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Introduction: There has been growing interest in determining the influence of post-operative immobilization posture and rehabilitation protocol on healing rates and clinical outcomes. Current consensus calls for the use of an immobilization device post-operatively, which commonly comes in the form of a standard sling or an abduction brace with the arm positioned in varying degrees of abduction. There is a lack of high-level evidence in the literature to recommend one type of immobilization device or arm position over another. Objectives: This study aimed to summarize the current clinical and biomechanical evidence for the optimal postoperative positioning and bracing of the arm following arthroscopic rotator cuff repair. Methods: A comprehensive search of the electronic databases EMBASE, MEDLINE, and PubMed was performed using a combination of the following keywords and medical subject heading (MeSH) terms: ‘arthroscopic’, ‘rotator cuff repair’, ‘sling’, ‘brace’ and ‘immobilization’. This systematic review was conducted following the Preferred Reporting for Systematic Reviews and Meta-analysis (PRIMSA) guidelines. Two reviewers performed an independent assessment of the methodological quality of each eligible clinical study using the Methodological Index for Non-Randomized Studies (MINORS).Results: Based on current biomechanical evidence, placement of the arm into an abducted position following rotator cuff repair was found to be favorable. An abduction angle of 30° was associated with lower strain on the repair while maintaining appropriate contact pressure at the footprint. However, the use of an abduction brace did not result in a clinically significant improvement in long-term PROM, ROM, and re-tear rates when compared to a traditional sling in clinical studies.Conclusion: Despite observing favorable outcomes with abduction bracing after rotator cuff repair in biomechanical studies these findings were not reproduced in clinical studies. However, current clinical studies are comprised of small sample sizes, varying tear sizes, and significant heterogeneity in both, the degree of abduction and forearm rotation. Future studies should be directed towards prospectively investigating the effect of immobilization position among patients with similar rotator cuff tear sizes.

The presence of heavy metals (HMs) on Earth is essential to all forms of life. These metals are essential for plant and animal development but can have numerous negative effects on the living environment. In this review, we looked at where HMs come from, why they are harmful, and how they affect plants. Articles indexed in Google Scholar, PubMed, Research Gate, Science Direct, and a few books on heavy metals were consulted for this study. Heavy metals are essential for plant development and growth. According to this analysis, the hazardous effects of HMs are on the rise all throughout the globe, and this trend may be attributed mostly to human activity. Because of its impact on agricultural productivity and environmental changes, soil pollution caused by HMs is among the most crucial elements. Plants have evolved very sophisticated defense systems to deal with these environmental challenges. The threat that HM stress poses to plants has attracted a lot of attention worldwide because it could stunt agriculture’s long-term expansion. In spite of their importance for plants, this study found that HMs pose a significant threat to plant life. The novelty of this review lies in its detailed examination of both the beneficial and detrimental roles of HMs, providing a balanced perspective often overlooked in current literature. The significance of this work is underscored by its potential to inform sustainable agricultural practices and environmental management strategies, as it highlights the delicate balance required to harness the benefits of HMs while mitigating their risks. Despite their necessity for plant development, this review underscores the significant risks HMs pose to plant health and ecosystems.Less than 10 cases have been reported in the literature of the association of germline BRCA1 and Squamous cell Carcinoma – the esophagus. The article focuses on the probable pathogenesis of BRCA1 mutation with non-classic malignancies and the response of Poly adenosine diphosphate ribose polymerase inhibitors (PARP) inhibitors in such a scenario. We report an unusual manifestation of the BRCA1 gene with second primary oesophageal squamous cell cancer occurring five years later to triple-negative breast cancer.

An autoimmune condition known as Systemic Lupus Erythematosus (SLE) affects several systems and manifests itself in a variety of ways. It is far more common among young women who are fertile.It has been demonstrated that a mix of environmental and genetic variables may trigger immunological responses, triggering T and B cells, and leading the B cells to overproduce pathogenic autoantibodies and dysregulate cytokines, which ultimately result in harm to many organs and tissues. One feature of SLE is the presence of antibodies against cytoplasmic and nuclear antigens. An autoimmune illness is also type 1 diabetes. β-cell antibodies (Ab) and other antibodies that cause the autoimmune death of the pancreatic β-cells, which make insulin, are part of the multifactorial pathophysiology of type 1 diabetes mellitus (T1DM).Immunosuppression is the therapy for systemic lupus erythematosus (SLE), and diabetes itself compromises immunity, making infections more opportunistic. We came across an unusual instance of a patient with SLE, T1DM, hypothyroidism on immunosuppression who subsequently acquired pulmonary TB.Key phrase: Autoimmune diseases such as type 1 diabetes mellitus (T1DM) and Systemic Lupus Erythematosus (SLE).

Primary adrenocortical insufficiency or Addison’s disease (AD) is a rare, life-threatening condition with different aetiologies, but the most common cause is autoimmune destruction of the adrenal cortex. Autoimmune Addison’s disease (AAD) can present as an isolated condition or associated with others, as part of an autoimmune polyglandular syndrome (APS). The aim of this work is to investigate and emphasise the roles of autoantibodies in adrenocortical insufficiency, through the description of three clinical cases.

Myocardial infarction is the leading cause of morbidity and mortality worldwide. The overall aim of the study was to evaluate community awareness about myocardial infarction.It was a community-based cross-sectional study conducted during one month including both male and female participants aged 18 years and over in Nangarhar province of Afghanistan. The percentage of awareness for risk factors was as follows: Diabetes (56.4%), Hypertension (43.4%), Elderly (42.1%), Obesity (39.8%), Physical inactivity (38.5%), Hyperlipidemia (37.6%), and Family history (33.8%). Furthermore, knowledge about symptoms and signs was as the following: chest pain (67.4%), pain in neck and jaw (57.8%), Dyspnea (50.7%), pain in arms (46.1%), weakness/fainting (40.1%), cold sweats (38.2%), nausea and vomiting (34.5%), anxiety (29.6%), fever (22.7%), hypotension/shock (20.1%), and silent myocardial infarction (11.3%). Moreover, 24% of participants did not know about the prevention strategies for myocardial infarction. Regarding treatment, 80.3% of participants exactly knew to go to the emergency room, 11.9% of participants would intend to go to a general practitioner (GP), 5.6% of participants would ask others for advice on what to do, and 2.2% of participants would wait to see if the symptoms go away spontaneously or if the symptoms were due to other diseases. The current awareness level about myocardial infarction especially atypical symptoms, risk factors, prevention, and treatment strategies in Nangarhar residents was insufficient, especially in females and healthy individuals, and warrants designing and implementing immediate awareness programs in order to avoid delay of treatment-seeking, misbeliefs about the disease and subsequent morbidity and mortality.

Purpose: Loop Diuretics (LD) are the first-line pharmacotherapy to address Heart Failure (HF)-associated edema and dyspnea. However, LD causes frequent urinary, resulting in inconvenience and possibly undermining the quality of life. While prescription adjustment is an essential part of Palliative Care Consultation (PCC), it remains unclear how PCC affects the deprescribing of diuretics for adults with HF. Methods: We conducted a pre-post analysis of the percentage of HF patients who were prescribed LD in a national Electronic Health Record (EHR) database 12 months before and after the first PCC. The difference in prescription rates between the periods was determined. Adjusted associations of post-PCC LD prescription with pre-PCC LD prescription and patient’s characteristics, insurance, provider type, and clinical factors were quantified.Results: From 2010 to 2018, 5,969 patients with newly diagnosed HF received at least one PCC, among whom 2,539 (42.5%) were prescribed LD before and 1,552 (26.0%) after their first PCC. Despite a decrease in LD prescription rate encompassing the date of PCC, post-PCC LD prescribing was strongly associated with pre-PCC prescribing (aOR[95%CI] 3.2[2.8,3.7]) and varied by age at first PCC, year of HF diagnosis (aOR[95%CI] 2.1[1.9,2.4]) and months from HF diagnosis to first PCC. While our finding demonstrates reduced polypharmacy associated with PCC, the strong association between pre- and post-PCC indicates reverse therapeutic inertia. Future research should investigate the benefits and costs of polypharmacy among specific patient groups to help develop personalized treatment for HF.

Background: Linagliptin is an anti-diabetic drug that claims no adverse effects and treatment of gestational diabetes mellitus (GDM) demands a safe anti-diabetic medication. Therefore, this study investigates the anti-diabetic efficacy of linagliptin in an induced GDM.Materials and methods: Thirty-two matured female rats (100 - 200 g) were utilized. Sixteen non-pregnant/diabetic animals were fed with a normal diet and sixteen rats were fed with a high-fat (HFD), mated at the estrous stage in 2:1, and pregnancy was confirmed with a spermatozoa in a vaginal smear. The pregnant rats were intraperitoneally injected with a single dose (30 mg/kgb. wt)of streptozotocin (STZ) to induce GDM. The animals were grouped into 4 groups, 8 rats/groups. Group I: control; Group II: control + 10 mg/kgb.wt linagliptin; Group III: GDM; Group IV: GDM + 10 mg/kgb.wt linagliptin. The animals were sacrificed after 14 days of treatment. Blood samples were collected for biochemical parameters.Results: Fasting blood glucose (FBG) insulin, glycated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C), malondialdehyde (MDA), interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-alpha (TNF-α) levels significant (p < 0.05) elevated in GDM rats, with significant reduction in high-density lipoprotein-cholesterol (HDL-C), catalase (CAT), superoxide dismutase (SOD) and reduced glutathione (GSH). Linagliptin administration significantly (p < 0.05) decreased the FBG, insulin, HbA1c, TC, TG, LDL-C, MDA, IL-6, IL-1β, and TNF-α and ameliorates the HDL-C, CAT, SOD, and GSH levels significantly.Conclusion: Linagliptin remarkably showed anti-hyperglycemic, anti-oxidative, and anti-inflammatory properties. Linagliptin could be a promising drug for hyperglycemia treatment during gestation.

This research focused on assessing the levels of selected metal contamination in seven different rice brands (Jasmine, Basmati, Mapembe, Morogoro, Shinyanga, Mbeya, and Cheju). Cheju rice was obtained from local producers from the Cheju area in Zanzibar, while the remaining rice brands namely, Jasmine, Basmati, Mapembe, Morogoro, Shinyanga, and Mbeya were randomly taken from local markets at Darajani and Mwanakwerekwe in Zanzibar. Samples were prepared in accordance with applicable Safe Operating Procedures (SOPs) and laboratory SOPs using information provided by field sample preparation. The samples were ground to fineness and an aliquot of about 10.0 g was measured on the beam balance and mounted on the sample holders for laboratory analysis. An Energy Dispersive X-Ray Fluorescence (EDXRF) technique with a Rigaku NEX CG EDXRF model spectrometer was used for metal analysis. The study revealed that the percentage of metal contamination varied considerably from one rice brand to another, with Basmati and Jasmine rice each exhibiting a contamination level of 50%, while Shinyanga, Mbeya, Mapembe, and Cheju rice showed a level of 25% each. Notably, Morogoro rice had no observable heavy metal contamination. Additionally, a significant positive correlation was observed between several metal pairs: Au and Cr (r² = 1.00), Au and Ti (r² = 0.613), Cr and Ti (r² = 0.613), Ni and Pb (r² = 0.748), Ni and Hf (r² = 0.660), Pb and Hf (r² = 0.656), and Ti and Sn (r² = 0.671). The individual occurrence (percentage) for metals across all rice brands were as follows: 71.42% for Sn, and 28.57% for Hf, Ni, Pb, and Ti, while traces of Au, Cr, and Y each had an occurrence level of 14.28%. While Morogoro rice showed no metal discernible analyzed heavy metal contamination, the other rice brands were observed to have a considerable heavy metal contamination trend. The patterns of metal occurrence in each rice brand were observed as follows: Basmati: Sn > Ti > Au > Cr; Jasmine: Sn > Hf > Ni > Pb; Shinyanga: Sn > Pb; Mbeya: Sn > Hf; Mapembe: Sn > Ti; Cheju: Ni > Y. The patterns, then yield the ranking of metal contamination across all seven rice brands from lowest to highest is as follows: Morogoro < (Mapembe, Cheju, Mbeya, Shinyanga) < (Jasmine, Basmati). Furthermore, the data analysis indicated that the concentrations of Cr (1.08 mg/Kg), Ni (4.65 mg/Kg), and Pb (3.05 mg/Kg) detected in the samples surpassed the maximum permissible limits established by WHO/FAO which were 1.0 mg/Kg, 0.10 mg/Kg and 0.20 mg/Kg respectively. Consequently, the study concludes that Morogoro rice is the most superior and considered the safest choice for consumption, while Jasmine and Basmati rice are associated with higher levels of metal contamination. Thus, it is highly recommended that Tanzania intensify its rice cultivation efforts to reduce reliance on rice imports from other nations.

Introduction: Nutrition is increasingly recognized as a key component of optimal sports performance. On the other hand, insufficient and continuous food intake can compromise athletic performance and success where Nutritional Knowledge can play a leading role.Methods: One hundred and three youth athletes from 6 different clubs belonging to the District, Honor, and National Championship participated in this study. To assess Nutritional Knowledge, consumption of alcohol and tobacco the Abridged Nutrition for Sport Knowledge Questionnaire was applied.Results: The percentage of Nutritional Knowledge obtained in the District Championship was 31.25%, in the Honors it was 35.56% and in the National Championship it was 35.02%. No significant differences were found between the Nutritional Knowledge of athletes. In turn, there were statistical differences in the consumption of alcohol and tobacco among the athletes of the 3 Championships, with the District division having the highest percentage of smokers (100%) and alcohol consumers (42.6%).Conclusion: It is essential to increase the Nutritional Knowledge observed in these young athletes since it can have an influential role in their food choices.

Mental illness is an international health crisis that puts the lives of over three hundred million people (Four percent of the world’s population) at risk. The study was conducted at the Erigavo Mental Hospital in Somaliland and its main focus was the bond between substance abuse and mental illness. The research was to check the influence of the different drugs, screen mental health problems, and draw a link between drugs and mental illness. The sources of the quantitative data were a total of 27 employees and managers. This study is cross-sectional. We employed the measure of the magnitude and direction of a linear relationship between two variables with the Pearson correlation coefficient. The outcomes that were acquired show that there was use and particularly abuse of khat, substance smoking, and alcohol consumption, the score means of which were quite high. The investigation results, however, imply that through drug use and other forms of alcohol drug abuse, one of them counter various mental health problems. Furthermore, the addicted people demonstrated the tendency to use force in their attempt to solve the conflicts and to experience the highest degree of tension, with the mean score of the former giving 4.11 while the standard deviation of the latter giving 1.086, thus this shows the mental impact of drug use on the inhabitants of Erigavo. The main result of the study was the strong, positive relationship between drug addiction and mental illness, which became evident through an r - value of 0.509 and a p - value of 0.559. It means that those people who are involved in drug misuse are the ones who are likely to have mental health disorders. Based on the findings of the study, we suggest a combination of measures to recover drug addiction and mental illness. This consists in strengthening prevention. The study that lays the groundwork for suggestions, involves an approach that is holistic in nature. The main ideas of preventing drug usage, psychological health care, enhancing mental health services, and working towards certified professionals are key integrated activities of the whole concept. The hospital, thus, will be in a better position to eliminate the two major disease components namely; drug abuse and mental ailment. Thus, in this way, with the help of the new treatment approaches, a hospital provides and their patients who are quite likely to recover and lead healthy.

Purpose: American expert consensus publications recommend discontinuation of antiplatelet agents 6 to 12 months after Percutaneous Coronary Intervention (PCI) in patients with Atrial Fibrillation (AF) who require chronic anticoagulation, and use of oral anticoagulant monotherapy thereafter. This study aimed to assess real-world long-term antithrombotic therapy management practices and factors associated with the continuation of antiplatelet agents past 12 months post-PCI in patients with AF requiring chronic anticoagulation. Methods: Patients with AF and a history of PCI greater than 12 months before their most recent encounter with physicians at an outpatient electrophysiology clinic were identified by chart review. Patient demographics, clinical characteristics, and current antithrombotic regimen were collected from encounters that occurred between July 2019 and June 2022. The independent predictive factors associated with the continuation of antiplatelet agents were identified using univariate and regression analyses. Results: Out of 66 patients, 67% continued antiplatelet therapy for greater than 12 months post-PCI. Patients on antiplatelets were significantly less likely to have bare metal stents (p = 0.006), be greater than five years post-PCI (p = 0.002), and have a HASBLED score of two or less (p = 0.028) when compared to patients on oral anticoagulant monotherapy. Bare metal stent history (p = 0.045) and HASBLED score of two or less (p = 0.016) were also significant in regression analysis.Conclusion: This study found that most patients with AF and a history of PCI continued antiplatelet therapy longer than 12 months post-PCI, often despite the high bleeding risk.

Background: Clinical research is a vital component of medical advancements, contributing to the discovery of new treatments, procedures, and health interventions. This paper discusses the importance of clinical trials, the structure and phases of trials, ethical considerations in research, and the role of modern technologies in reshaping clinical trials.Objective: This article aims to provide a comprehensive overview of the clinical trial process, ethical compliance, and the integration of technological advancements, with real-world examples and recent studies to support the discussion.Methods: The article provides a descriptive analysis of the different types of clinical research, the various phases of clinical trials, and ethical considerations based on established guidelines such as the Declaration of Helsinki and the Belmont Report. It also examines how recent technological innovations, including AI, wearable devices, and Electronic Health Records (EHRs), have revolutionized the field.Results: The integration of technology into clinical research has resulted in more efficient, data-driven, and patient-centric trials. Ethical compliance, guided by international regulations, remains a critical factor in ensuring patient safety and maintaining public trust in clinical research.Conclusion: The future of clinical research relies heavily on technological innovation and strict adherence to ethical guidelines. As new treatments and therapies emerge, the structure of trials and the responsible use of technology will play an essential role in shaping the future of healthcare.

Background: Non-Communicable Diseases (NCDs) in India have increased from 37.9% in 1990 to 61.8% in 2016. They are slowly progressive are of long duration and are responsible for more than 50% of the global burden of disease Very few studies have been conducted that studied the prevalence of risk factors in non-communicable diseases among medical students. The authors observed that most of the students are at risk of developing NCDs, and the cumulative effect of risk factors bundles up and eventually leads to disease as students advance through their lives.Aim and objectives: (i) To estimate the prevalence of risk factors of NCD amongst medical students, (ii) To study the association between various risk factors and NCDs in study subjects.Settings and design: A cross-sectional analytical study involving 362 undergraduate students of Rama Medical College using simple random sampling.Material and methods: The study used a pretested structured questionnaire which was conducted by using the WHO NCD steps approach.Statistical analysis used: Data analysis was done by using M S Excel and software SPSS version 26.Results: Our study results showed that physical activity is Prevalent in female students at 51% and in male students at 48.9%, almost equal. Junk food consumption had an overall prevalence of 69.34% of females outnumbering males in junk food consumption. The association of BMI with NCD as a risk factor was statistically significant in the current 75 smokers only.Conclusion: There is a huge opportunity to reduce modifiable risk factors and NCD among our future doctors by encouraging them to change their behavior-related lifestyles such as smoking habits, alcohol use, junk food, etc.

According to a 2022 systematic review on the prevalence of psychiatric disorders in general hospitals, it was estimated that approximately one-third of medical inpatients present with a coinciding psychiatric condition. However, other studies have reported that a low rate of patients actually obtain an inpatient psychiatric consult; and even fewer patients receive a consultation when it would not be traditionally indicated. Therefore, we have seen an emergence of the use of Proactive Consultation-Liaison (C-L) Psychiatry across many hospital settings. This model of care utilizes systematic screening for active mental health concerns, proactive interventions tailored to individual patients, team-based delivery, and care integration with primary services to provide psychiatric consultation earlier. This study conducted a focused PubMed search to review the research to date on proactive C-L psychiatry and its impact on hospital length of stay (LOS) in patients over 18 years old. Results show a consequential reduction in average hospital LOS when proactive C-L psychiatry services are used compared to reactive, on-request consultation services. A shortened LOS is seen with this practice when there is a quicker time for consultation or referral. Thus, there is evidence of proactive C-L psychiatry’s success in decreasing average hospital LOS and improving patient care. Additional studies are necessary to determine its significance, as little research to date has been completed on the topic. It is recommended to expand the scope of investigation to different patient populations, including but not limited to pediatrics and patients without an underlying mental health illness.

A recurrent miscarriage may be defined in the African context as the foetal demise of two or more successive pregnancies before the attainment of the age of viability. A literature review was done to assess the trend of recurrent miscarriage in sub-Saharan Africa. Identifying the main causes, considering the population at risk, and the availability of accurate diagnostic utilities to effectively ensure good management of recurrent miscarriage is an important gynaecologic issue. Over the years, studies have identified several etiologies and yet there’s been no tangible implementation of therapeutic strategies. Routine modifications should also be employed to develop new approaches to reproductive prognosis. There is notably scanty information on the cases of spontaneous abortion due to chromosomal abnormalities. Genetic and immunological factors should be considered in the work-up plan for women with RM. About 70% of the cases of RM are considered unexplained, and this may be due to limited resources. We concluded that there is relatively poor management of miscarriage and cases of missed and inaccurate diagnosis of the causes of spontaneous abortion in sub-Saharan Africa. More studies are needed in order to assess the extent of genetic induced miscarriage, where resources are limited, folic acid supplements should be provided for pregnant women.

Insulin resistance, often referred to as impaired insulin sensitivity. This clinical case focusses on a woman with insulin resistance and a long-standing and recurring history of obesity to demonstrate how diet therapy can be applied in addition to standard medication therapy.

Venous Thromboembolism (VTE) is a major public health concern, affecting approximately 900,000 people annually in the United States. In rare cases, a Patent Foramen Ovale (PFO) may allow a venous thrombus to cross into the arterial circulation, causing a paradoxical embolism. This case report presents a 46-year-old male who developed left renal artery stenosis after a paradoxical embolism, likely triggered by a prolonged flight and binge alcohol consumption. The patient was found to have a moderate-sized PFO and renal infarction, confirmed by imaging studies. Despite initial anticoagulation therapy and a planned stenting procedure, intraoperative findings revealed only mild stenosis, leading to cancellation of the stent placement. The patient ultimately underwent PFO closure with an Amplatzer Talisman device. This case underscores the diagnostic challenges in managing paradoxical embolism and the need for individualized treatment, particularly concerning anticoagulation duration, the decision for PFO closure, and post-procedural antithrombotic therapy. Further research is required to establish optimal management strategies for cryptogenic embolic events.

This paper examines the effects of globalization on nations, focusing on economic, social, and cultural dimensions. It analyzes the roles of protectionism and globalization in shaping consumer welfare and producer earnings through qualitative methods and the Customs Union theory framework. The study discusses the benefits and drawbacks of globalization in the context of World Trade Organization (WTO) regulations. The findings indicate that globalization has intensified financial flows between countries, which can exacerbate economic crises. Countries with abundant human resources can capitalize on the international division of labor to specialize in high-value sectors, while those with limited resources risk falling behind in the digital landscape. This division of labor fosters specialization and improves production efficiency through targeted education. However, multinational corporations often impede cost-effective production in developing nations, underscoring the necessity to restructure research and development to facilitate technology adoption in underdeveloped areas. This restructuring can help close the technological gap and encourage equitable participation in the global economy. Jel code Classification: D6: Welfare economics, Fo1 Global outlook, F40: General F4: Macroeconomics aspects of international trade and finance

Numerous instances of consecrated communion wafers turning into human tissue and blood have been reported throughout history and the contemporary international media, referred to as Eucharistic miracles. Various suggestions have been put forth to explain such phenomena, ranging from miraculous to natural. Here, a novel demonstration is provided showing that the appearance of a bleeding host can occur by placing ordinary, non-consecrated wafers under similar conditions as described for many of these events. Using basic forensic methods, distinctions between ensuant reddish areas and genuine blood were noted. In previous studies with miracle wafers, isolated DNA was resistant to amplification with human-specific primers, which has been attributed to its divine nature. The current study shows that multiple types of non-human DNA existed in unconsecrated wafers, providing an alternative explanation for such findings. Finally, a minimal protocol of scientific examination is outlined to aid in the standardization of such investigations in the future, including a distinctive approach to authenticate the genuine shared origin of such occurrences.

Tardive Dyskinesia (TD) is an iatrogenic complication caused by antipsychotic agents and rarely by other anti-depressive/antiepileptic or anti-nausea medication. It is mostly a benign condition with implications regarding esthetic issues but it can also impact social and emotional well-being. We are reporting a case in which severe TD ensued in an elderly lady with newly diagnosed dementia, who presented to the psychiatric ER with a Capgras syndrome and paranoia accompanied by behavioral disturbances. She was treated with 4 consecutive antipsychotic agents (haloperidol, brexiprazole, risperidone, and olanzapine) due to unresponsive psychosis in conjunction with biperiden and developed a severe case of TD, which was complicated by two successive episodes of jaw subluxation. In spite of the good outcome following the reduction of the subluxation, we emphasize the danger of this rare painful, and bothersome side-effect and recommend how to pharmacologically deal with the TD setting in which it occurred.