconstrictive effects, hemodynamic response, and pain control using a solution of 2% lignocaine hydrochloride with clonidine hydrochloride in comparison with the standard solution of 2% lignocaine hydrochloride and adrenaline bitartrate for pterygomandibular nerve blocks. Materials and Methods: A parallel arm, triple-blind randomized controlled study was conducted on 152 patients belonging to ASA-I (American Society of Anesthesiologists) category in the age group of 18-45 years, requiring surgical extraction of impacted mandibular third molars. The patients were divided equally into two groups randomly by computer-generated sequence; Group 1: 2% lignocaine hydrochloride with 1 ml of clonidine hydrochloride (150 μg/ml) and Group 2: 2% lignocaine hydrochloride with adrenaline bitartrate 1: 80,000 (12.5 μg/ml). The variables evaluated were systolic, diastolic, and mean arterial blood pressures, heart rate (HR), blood loss, onset, depth (pain), and duration of anesthesia. Results: There was a statistically nonsignificant difference seen between the two groups (P > 0.05) for the onset of anesthesia, pain assessed, and blood loss, whereas a statistically highly significant difference was seen for cardiovascular variables (systolic, diastolic and mean arterial blood pressures, and HR) at various intervals with higher values for Group 2 (P < 0.001) and for the duration of action of local anesthesia (LA), with higher values for Group 1 (P < 0.001). Conclusions: Clonidine as an additive to lignocaine has proved to have the onset of action, vasoconstrictive properties, and pain control, equivalent to adrenaline. However, with better stability of hemodynamic variables and prolonged duration of action of LA with clonidine, it can be considered as a better, safer, and more effective additive to lignocaine than adrenaline

ABSTRACT Introduction: Successful free tissue transfer depends on a multitude of factors, and adequate drainage of venous blood is one of the most critical part of successful free tissue transfers. Material and Methods: We report 6 cases of microvascular free flaps used for covering various defects, which developed venous congestion, that were salvaged with heparinised saline irrigation through the distal end of the congested vein by the help of an intravenous cannula. The irrigation was continued for 5 days. Results: All the flaps were successfully salvaged. Conclusion: This method has potential applications in situations for successful salvage of free tissue transfer particularly due to venous thrombosis.

Reforms of the Indian mining sector go back as far as 1991. The present round of reforms, however, fails to address the most important part of the mining sector: coal mining. A big reform has to be introduced to allow the coexistence of both public and private sectors in commercial exploitation of coal resources for the energy needs of the country. It is important to at least attempt to quantify the tangible financial benefits of the present reform accruing to the mining industry directly or indirectly. These aspects cannot be bye-passed as they strengthen the arguments for a true overhaul of the entire legal system governing the mining sector. In order for the mining sector to realize its full potential, more steps than those in the reform need to be undertaken to create a conducive environment for the industry to flourish.

Background: Implant therapy has become an important part of treatment to restore function and esthetics in partially/completely edentulous patients. Inspite of the progress made in implant dentistry since its inception, there have been some loopholes in scientific based knowledge and established clinical experience amongst dental professionals and postgraduates.So,an analysis was performed of the real picture. Objectives: A study was conducted to assess and compare the knowledge, attitude and practice of dental implants among dental postgraduate students and dental practitioners (General and institutional)in Davangere City, Karnataka and to identify the variations in their knowledge, attitude and practice with respect to dentist's factors (years of experience, implant training and their specialization). Materials and Methods: A cross sectional questionnaire based survey was conducted using census approach with informed consent. A pretested, self administered questionnaire containing demographic details and knowledge ,attitude and practice based questions was distributed and collected back from the respondents. Responses were coded before and decoded after the analysis. Statistical analysis was performed using SPSS SoftwareV17.0. Results: The results were determined after the statistically analyzed and concluded that the knowledge was widespread among postgraduates and dental practitioners and variations existed amongst the subjects with respect to age, gender, years of experience, practice type, implant training and their specialization. It was also found that the attitude and practice towards implants and their evidence based knowledge about the same was variable.

Abstract Background As AI-driven health data platforms like IDERHA scale across Europe, secondary use of personal health data raises ethical and public health challenges around trust and transparency. Conventional models of transparency, rooted in compliance or disclosure, often fall short in building sustained trust among diverse populations. This study explores how communication practices influence public perceptions of transparency, particularly under uncertainty and in the aftermath of data misuse. Methods Under Work Package 6 (Task 6.2) of the IDERHA project, we conducted two focus groups with patients, citizens, and data holders across multiple European settings. The qualitative study aimed to understand how transparency is experienced and what communication approaches support or undermine trust. Data were thematically analysed to identify key patterns in transparency-related expectations, frustrations, and proposals for improvement. Results Participants expressed dissatisfaction with current transparency practices, citing vague disclosures, limited feedback loops, and inadequate explanations of future data use. Frustration intensified following incidents like data breaches, where apology and accountability were often missing. Participants emphasized the need for specific, accessible, and culturally sensitive communication. They advocated for transparency as a dynamic and reciprocal process, not a one-time disclosure. Conclusions Findings support a shift from transactional to participatory models of transparency. Trustworthy communication should be iterative, inclusive, and responsive-recognising citizens as partners in data governance. These insights inform the design of communication infrastructures for projects like IDERHA and contribute to policy development within the European Health Data Space (EHDS), aiming to improve legitimacy and acceptance of secondary data use. Key messages • Transparency must be ongoing, inclusive, and responsive to sustain public trust in health data sharing. • Apology and accountability are key components of trustworthy communication after data misuse.

Background Length of stay at US acute care hospitals has been steadily decreasing since 1960, and there is ongoing concern that increasing financial pressures on hospitals with high proportions of Medicaid patients may be causing unduly short lengths of stay. Objective To study temporal trends in hospital utilization on internal medicine services at Temple University Hospital, which has the highest percentage of Medicaid and uninsured patients in the state of Pennsylvania. Design Examination of temporal changes in hospital practice over three time periods spanning 13 years. Measurements Numbers of discharges, 1- and 12-month re-admission rates, and lengths of stay. US census data from 1990 to 2000 were examined for the eight major zip codes in which hospitalized patients live. Main Results The number of internal medicine admissions increased from 1991 (117/month) to 2004 (455/month); p < 0.0001. Mean length of stay for the index admission decreased from 8.7 to 4.9 days; p < 0.001. The percentage of patients readmitted within 12 months of the discharge date of the index admission increased from 42.3% to 49.5%; p = 0.045. Mean cumulative length of stay over 12 months, including readmissions, decreased significantly (15.8 to 12.5 days; p = 0.031). Compared to all US hospitals, our hospital had a greater increase in admissions and a greater decrease in length of stay. During this time period, in surrounding zip codes, there were decreases in total population and total number of persons living in poverty, but also multiple closures of area hospitals that served poor patients. Conclusion During the 13-year study period, despite increased readmission rates, the overall number of hospitalized days per year on the internal medicine inpatient service decreased. As local hospitals serving this inner city low income area have closed, our hospital had atypically high increases in numbers of admissions and decreases in length of stay. This raises questions about current adequacy of hospital care in inner city areas of poverty.

Abstract Background The IDERHA project develops a European-scale data infrastructure to integrate electronic health records, imaging, and patient-generated data for secondary use in research and personalised care. While offering transformative potential, this raises significant public health questions around trust, especially across citizens, borders and institutions. Current frameworks relying on consent and anonymisation may fall short in addressing public concerns. This study investigates how trust in health data sharing is built, maintained, and broken down, under conditions of uncertainty, and asks what governance mechanisms can foster resilient, inclusive, and trustworthy data reuse. Methods We conducted two qualitative studies involving focus groups with patients, citizens, data users, and data holders across diverse European contexts. Discussions explored experiences and expectations around secondary data use, focusing on the relational, emotional, and structural aspects of trust. Workshop data were thematically analysed to identify trust drivers and conditions contributing to trust-breakdowns. Results Participants expressed concern about data misuse, future re-identification risks, and opaque reuse contexts,particularly among marginalised groups. Trust-breakdowns were often catalysed by minor issues such as vague communication or lack of institutional responsiveness. Participants called for anticipatory forms of governance, culturally inclusive communication, and co-designed safeguards. Mistrust was not seen as irrational, but as a legitimate response to uncertainty and past institutional failures. Conclusions Trust in health data reuse cannot rely solely on technical measures. Public health governance must adopt proactive, iterative frameworks that recognise mistrust as a diagnostic tool. Our results inform the evolving European Health Data Space (EHDS) and support the development of inclusive policies and ethical infrastructures for trustworthy health data sharing. Key messages • Trust in health data sharing requires proactive, inclusive governance beyond consent and anonymisation. • Mistrust offers critical insights into ethical blind spots and should guide policy design.

No definite treatment is known for COVID-19 till date. The objective of this study is to assess the efficacy of customized Homoeopathic medicines, when used as an add-on treatment to Standard of Care (SOC), in patients suffering from moderate to severe COVID-19 infection. This was a randomized, controlled, single-blind, parallel-group trial where 214 COVID19-positive patients were screened for moderate and severe cases of COVID-19. Adjuvant homoeopathic medicines were given in the treatment group and SOC was given to both groups. The duration of oxygen support was compared as the primary outcome. Subjects were followed for 28 days or till the end-point of mechanical ventilation/ death. Of 129 subjects included, 57 and 55 were severe; and 8 and 9 were moderate cases in Homoeopathy and SOC arms, respectively. In all, 9 (15.2%) participants in Homoeopathy and 20 (32.2%) participants in SOC arms eventually expired (p<0.05). Oxygen support was required for 9.84±7.00 and 14.92±7.549 days in Homoeopathy and SOC arms, respectively (p<0.005). Subjects receiving Homoeopathy (12.9±6.days) had a shorter hospitalization stay than in SOC (14.9±7.5 days). Homoeopathy arm (10.6±5.7 days) also showed statistically significant mean conversion time of of Realtime-Polymerase Chain Reaction (RT-PCR) from positive to negative than the SOC arm (12.9±5.6 days). The mean score of Clinical Outcome Ordinal Scale (COOS) was lower in the Homoeopathy arm. Laboratory markers [Interleukins (IL)-6, C-reactive protein (CRP), Neutrophils-Lymphocytes ratio (NLR)]were normalized earlier in Homoeopathy arm. Homoeopathy, as add-on therapy with SOC for COVID-19 management, demonstrates a reduction in mortality and morbidity, by reduced requirement of oxygen and hospitalization. Some laboratory markers are normalized at an earlier time. Hence, there is overall control over the disease. Registry: The study was registered on the http://ctri.nic.in/Clinicaltrials website under identifier number: CTRI/2020/12/029668 on 9th December 2020.

The aim of the study is to investigate the effectiveness of the modified Akinosi technique [MAT] in endodontic management of mandibular molars with symptomatic irreversible pulpitis, and to compare it with the standard inferior alveolar nerve block for effective pulpal anesthesia. A total of 80 clinically healthy patients of both genders, between 16 and 65 years, diagnosed with symptomatic irreversible pulpitis in mandibular first and second molars were included in the study. The subjects were divided into two groups. Group A received nerve block and pulpal anesthesia through Inferior Alveolar Nerve Block technique, while Group B received nerve block through MAT with 2% lignocaine containing 1:200,000 adrenaline. All endodontic treatments were performed in a single visit. We evaluated the presence of pain during various phases of endodontic treatment with Visual Analog Scale. The pain level was registered at the end of the following phases of the endodontic treatment: 1. During access cavity preparation; 2. While determining working length for all the root canals; 3. During cleaning and shaping of root canals. In Group B, 80% of patients reported no pain, as compared to 51% in Group A. MAT is an effective method for achieving pulpal anesthesia in endodontic treatment of symptomatic irreversible pulpitis.