Dalice in Limboland. Karuna Metta. LKC

DENTITION ENGLISH, DIENTE IN SPANISH, DONTO IN BENGALI

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I believe that the root of the work of being human is learning how to think. From this, we learn how to love, share, coexist, tolerate, give, create, and so on. I believe the first and most important duty we have is to actualize the potential we were born with—both for ourselves and for the world. The unspoken line of everything I write is: “This idea changed my life.” Because ideas are what change lives—and that was the first idea that changed mine. Brianna Wiest — July 2016

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5 bhava of Bhakti

In the context of Bhakti (devotional) traditions, the five Bhavas (or Pancha Bhava) represent different attitudes or relationships (bhakti moods) that a devotee can have toward the Divine. One of these is Vātsalya Bhava (parental love). Here are the five:

1. Śānta Bhāva (शान्त भाव) – A peaceful, neutral devotion, where the devotee sees God with reverence but without active emotional involvement. (Example: Rishis and sages like Sanaka, Sanandana, and Shukadeva)

2. Dāsya Bhāva (दास्य भाव) – The attitude of a servant toward their master, where the devotee worships God with deep obedience and surrender. (Example: Hanuman’s devotion to Lord Rama)

3. Sākhyā Bhāva (साख्य भाव) – The mood of friendship, where the devotee considers God as a close friend and interacts with Him informally. (Example: Arjuna and Sudama’s relationship with Krishna)

4. Vātsalya Bhāva (वात्सल्य भाव) – The mood of parental love, where the devotee sees God as their own child, expressing love, care, and affection. (Example: Yashoda and Nanda’s love for baby Krishna)

5. Mādhurya Bhāva (माधुर्य भाव) – The attitude of divine romantic love, where the devotee sees God as their beloved, experiencing devotion through deep emotional and even mystical union. (Example: Radha’s love for Krishna, the Gopis of Vrindavan)

Each of these bhavas represents a different way of experiencing and expressing devotion toward the Divine, with Mādhurya Bhāva often considered the highest in traditions like Gaudiya Vaishnavism. Are you exploring these concepts for spiritual practice, philosophy, or something else?

P MIGRAINE X GEPANTS

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This 17-year-old girl with a 5-year history of migraine has experienced some improvement in her migraine frequency with better sleep, stress management, and regular exercise. She currently has 3-4 migraines per year, but ibuprofen has been ineffective for acute migraine treatment, and sumatriptan caused nausea and vomiting when tried. She is also on medications for anxiety and depression (fluoxetine), oral contraceptives, and methylphenidate for ADHD.

Key Points:

• Chronic migraine has improved significantly with lifestyle changes.

• The patient’s acute migraine treatment with ibuprofen is ineffective.

• She experienced nausea and vomiting with sumatriptan, a serotonin receptor agonist.

• The mother is asking about gepants (a newer class of medications for migraine treatment).

Differential Diagnosis:

The patient's presentation suggests chronic migraine that has significantly improved in frequency with lifestyle modifications but requires better acute management. Her history of nausea with sumatriptan suggests potential side effects, and her question about gepants suggests interest in alternative acute treatment options.

Gepants in Migraine Treatment:

Gepants are a newer class of calcitonin gene-related peptide (CGRP) receptor antagonists that have been shown to be effective for both acute and preventive treatment of migraine.

1. Mechanism of Action: Gepants work by blocking the CGRP receptor, which plays a key role in migraine pathophysiology, particularly in the dilation of blood vessels and transmission of pain in the brain.

2. Approved Medications:

   • Rimegepant (Nurtec ODT)

   • Ubrogepant (Ubrelvy)

   These are FDA-approved for acute treatment of migraine attacks. Rimegepant is also approved for migraine prevention.

3. Benefits of Gepants:

   • Gepants are generally well-tolerated and do not carry the same serotonin-related side effects (e.g., nausea, vomiting) that are seen with triptans, such as the reaction the patient had with sumatriptan.

   • No vasoconstriction: Unlike triptans, gepants do not cause vasoconstriction, making them safer for patients with certain cardiovascular conditions.

   • Rapid onset: Gepants work relatively quickly, providing migraine relief within 2 hours.

   • Lower side effect profile: They have a lower incidence of common migraine treatments’ side effects, such as nausea, dizziness, or somnolence.

4. Considerations:

   • Gepants can be expensive, which may affect accessibility, especially for adolescent patients.

   • They are typically considered second-line therapies after failure of NSAIDs and triptans.

   • They may be a good option for patients who cannot tolerate triptans or those with contraindications to their use (e.g., cardiovascular disease).

Treatment Strategy:

Given the patient's history of ineffective ibuprofen and nausea with sumatriptan, gepants may be a suitable alternative for acute migraine treatment.

1. Acute Treatment:

   • Gepants (e.g., rimegepant or ubrogepant) may be an appropriate first-line option for this patient.

   • These medications can be used on demand to treat acute migraine attacks.

2. Preventive Treatment:

   • Since her migraine frequency has decreased with lifestyle modifications, preventive treatment may not be needed at this point. However, if the frequency increases, CGRP inhibitors (e.g., rimegepant) or beta-blockers can be considered as preventive treatments.

   • Given her history of anxiety and depression, preventive treatments should be chosen carefully to avoid exacerbating her psychiatric symptoms.

3. Non-Pharmacologic Strategies:

   • Continuing stress management, exercise, and sleep hygiene will be important to maintaining her improved migraine frequency.

   • Biofeedback or cognitive behavioral therapy may also help in managing both her migraines and underlying anxiety and depression.

Conclusion:

The most appropriate next step in treating this patient's acute migraine episodes would be the use of gepants (e.g., rimegepant or ubrogepant). These medications are effective, well-tolerated, and do not cause the nausea and vomiting seen with sumatriptan. As her migraine frequency is low (3-4 times per year), preventive treatments may not be necessary at this time, but they should be considered if the frequency increases in the future. Non-pharmacologic strategies should continue as part of her overall migraine management plan.

P HEADACHE

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This 15-year-old boy has chronic headaches that have been ongoing for the past 2 years, significantly impacting his quality of life by causing him to miss 8 to 9 days of school per month. Despite using ibuprofen daily, his headaches persist. He has tried magnesium, which helped but caused diarrhea, and coenzyme Q10, which was ineffective.

Given the chronicity, frequency, and lack of response to common over-the-counter pain management strategies, there are several potential differential diagnoses to consider for this patient.

Key Points:

• Chronic daily headache: The patient’s pattern of headaches occurring almost every day (headaches most days of the month) suggests a chronic daily headache disorder.

• Headache-related disability: Missed school days and the lack of effective treatment suggest a significant impact on his life, which is common in migraine or tension-type headaches that have become chronic.

• Inadequate response to ibuprofen: This suggests a more complex or severe form of headache, such as chronic migraine, that does not respond well to standard over-the-counter analgesics.

Differential Diagnoses:

1. Chronic migraine:

   • Chronic migraine is defined as headaches occurring on 15 or more days per month for more than 3 months, with at least 8 days of migraine symptoms (headache with photophobia, phonophobia, or nausea).

   • The patient’s chronic headache pattern, disability (school absenteeism), and history of treatment with ibuprofen (which provides inadequate relief) point toward this possibility.

   • The fact that magnesium provided some benefit but caused diarrhea and that coenzyme Q10 did not work suggests attempts at using non-pharmacological supplements for migraine prevention, which are less effective for chronic cases.

2. Tension-type headache:

   • This is also a common type of primary headache, but it tends to be more bilateral and pressing/tightening in quality. Unlike migraines, tension-type headaches are not typically associated with nausea or significant disability (e.g., school absenteeism) unless they become chronic.

   • If his headaches have a non-pulsatile quality and involve a sensation of tightness or pressure rather than throbbing, this could be a possibility.

3. Medication overuse headache (rebound headache):

   • This could occur if the boy has been using ibuprofen regularly for more than 10-15 days per month, leading to overuse. Rebound headaches typically occur due to frequent analgesic use and can cause a worsening of headache frequency and intensity.

   • If he has been using ibuprofen daily for a long period, this could contribute to the chronicity of his headaches.

4. Cervicogenic headache:

   • This type of headache can arise from neck problems and may be more common in individuals with postural problems or tension in the neck muscles. It is less likely to be the primary cause but could be considered if his headaches have a radiating quality from the neck or a pattern associated with neck strain.

5. Secondary causes (less likely, but worth considering):

   • Intracranial pathology (e.g., tumor, venous thrombosis, or intracranial hypertension) is less likely in this patient given the normal neurological examination and lack of red flag symptoms like neurological deficits, nausea/vomiting, or visual disturbances. However, if his headache pattern worsens or changes, further investigation could be warranted.

6. Asthma-related headaches:

   • Although asthma itself does not directly cause headaches, it could contribute to headaches if poorly controlled or leading to sleep disruption due to nocturnal asthma symptoms.

Diagnostic Approach:

Given this patient’s presentation of chronic headaches, a thorough history and physical examination are critical, especially to assess:

• Headache characteristics (e.g., duration, location, quality, triggers, associated symptoms such as nausea or visual changes).

• Medication use to rule out medication overuse headache.

• Examination for any neurological deficits that would suggest a secondary cause (e.g., brain tumor, increased intracranial pressure).

If the clinical suspicion points toward chronic migraine, diagnostic imaging (such as MRI of the brain) is generally not necessary unless there are red flag symptoms (e.g., sudden onset, significant neurological deficits, or abnormal examination findings). However, if there are concerning features or a change in headache pattern, MRI could be considered to rule out secondary causes.

Management Plan:

1. Migraine prophylaxis: For chronic migraines, medications like amitriptyline, topiramate, or valproate are often recommended. CGRP inhibitors (e.g., erenumab) are also newer options for chronic migraine management.

2. Acute management: Triptans (e.g., sumatriptan) or NSAIDs for acute attacks, especially for a migraine pattern.

3. Lifestyle modification: Stress management, regular sleep, hydration, and avoidance of known triggers.

4. Headache diary: Encourage tracking of headache frequency, duration, intensity, and associated symptoms, as well as medication use, to better understand patterns and triggers.

Conclusion:

The most likely diagnosis in this 15-year-old boy is chronic migraine, which can lead to frequent headaches that are difficult to treat with simple analgesics. This condition should be managed with preventive treatment, such as amitriptyline or topiramate, and acute treatment options like triptans or NSAIDs. Monitoring for medication overuse headache is important if ibuprofen is used excessively. Further diagnostic imaging would be indicated if there is concern for secondary causes.

P MIGRAINE

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This 13-year-old girl is presenting with typical migraine features: headache with phonophobia (sensitivity to sound), photophobia (sensitivity to light), and a moderate headache that lasts for several hours. There are no red flags such as vision loss, nausea, vomiting, sensory symptoms, or weakness, which is reassuring and suggests that the headaches are likely primary and not secondary to a more serious condition.

The patient is having migraines once or twice a week, which is frequent and affecting her daily life, with 2 missed school days in the past month. Her migraines are not relieved by acetaminophen, but sleep helps.

Treatment Approach:

• Acute migraine treatment generally includes NSAIDs (e.g., ibuprofen or naproxen), which are effective for many patients, especially when used early in the course of the headache. NSAIDs work by reducing the inflammatory response associated with the migraine.

• Preventive treatment is considered when migraines are frequent (more than 4 headaches per month) and significantly affect quality of life. Since this girl is having migraines once or twice a week, it is reasonable to start her on preventive treatment if the current approach (NSAIDs and lifestyle modifications) does not suffice.

In addition to NSAIDs, other medications for acute treatment may include triptans (e.g., sumatriptan) if symptoms are not adequately managed with NSAIDs alone.

Non-pharmacological treatments like maintaining a consistent sleep schedule, avoiding known triggers (such as certain foods, dehydration, or stress), and ensuring regular physical activity can also be helpful in managing her migraines.

Differential Diagnosis Considerations:

• Tension-type headache: The patient’s symptoms (mild/moderate headache with phonophobia and photophobia) make this less likely because tension-type headaches are generally not associated with such symptoms.

• Cluster headaches: These are typically characterized by severe, unilateral periorbital pain with autonomic features such as tearing and nasal congestion, which this patient does not have.

• Sinus headache: While this can present with facial pain and pressure, it does not typically involve phonophobia or photophobia.

Conclusion: The most appropriate approach for this patient is to begin NSAIDs for acute migraine relief, and if these headaches continue to be frequent and disabling, preventive treatment should be considered (e.g., beta-blockers, topiramate, or amitriptyline).

P HEADACAHE WITH B/L PAP

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This 16-year-old girl presents with bilateral papilledema, headaches, light and sound sensitivity, nausea, and brief double vision. These symptoms suggest increased intracranial pressure (ICP), and the presence of papilledema is a red flag indicating potential intracranial pathology. The recent weight gain following oral contraceptive use and the family history of migraine and a relative with a brain aneurysm further contribute to the complexity of the case.

Key considerations:

• Bilateral papilledema is a sign of increased intracranial pressure, which can be caused by a variety of conditions, including intracranial mass lesions, venous thrombosis, or idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri.

• The headaches, nausea, double vision, and weight gain in the setting of oral contraceptive use raise concern for idiopathic intracranial hypertension (IIH), which is a condition where there is increased ICP without a structural lesion, and it can be triggered or exacerbated by oral contraceptives.

Given the symptoms and clinical findings, the most appropriate next step in diagnosis would be to assess for increased intracranial pressure and to rule out secondary causes.

Most appropriate diagnostic test:

• MRI of the brain with venography or CT scan of the brain with venography (in cases where MRI is not available) to rule out structural abnormalities, such as tumors, venous thrombosis, or other causes of increased intracranial pressure.

In addition to imaging to rule out masses or other structural causes, a lumbar puncture (LP) could be considered to measure the opening pressure and analyze cerebrospinal fluid (CSF) in suspected IIH.

Thus, the most appropriate diagnostic test to perform in this patient would be an MRI of the brain with or without MR venography, to evaluate for any intracranial mass or other causes of increased intracranial pressure. If the MRI is normal, a lumbar puncture to assess opening pressure and CSF characteristics would be the next step in confirming a diagnosis of idiopathic intracranial hypertension (IIH).

P HEADCHE WITH WOBBLE

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In this case, the patient is a 10-year-old boy presenting with chronic headaches that have been occurring for an extended period. His headaches seem to follow a pattern related to school and improve over the summer, which suggests a possible environmental or stress-related trigger. His neurological exam reveals mild wobbling when walking heel-to-toe, and his mother reports a history of migraines.

When considering the most likely indication of a secondary headache disorder, we need to be vigilant for red flags or findings that could indicate a cause other than primary headaches (such as migraine or tension-type headache). Secondary headaches can result from conditions like structural abnormalities, infections, or increased intracranial pressure.

Key findings to consider for a secondary headache disorder:

• Neurological signs: Focal neurological findings (e.g., vision changes, numbness, weakness, or tingling) or signs of increased intracranial pressure (e.g., morning headaches, nausea, vomiting, or altered mental status).

• Recent changes in headache pattern: If the headaches change in severity, frequency, or character, or if they become more persistent or occur at unusual times, it could indicate something more serious.

• Associated symptoms: Such as vision changes, nausea/vomiting (suggesting increased intracranial pressure), or behavioral changes.

In this case:

• Wobbling when walking heel-to-toe is a subtle neurological sign. While it may not be a dramatic finding, it raises concern for possible cerebellar dysfunction, which could be indicative of a more serious condition like a mass effect, space-occupying lesion, or structural abnormality in the brain.

• Chronic, recurrent headaches with a recent increase in frequency also raise suspicion, as the headache pattern has changed from occasional headaches to more frequent headaches associated with the school year.

Thus, the mild wobbling when walking heel-to-toe is the most likely indication that this patient may have a secondary headache disorder, as it could suggest a neurological cause beyond simple migraine or tension-type headaches.

P HEADACHES

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A SWAMI RAMA

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Summary of Key Teachings from Verses 13-20 (Bhakti Yoga)

• Loving and Compassionate Nature: The ideal devotee is free from animosity and attachment, loving all beings equally without ego or pride. They forgive, remain kind, and treat pain and pleasure alike.

• Contentment and Self-Control: Such a devotee is content and has a controlled nature, with firm resolve and dedication. They do not crave for the fruits of their actions and perform duties with complete surrender to the divine.

• Equanimity: The devotee is not affected by success or failure, honor or dishonor. They maintain mental balance in the face of both praise and criticism, cold and heat, pain and pleasure. They live without attachment to worldly possessions, including a home.

• Selflessness and Non-Expectancy: They renounce desires and expectations, performing actions with pure devotion without seeking personal gain or recognition.

• Detachment and Freedom from Duality: The true devotee is indifferent to the opposites of life, such as joy and sorrow, and is free from insecurities. They are unaffected by external circumstances and remain unaffected by fear or anger.

• Faith and Dedication: The essence of Bhakti Yoga is devotion that comes from unwavering faith and dedication to the Lord. The devotee's heart and mind are completely aligned with the divine, and their actions are performed solely in service of the Lord, not for personal benefit.

• Virtuous Life: Key virtues for an aspirant on the path of perfection include kindness, humility, contentment, control over senses, and mental tranquility. By cultivating these qualities, one removes imperfections in mind, action, and speech, gradually attaining spiritual liberation.

• The Difficulty and Purity of Bhakti: Bhakti Yoga is not merely emotionalism but a deep, conscious practice of single-pointed devotion, requiring purity of mind and heart. The path is one of surrender, offering everything to the Lord without expectation of reward. It is an ecstasy where the lover and the beloved become inseparable.

• The Reward of Bhakti: Devotees who walk this path attain liberation, freedom from the cycle of birth and death, and live in eternal union with the divine. Their love for God transcends all, and they become free from all worldly suffering.

These verses reflect the profound and demanding nature of true devotion in Bhakti Yoga, emphasizing the importance of selflessness, purity, and unwavering love for the Divine.

SPRING CLEAN - “Clutter is not just physical stuff. It’s old ideas, toxic relationships, and bad habits. Clutter is anything that does not support your better self.” – Eleanor Brown

Happy Older People Live Longer

JUNK FOOD X BRAIN REWIRING

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Here’s a summary in bullet points of the article "How Quickly Junk Food Rewires the Brain for Obesity":

• Rapid Brain Changes: Junk food can rapidly alter brain function and increase the likelihood of obesity by triggering changes in the reward system.

• Dopamine and Reward: High-fat, high-sugar foods stimulate the brain’s dopamine receptors, which are linked to pleasure and reward. Over time, this can lead to cravings and a reduced sensitivity to rewards, encouraging overeating.

• Addictive Patterns: Similar to drug addiction, junk food consumption leads to patterns of compulsive eating. The brain starts to crave more unhealthy food, resulting in a cycle of overeating.

• Inflammation and Brain Function: Diets rich in processed foods may lead to inflammation in the brain, affecting cognitive function and making it harder to make healthy food choices.

• Long-term Effects: Continuous consumption of junk food can reshape brain circuits, making it harder to reverse the cravings for unhealthy food and contributing to long-term obesity risks.

• Impact on Appetite Control: Junk food can interfere with the brain’s ability to control hunger, leading to an increase in food intake and difficulty in regulating portion sizes.

• Obesity and Mental Health: The brain changes associated with junk food consumption may also affect mood and increase the risk of mental health disorders like depression and anxiety.

Let me know if you'd like more information or further details!

"It's always been my philosophy: Turn the page. If something falls through, turn the page. It's over with, get used to it, get on with it. Very simple. It's always worked for me." ~ Merv Griffin

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Here are some notable quotes by Merv Griffin:

1. "I learned a long time ago that you have to be yourself. You have to do what you feel is right for you."

2. "I always liked being a part of the entertainment world. It has always been a part of me."

3. "You can’t just let your life be about other people. You have to live your life for yourself."

4. "The key to success is to find something you love and do it well."

5. "Television is a powerful medium for education and for entertainment."

6. "I think the best part of my life has been when I decided to be in control of my destiny."

7. "I’ve had a great life, and I’m not about to let it get spoiled by a few mistakes."

These reflect his thoughts on life, success, and entertainment, reflecting the wisdom he gained over his career. Let me know if you'd like more!

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YI X UNWELL APP INCR RISK OF SBI X ‘Unwell appearance’ (irritability, inconsolability, abnormal colour)

WALKING X MITO X BOOSTS BMR

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Walking also stimulates mitochondrial biogenesis [1], creates new mitochondria, and enhances their efficiency [2], leading to better athletic endurance and increased fat oxidation. As a result, walking helps you burn more calories and boosts your basal metabolic rate (BMR), which is essential for sustained weight loss and overall health improvement.

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Summary Bullet Points: Walking for Weight Loss & Health

• Walking & Metabolism: Walking enhances mitochondrial function, improving fat oxidation and metabolic flexibility.

• Weight Loss Benefits: Regular walking boosts basal metabolic rate (BMR) and helps burn calories efficiently.

• Optimal Routine: At least 30 minutes of brisk walking, 5 days a week supports weight loss and overall health.

• Pace Matters: Faster walking (3 mph or more) provides greater benefits than slow strolling.

• Stress Reduction: Walking lowers cortisol levels, reducing stress-related weight gain and improving metabolic health.

• Beyond Weight Loss: Supports cardiovascular health, insulin sensitivity, mental well-being, and better sleep.

• Step Count Goal: 10,000 steps/day is beneficial, but even lower step counts contribute to improved health.

• Sustainable Strategy: Combine walking with a balanced diet, good sleep, and stress management for long-term health.

• Motivation & Adherence: Track progress, set realistic goals, walk with friends, and incorporate interval training for engagement.

• Holistic Health Approach: Walking, paired with nutrient-dense foods, supports overall energy production and longevity.

Would you like a more condensed version or additional focus on a specific area?

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DELIVERY X ATMOS PRES DROPS X Sudden drops in atmospheric pressure (e.g., typhoons, hurricanes) correlate with an increase in spontaneous-onset deliveries.

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Summary Bullet Points

• Workload & Complications: Fluctuations in daily delivery volume impact obstetricians' workload and maternal–fetal outcomes.

• Weather Influence: Sudden drops in atmospheric pressure (e.g., typhoons/hurricanes) may increase daily delivery volume in the following days.

• Objective: Investigated the association between atmospheric pressure drops and spontaneous-onset deliveries, considering gestational age and lagged effects.

• Methods:

  • Time-stratified case-crossover design using Japan Perinatal Registry Network data (2011–2020).

  • Analyzed 1,074,380 spontaneous-onset deliveries across 47 prefectures.

  • Quasi-Poisson regression with distributed lag nonlinear models (lag: up to 14 days).

  • Meta-analysis combined prefectural estimates; stratified by gestational week (<37, 37, 38, 39, 40, 41+ weeks).

• Results:

  • Delivery volume increase peaked within 0–4 days after a pressure drop, diminishing after 1 week.

  • Strongest associations at 38–40 weeks gestation:

    • 38 weeks: Relative risk (RR) = 1.07 (95% CI 1.00–1.14)

    • 39 weeks: RR = 1.08 (95% CI 1.02–1.14)

    • 40 weeks: RR = 1.10 (95% CI 1.03–1.19)

• Conclusions: Pressure drops were associated with a modest increase in spontaneous-onset deliveries, particularly at full-term gestation.

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TICS MX

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Suggested Management Plan for Motor and Vocal Tics

1. Reassurance & Monitoring:

   • Educate parents and school staff about the nature of tics (often transient in children).

   • Reassure that tics often fluctuate and may resolve spontaneously.

2. Identify & Minimize Triggers:

   • Encourage a structured routine to reduce stress and anxiety.

   • Identify any environmental triggers (e.g., fatigue, excitement, stress).

3. Behavioral Strategies:

   • Consider Habit Reversal Therapy (HRT) or Comprehensive Behavioral Intervention for Tics (CBIT) if tics become problematic.

   • Encourage distraction techniques and relaxation exercises.

4. School Support:

   • Provide education to teachers to avoid drawing attention to tics.

   • Implement classroom accommodations if needed (e.g., movement breaks, quiet workspace).

5. Psychological Support (if needed):

   • Assess for co-occurring anxiety, ADHD, or sensory sensitivities.

   • Referral to CAMHS (Child and Adolescent Mental Health Services) or a psychologist if symptoms significantly impact daily life.

6. Medical Referral (if severe or persistent):

   • Consider referral to a pediatric neurologist if tics are significantly impairing function or worsening.

   • Medication (e.g., clonidine, guanfacine, or risperidone) only if tics are severe and distressing.

7. Parental Support & Guidance:

   • Provide resources on tic disorders (e.g., Tourette’s Syndrome UK, local support groups).

   • Encourage a calm, accepting home environment.

Would you like any additions or modifications to this plan?

All problem is a process to its end spectrum

PIERRE ROBIN

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Here’s a summary table for the paper:

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Summary Table: Towards Reaching Consensus in the Diagnosis and Management of Infants With Robin Sequence

Category	Details
Authors	Christian F. Poets, Mirja Quante, Cornelia Wiechers
Publication Date	25 March 2025
DOI	10.1111/apa.70072
Funding	Supported by the European Reference Network on Craniofacial Malformations
Background	- Randomized controlled trials (RCTs) are challenging in rare diseases like Pierre Robin Sequence (RS). - Some treatments, such as prone positioning, lack strong evidence despite being widely used.
Challenges in RS Management	- Prone positioning can improve symptoms but does not eliminate moderate-to-severe obstructive sleep apnea syndrome (OSAS). - Potential safety concerns, including association with sudden infant death syndrome (SIDS). - Lack of consensus on optimal treatment and diagnostic approaches.
Goel et al.’s Approach	- Conducted a three-tiered consensus-building process: reviewing evidence, consulting experts, and incorporating parental perspectives. - Addressed both diagnostic methods and treatment strategies.
Diagnostic Concerns	- Disagreement over the accuracy of cardiorespiratory polygraphy (PG) vs. full polysomnography (PSG) for assessing apnea-hypopnea index (AHI). - Questioned the necessity of PSG for all RS infants due to cost, stress, and wait times.
Treatment Considerations	- Debate over effects of continuous positive airway pressure (CPAP) and high-flow nasal cannula (HFNC) on facial growth. - Importance of treatments that support proper neuromuscular function and mandibular development. - Tübingen Palatal Plate (TPP) therapy linked to better oral feeding and mandibular catch-up growth.
Need for Data-Driven Consensus	- Lack of comparative trials between treatment approaches. - Existing randomized trials are limited in scale and duration. - Standardized outcome measures would improve treatment evaluation.
Conclusion	- More prospective data collection and expert consensus on outcome parameters are necessary for evidence-based RS management.

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Would you like any modifications or additional details? 😊

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Buddha's advice to his son.

"This is because that is.

Myself and others are not separate.

Do not reject one thing only to chase after another.

Practice this and you will become a refreshing source of vitality and happiness for others."

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ESO ATRESIA REPAIRED PT X MOTOR IMPAIRMENT

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School-aged children born with oesophageal atresia remain at risk for persistent motor impairments. Encouraging sports participation is recommended, and further research is needed to explore the underlying mechanisms of motor impairment.

Summary

• Children born with oesophageal atresia are at increased risk for impaired motor function and reduced physical fitness.
• Overall motor performance remained significantly below the norm throughout childhood across all motor domains, with sports participation and not having undergone thoracotomy identified as positive predictors.
• Encouraging sports participation is strongly recommended, along with further research to better understand the underlying mechanisms of motor impairment.

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From Honen:

On further consideration, seeing you again in this world is not important. Visiting you now may even increase my attachment to your lifeless form. No one remains here forever. The only difference is that some will leave here before me, and some will leave after. Pondering this thought, it is impossible to predict the length of our lives, and although we may live a long time, the past is in the end like a phantom dream.

Therefore, remember that together we will enter the same Buddha-land of Amida Buddha. Upon the lotus flower we will dispel memories of sadness in this defiled world of suffering, we will reminisce about our past karmic connection, and we will vow to save and lead people to enlightenment in the future.

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preterm imms

 

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PRETERM CHLDRN MORE AT RISK OF KD

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We identified 1645 cases (61% male) and 15 463 matched controls. The median age of KD diagnoses was 2.6 years. Preterm birth was significantly associated with increased odds of developing KD (OR 1.24, 95% CI 1.01–1.53), particularly for children diagnosed before 1 year of age (OR 1.82, 95% CI 1.15–2.86). Prenatal maternal smoking was also associated with diagnoses before 1 year of age and the risk was increased in males if their mothers were 35 years of age or older at the time of delivery. The risk was higher among children of Asian or African descent. Perinatal factors had a higher impact on the risk of KD in children with Asian parents.

Conclusion

Prematurity was significantly associated with an increased risk of developing KD. Other risks were prenatal maternal smoking, advanced maternal age, and being of Asian or African descent.

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dmhc limboland cwtr

Almighty Aging

Danda Kamandalu. Aham Brahmasmi

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Every generation has a “monoculture” of sorts, a governing pattern or system of beliefs that people unconsciously accept as “truth.

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Your “shadow selves” are the parts of you that at some point you were conditioned to believe were “not okay,” so you suppressed them and have done everything in your power not to acknowledge them. You don’t actually dislike these parts of yourself, though. So when you see somebody else displaying one of these traits, it’s infuriating, not because you inherently dislike it, but because you have to fight your desire to fully integrate it into your whole consciousness. The things you love about others are the things you love about yourself. The things you hate about others are the things you cannot see in yourself.

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CS LEWIS

“It is one of the evils of rapid diffusion of news that the sorrows of all the world come to us every morning. I think each village was meant to feel pity for its own sick and poor whom it can help, and I doubt if it is the duty of any private person to fix his mind on ills which he cannot help. (This may even become an escape from the works of charity we really can do for those we know.) A great many people now seem to think that the mere state of being worried is in itself meritorious. I don't think it is. We must, if it so happens, give our lives for others; but even while we're doing it, I think we're meant to enjoy our Lord and, in Him, our friends, our food, our sleep, your jokes, and the birdsong and the frosty sunrise.”

Enlightened person C will not suffer along with BXM

Mounam vakhyanam. Silence is the God

MAT HEP C X NN

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Neonatal Management of Maternal Hepatitis C (HCV) Exposure

1. Perinatal Transmission Risk

• Vertical transmission occurs in 5-6% of cases, increasing to 10-15% if the mother is co-infected with HIV.

• No proven strategies to reduce transmission risk at birth.

2. Delivery Considerations

• Mode of Delivery: Routine C-section not recommended unless obstetric indications exist.

• Avoid fetal scalp monitoring and prolonged rupture of membranes to minimize transmission risk.

3. Postnatal Care of the Neonate

• Breastfeeding: Safe unless the mother has cracked/bleeding nipples.

• Isolation Precautions: Standard precautions only—no additional isolation required.

• Hepatitis B and HIV Testing: If maternal co-infection is suspected, follow standard protocols.

4. Diagnostic Testing in the Infant

• HCV RNA (PCR):

  • Can be tested ≥2 months (earlier testing may have false positives).

  • If negative at 3 months, repeat at 6 months to confirm clearance.

• Anti-HCV Antibody:

  • Not useful before 18 months due to transplacental maternal antibodies.

  • If positive at 18 months, indicates chronic infection.

5. Follow-up and Long-term Care

• If HCV RNA positive, refer to pediatric hepatology for monitoring and potential treatment.

• Direct-acting antiviral (DAA) therapy is not currently approved for children <3 years but may be considered in older children.

• Monitor liver function and screen for hepatobiliary complications.

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Direct-Acting Antiviral (DAA) Therapy for Pediatric Hepatitis C

1. Indications for Treatment

• Recommended for children aged ≥3 years with chronic HCV infection (HCV RNA positive).

• Goal: Achieve sustained virologic response (SVR) and prevent long-term liver damage.

2. FDA-Approved DAA Regimens in Pediatrics

Age Group	Preferred DAA Regimen	Duration	Genotypes Covered	Notes
≥3 years	Sofosbuvir + Ledipasvir (Harvoni)	12 weeks	GT 1, 4, 5, 6	For children ≥17 kg
≥3 years	Sofosbuvir + Ribavirin	12–24 weeks	GT 2, 3	Weight-based Ribavirin dosing
≥12 years	Glecaprevir + Pibrentasvir (Mavyret)	8 weeks	All genotypes (1-6)	No Ribavirin needed
≥12 years	Sofosbuvir + Velpatasvir (Epclusa)	12 weeks	All genotypes (1-6)	Pan-genotypic

3. Monitoring During Therapy

• Baseline: HCV genotype, liver function tests (LFTs), HCV RNA, renal function.

• During Therapy: Monitor adherence and side effects (minimal with DAAs).

• Post-Treatment (12 weeks after completion): HCV RNA to confirm SVR (cure).

4. Contraindications & Considerations

• DAAs not approved for children <3 years.

• Ribavirin-containing regimens require hemoglobin monitoring due to risk of anemia.

• Avoid co-administration with certain anticonvulsants and rifampin due to drug interactions.

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Maya Karma Saranagati Kripa Grace

The six points (or limbs) of Śaraṇāgati (शरणागति) – complete surrender in devotion, particularly in the Vaishnava tradition – are:

1. Ānukūlyasya saṅkalpaḥ (अनुकूलस्य संकल्पः) – Accepting everything favorable to devotional service.

2. Prātikūlyasya varjanam (प्रातिकूलस्य वर्जनम्) – Rejecting everything unfavorable to devotion.

3. Rakṣiṣyatīti viśvāsaḥ (रक्षिष्यतीति विश्वासः) – Having firm faith that the Lord will protect.

4. Goptṛtve varaṇaṁ (गोप्तृत्वे वरणम्) – Accepting the Lord as the sole guardian and maintainer.

5. Ātma-nikṣepaḥ (आत्म-निक्षेपः) – Complete self-surrender (offering oneself to God).

6. Kārpaṇya (कार्पण्य) – A deep sense of humility and helplessness before the Lord.

These principles define the essence of absolute surrender in Bhakti (devotional) traditions, particularly in Sri Vaishnavism and Gaudiya Vaishnavism. Would you like a deeper explanation of any of these points?

CXE

That which is fundamental doesn’t drive anything. Quarks are fundamental to matter - they don’t drive your body’s growth. Rather they build the reality within which growth happens.

Consciousness is Reality in which Evolution occurs 

FN

Nietzsche famously and correctly argued that the Achilles heel of modernity is nihilism, the raging abyss of meaninglessness over which the tightrope to the future is stretched.

GASSET- I AM MYSELF PLUS MY CIRCUMSTANCE

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The phrase "I am myself plus my circumstance" is often attributed to the Spanish philosopher José Ortega y Gasset. It comes from his book Meditations on Quixote and reflects his philosophical perspective on the relationship between individuals and their environments.

Here’s a breakdown of what this means:

1. Self and Context Are Intertwined: Ortega y Gasset argues that we cannot separate who we are from the circumstances in which we live. Our identities are not purely internal or independent of the world around us; they are deeply influenced by the social, historical, and cultural contexts in which we exist. In other words, we are shaped by our environment, and that environment is an essential part of who we are.

2. Circumstances Define Us: This idea suggests that a person’s situation—be it their social class, family, culture, historical moment, or geographical location—plays a crucial role in defining their identity. We are not just isolated individuals; we are part of a larger web of influences and relationships. Our choices and actions are often framed by the circumstances we face.

3. Personal Agency Within Context: While the phrase emphasizes the importance of circumstances, it doesn’t suggest that we are completely determined by them. Instead, it implies a dynamic interplay where individuals navigate, respond to, and sometimes transcend their circumstances. Personal agency exists, but it is always in conversation with the external world.

4. Philosophical Implications: This thought connects to existentialist ideas about the self and the world. It challenges the idea of a fixed, isolated identity and promotes a view of the self as fluid and shaped by both internal desires and external factors.

In short, "I am myself plus my circumstance" underscores the idea that who we are is never just a product of individual choice but is inseparable from the world and context in which we find ourselves. Our personal identity is constantly in dialogue with our circumstances.

NEPANTLA

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Nepantla is a Nahuatl word that means "in-between" or "the space in-between," referring to a liminal space or state of transition. It is often used in the context of cultural, social, and personal identity, describing the experience of being in a state of flux or negotiation between different worlds, cultures, or identities. The concept has been embraced in various disciplines, including literature, anthropology, and philosophy, particularly in the study of borderlands, hybridity, and intersectionality.

Here are some key ideas associated with Nepantla:

1. Cultural Liminality: It is the space between two distinct cultures or worldviews. For example, someone living between the cultural norms of their heritage and the dominant culture may experience nepantla, constantly negotiating their identity in the process.

2. Identity Formation: Nepantla is often used to describe the internal conflict and reconciliation that occurs when an individual has to navigate multiple aspects of their identity—ethnicity, gender, sexuality, etc.—which can be seen as being in-between different social roles or categories.

3. Transformation and Growth: The in-between space is not seen as static or limiting, but as a fertile ground for transformation, personal growth, and the creation of new identities and possibilities. It’s a place where one can redefine oneself or find strength in the process of change.

4. Chicana/Latina Feminist Thought: Nepantla has been particularly significant in Chicana and Latina feminist thought. Scholars such as Gloria Anzaldúa have used the concept to explore how women of color experience overlapping marginalizations and how they navigate the boundaries between different identities, particularly at the intersection of race, class, gender, and culture.

In essence, nepantla is a metaphorical space of transition and multiplicity, where diverse identities and experiences intersect and give rise to new possibilities and understandings. It celebrates the power and creativity that can emerge from the process of navigating this in-between space.

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SS

Even though things aren’t going perfectly in life, the imperfection is perfectly itself.

It is a perfect appearance of imperfection.

See that perfection lies not in the appearance of things, but in the very thing itself, being as it is.

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The appearance of limitation is perfect.

It is a perfect appearance of limitation.

Limitation is perfectly being as it is designed to be.

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The appearance of illness is perfect.

It is a perfect appearance of illness.

Illness is perfectly being as it is designed to be.

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The appearance of pain is perfect.

It is a perfect appearance of pain.

Pain is perfectly being as it is designed to be.

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Endless striving to mould the appearance of imperfection into our idea of perfection leads to suffering.

Allowing things to be as they are, enables creativity and influences spontaneous changes in accordance to the destiny of the body/mind to arise and be as they are.

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On the path of Self inquiry, we should find that which claims that something is imperfect and should change, and lose belief in it.

Let that "sufferer" be as it is because even that is perfectly arising and being itself, but we can lose belief in its claim that something is missing, that something is not what it should be.

Practice this and you will come to find great truth in it.

RD BK BLOOMING IN THE RUINS

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The summary table for Blooming in the Ruins would typically include key quotes from the work and their significance, alongside any reflections or insights related to those quotes. Here’s an example format for how it might look:

Quote	Context	Significance/Reflection
"In the darkest of times, we bloom."	In the midst of loss or adversity, there’s a sense of hope.	Resilience is found in our ability to grow through hardship.
"The rubble does not define us, it’s the roots we plant."	Reflects on the importance of where we place our efforts.	Focuses on how we respond to adversity, rather than being defined by it.
"Even the strongest walls can crack, but that’s where light enters."	A metaphor about vulnerability and growth.	Shows that challenges can lead to opportunities for growth and insight.
"We do not rebuild, we regenerate."	Emphasizes transformation over simple restoration.	Suggests that growth and change are inherent in the process of overcoming hardship.
"From the ruins, we reclaim our power."	A reclaiming of agency after destruction or collapse.	Reinforces empowerment and agency in times of crisis.

This table structure allows you to capture the essence of important quotes and their deeper meanings. If you’d like specific quotes or insights from a particular version of Blooming in the Ruins or any additional details, let me know!

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B "Mindfulness means to be present and to read the text of life closely. Mindlessness is opposed to mindlessness, which is allowing our life to run on auto pilot. To skim through life without understanding anything."

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"Mindfulness means to be present and to read the text of life closely. Mindlessness is opposed to mindlessness, which is allowing our life to run on auto pilot. To skim through life without understanding anything."

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B "Mindfulness leads to conscious choices rather than reactions

The life so short, the craft so long to learn.” Hippocrates

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since a long time studying near-death-experiences that consciousness is fundamental as also predicted by Pim van Lommel and now given a scientifically based description by a giant of quantum mechanics and information

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“Culture has tremendous inertia,

RD BK CHINA STUDY

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Here's a summary table quote based on "The China Study":

Key Aspect	Summary
Study Overview	The China Study is a large, long-term epidemiological study that explores the relationship between diet and disease, particularly the health benefits of plant-based diets.
Main Findings	The study found that a diet rich in plant-based foods and low in animal-based products is associated with lower rates of chronic diseases such as heart disease, cancer, and diabetes.
Dietary Emphasis	The study emphasizes the health benefits of whole foods, particularly plant-based foods, and the harmful effects of consuming animal products, especially processed meats.
Link to Chronic Diseases	The research highlights how diets high in animal products contribute to an increased risk of various chronic diseases, while plant-based diets promote health and longevity.
Impact on Nutrition Recommendations	The findings have influenced nutrition guidelines, encouraging lower consumption of animal-based products and promoting plant-based foods for better health outcomes.
Global Significance	The China Study has had a significant impact on global health discussions, particularly regarding dietary choices, disease prevention, and public health policies.
Criticism and Controversies	Critics argue that the study's conclusions are oversimplified or not directly applicable to all populations due to regional dietary differences and lifestyle factors.
Support for Plant-Based Diets	The study provides scientific support for adopting plant-based diets as an effective way to prevent and even reverse chronic diseases, emphasizing plant nutrition's role in overall health.
Long-Term Health Benefits	The China Study demonstrates the potential for a plant-based diet to reduce the incidence of long-term, preventable diseases and improve overall quality of life.

This table highlights the key findings, dietary recommendations, and global impact of "The China Study," particularly its support for plant-based diets in promoting long-term health and preventing chronic diseases.

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TOLSTOY As Ivan Ilyich’s health fades and he realizes that his time is limited, his ambition and vanity disappear. He simply wants comfort and companionship

DTH - AFTR ENDURING CASCADING EFFECTS OF RARE AUTOIMM DISEASE

UNPLUG -Almost everything will work again if you unplug it for a few minutes, including you.” ~Anne Lamott

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Consciousness is the link we need to connect to science so that we can have a holistic model that helps us make sense of the times we live in.

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FF LIGHT EVENT

for the first time since 2007 I hear someone else out there , who is well educated , has experienced the same thing I had been explaining to a few people and they never believed me. I will save this video. After it happened to me I never wanted anything else in this world except to maintain the feeling .. pure love , happiness. Nothing maters anymore in this world … I just want to stay in that state forever. I love being alone and enjoy that state of being … beautiful feeling , that amount of energy! Reducing but you know it won’t finish , it is connected to something bigger than the world

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I had a ndr at 20 and have been trying to put this in words to communicate to others, incredible, even some of the metaphors M. Faggin uses I have used. Viewing our lifes (present moment) from that 'I' Seity perspective (when your in what I call the 'soup of light') looks like a multitude of incredible pulsing colours. Individually we make this together and together we are making something grow..it would be more beautiful if the softer colours were more in action today..but I can feel 'the painting' changing towards that, which really helps given the actuel outside appearance of our world.

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Here is another example of this merger of science and spirituality. The physical, material stuff is so dense..so present..that it sometimes numbs our intuition for what most likely is reality. As we see it play out in front of our eyes...the more people believe in one reality..the more that reality manifests as the real one. I think we may get to a point where everything spiritual transfers to this reality. Where we eventually unify with the soul, fully aware, fully synchronized and co-create for eternity.

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