Cureus

IntroductionTraditional bone-setting remains a culturally significant healthcare practice in low- and middle-income countries, particularly in regions like Sudan where modern orthopedic services are often inaccessible or unaffordable .This study examines the role of traditional healing practices in orthopedic care in White Nile State, Sudan, assessing patient perceptions, treatment effectiveness, and sociocultural factors influencing healthcare choices. MethodsA cross-sectional analytical study was conducted among 147 patients, 7 traditional healers, and 4 orthopedic practitioners in urban and rural areas of White Nile State. Data were collected using structured questionnaires and interviews, focusing on treatment preferences, perceived effectiveness, and barriers to integration. Descriptive and inferential statistics were used to analyze quantitative data, while thematic analysis was applied to qualitative responses from healers and practitioners. ResultsFractures (45.6%) and arthritis (23.1%) were the most common orthopedic conditions. 30.6% of patients initially sought traditional treatment, all eventually utilized modern care (medication 71.4%, surgery 42.9%). Traditional healing was perceived as somewhat effective by 40% of users, whereas 59.9% rated modern care as very effective. Key factors influencing treatment choices included cultural beliefs (29.9%), accessibility (18.4%), and cost (16.3%). No significant demographic associations were found with treatment preference or effectiveness (p > 0.05). Traditional healers predominantly treated dislocations (100%) and fractures (71.4%) using manual techniques, with 57.1% referring complex cases to modern practitioners. Barriers to collaboration included lack of communication (85.7% of healers) and differing treatment philosophies (50% of practitioners). ConclusionThis study highlights the persistent dual reliance on traditional and modern orthopedic care in Sudan, with modern treatments perceived as more effective yet traditional methods remaining culturally entrenched especially in rural areas. The path forward requires bridging these systems through mutual respect, shared protocols, and community engagement to ensure safe, equitable, and effective musculoskeletal care for all Sudanese patients.

Background Urinary catheterization is a routine procedure after ureteroscopy lithotripsy URSL , but it often causes catheter-related bladder discomfort (CRBD) and urethral pain, which aggravates patients' postoperative discomfort. This study finds out the effect of topical anesthesia on CRBD and urethra pain in patients undergoing ureteroscopy lithotripsy and urinary catheterization. Methods In this study, 330 patients undergoing ureteroscopy lithotripsy enrolled, with 160 cases in the control group and 170 cases in the experimental group. The experimental group divided into two subgroups based on the local anesthetic used: Tetracaine Hydrochloride Gel subgroup and Oxybuprocaine Gel subgroup. Postoperative assessments conducted using CRBD scores and urethra pain numerical rating scale (NRS) score. CRBD and urethra pain NRS scores measured at T0, T1, T2, T3, T4, T5, and T6. Results Compared to the control group, the use of local anesthetics significantly reduced both CRBD scores and urethra pain NRS scores in the experimental group, with the differences being statistically significant (P < 0.01). In male patients, patients who used local anesthetics markedly decreased CRBD scores and urethra pain NRS scores compared to those not receiving local anesthetics, showing statistical significance (P < 0.01), whereas no significant difference followed in female patients. No statistically significant differences found between Rigid ureteroscopy lithotripsy R-URSL and Flexible ureteroscopy lithotripsy F-URSL) regardless of the use of local anesthetics. Within the experimental group, the effects of different local anesthetics were similar, with comparable impacts on CRBD scores and urethra pain NRS scores, and no statistical differences noted. These findings suggest that local anesthetics are effective in reducing postoperative CRBD scores and urethra pain NRS scores, especially in male patients. Conclusion Topical anesthesia following ureteroscopy lithotripsy reduces CRBD scores and urethra pain NRS scores in patients undergoing urinary catheterization, especially in male patients.

PurposeTo evaluate the predictive value of the thoracic spine-clavicle angle (TSCA) and the thoracic cage-clavicle angle (TCCA) for immediate postoperative shoulder balance. MethodsA total of 154 Lenke type 1 and 2 AIS patients who underwent corrective surgery in our hospital were included. The degree of clavicle angle (CA), thoracic spine tilt angle (TSTA), thoracic cage tilt angle (TCTA), proximal thoracic curve (PTC) Cobb angle, and main thoracic curve (MTC) Cobb angle were measured on standing full-length posteroanterior spine radiographs before and after surgery. Five parameters, TSCA, TCCA, correction rate of PTC, correction rate of MTC, relative PT/MT residual Cobb angle (RRCA), were calculated. Multinomial Logistic Regression was used to determine the risk factors of PSB. A p-value of less than 0.05 was considered statistically significant. ResultsFor TCCA, in group R (vs group B), pre-op right high (vs pre-op left high) (OR=8.102, 95%CI [1.650, 39.786], p=0.01) and RRCA (OR=1.015, 95%CI [1.004, 1.026], p=0.009) are risk factors. Pre-op left high (vs pre-op right high) (OR=0.123, 95%CI [0.025, 0.606], p=0.01) and correction rate of MTC (OR=0.886, 95%CI [0.809, 0.971], p=0.009) are protective factors. Correction rate of PTC shows no significant effect. In group L (vs group B), pre-op left high (vs pre-op right high) (OR=2.648, 95%CI [1.084, 6.469], p=0.033) is a risk factor. Pre-op right high (vs pre-op left high) (OR=0. 378, 95%CI [0. 155, 0.922], p=0. 033) is a protective factor. Correction rate of PTC, correction rate of MTC, and RRCA show no significant effect. ConclusionPreoperative shoulder balance, as defined by the TCCA, serves as an independent risk factor for PSB. Using postoperative balanced shoulders as the reference group, preoperative left shoulder high (vs right high) significantly increased the risk of postoperative left shoulder high, while significantly reducing the risk of postoperative right shoulder high. Preoperative right shoulder high (vs left high) significantly increased the risk of postoperative right shoulder high, while significantly reducing the risk of postoperative left shoulder high. The correction rate of MTC was an independent protective factor against postoperative right shoulder high, whereas RRCA was an independent risk factor for postoperative right shoulder high.

BackgroundGlaucoma is identified as one of the leading causes of blindness worldwide. Its chronic nature and the potential for irreversible vision loss contribute to significant distress among affected individuals. Around 25% of individuals with glaucoma are estimated to experience depression, negatively impacting their quality of life and treatment adherence. However, data on the prevalence of depression among people with glaucoma in Tanzania is limited. This study aimed to determine the prevalence and factors associated with depressive symptoms among adults with glaucoma at Muhimbili National Hospital. Materials and methodsA cross-sectional study was conducted involving 297 adults with glaucoma, who were recruited consecutively from the ophthalmology clinic at Muhimbili National Hospital between July and November 2024. Data on biopsychosocial factors were collected using interviewer-administered questionnaires and medical records. Patient Health Questionnaire-9 and Oslo Social Support Scale assessed depressive symptoms and social support, respectively. Data were analyzed using STATA version 16. Logistic regression analyses identified factors associated with probable depression, with statistical significance set at p-value<0.05. ResultsThe mean age of participants was 63.6 years (SD{+/-}12.8), with 159 (53.5%) being female. Prevalence of probable depression was 11.1%, with 8.7% moderate, 2.4% moderately severe, and none reporting severe depressive symptoms. Having moderate social support (AOR 0.14; CI: 0.04-0.47; P=0.001) and strong social support (AOR 0.08; CI: 0.03-0.25; P<0.000) were significantly associated with lower odds of probable depression. ConclusionApproximately 1 in 10 individuals with glaucoma experience depression. Having good social support was identified as a protective factor against depression in people with glaucoma. These findings underscore the need for a multidisciplinary approach integrating psychosocial services into ophthalmology clinics.

IntroductionRecent evidence has shown that vitamin C has analgesic properties in immediate postoperative context. However, while a clinical trial is currently underway to evaluate vitamin C for reducing opioid consumption in acute musculoskeletal (MSK) injuries emergency department (ED) patients, its direct analgesic effect in this population has not yet been established. This pilot study evaluated the feasibility of conducting a randomized placebo-controlled trial to determine the analgesic effect of vitamin C alone compared with placebo in acute MSK injured ED patients. MethodsWe conducted a double-blind, randomized controlled pilot trial stratified by fracture status in a tertiary care center. Adults ([&ge;]18 years) presenting to the ED with MSK injuries of [&le;] 48 hours duration and pain intensity >3/10 were randomized to receive vitamin C 900 mg twice daily for three days or placebo. Participants completed a six-day diary (electronic or paper) and were contacted on day six to document analgesic use, treatment adherence, and pain intensity. ResultsOverall, 147 patients were screened; 63 (42.9%) were excluded, 24 (16.4%) refused, leaving 60 (41.1%) participants, with a consent rate of 13.0/month. Mean age (SD) was 41.8 years (14.23) and 50% were female. Lost to follow-up rate differed between participants with electronic diary (n=7; 16.7%) and participants with paper diary (n=10; 55.6%). Patients compliance with treatment was 97.6%. The least-squares mean difference between group A and group B in the time-weighted sum of pain intensity differences over 72 hours (SPID72) was 348.7 (95% confidence interval [CI]:-698.9 to 1396.4) for the intention-to-treat analysis and 357.6 (95%CI:-709.67 to 1424.82) for the per-protocol analysis. ConclusionThis pilot study supports the feasibility of a larger randomized controlled trial on the analgesic properties of vitamin C for acute MSK injured ED patients. Strategies to reduce the missed patients and lost to follow-up rates are proposed. Trial registration numberNCT06306183, ClinicalTrials.gov

BackgroundNon-communicable diseases are the result of a combination of genetic, physiological, environmental and behavioral factors. Evidence revealed that tobacco smoking is a leading cause of CVDs-related disability and premature mortality among others. Nevertheless, there is dearth of evidence on national and substantial health risks and distribution of health losses from CVDs associated with tobacco smoking in Ethiopia. MethodsData on mortality, disability-adjusted life years, years lived with disability, and years of life lost from CVDS attributable to tobacco smoking were extracted from the global burden of diseases 2023 study for Ethiopia and regions and administrative cities from 1990 to 2023. Comparative Risk Assessment Framework was used to generate the estimates. Disability-adjusted life years were obtained by adding the estimates of years lived with disability and years of life lost. Spatiotemporal Gausian process regression technique was employed to smooth the estimates. Rates were estimated per 100,000 population. ResultsAn estimated 98332.1 (95% UI: 81623.8, 116279.3) CVDs-related mortalities occurred among adults aged 20 years and above in Ethiopia in 2023. The corresponding age-standardized death rate of CVDs attributable to tobacco smoking was estimated to be 221.1 deaths per 100,000 population (95% UI: 182.1, 261.5). A higher than the national age standardized death rate was estimated in Afar [266.2 (95% UI: 205.1, 332.2)], Benishangul-Gumuz [268.3 (95% UI: 216.9, 321.3)], South west [334.9 (95% UI: 250.3, 459.7)], and Addis Ababa [342.8 (95% UI: 260.6, 418.6)]. The age-standardized rate was estimated to be 5317.8 disability-adjusted life years (95% UI: 4503.3, 6237.6), 375.9 years lived with disability (95% UI: 275.9, 488.9), and 4941.9 years of life lost (95% UI: 4152.4, 5809.5). Stroke and ischemic heart disease were found to be the leading causes of deaths attributable to tobacco smoking. There was no significant trend shift in all the rates from 1990 to 2023. ConclusionThis study has revealed that tobacco smoking continued to inflict substantial burden of disability and mortality among adults aged 20 years and above in Ethiopia, with subnational variation and stable trend over the past three decades. Ischemic stroke, ischemic heart disease, and intracerebral hemorrhage were found to be the leading causes of disability and premature mortality.

BackgroundArthroscopic release for elbow stiffness is considered a minimally invasive and effective treatment. However, the extent to which each intraoperative step contributes to improvement in range of motion (ROM) has not been well investigated. PurposeTo sequentially evaluate the relationship between intraoperative surgical steps and changes in elbow ROM during arthroscopic release for severe elbow stiffness, and to identify the key procedural stage contributing most significantly to ROM improvement. MethodsFive elbows in five patients with severe elbow stiffness following fracture or dislocation were retrospectively reviewed. Arthroscopic release was performed using a stepwise posterior-based approach, starting from the posterior soft-spot portal, followed by exposure of the olecranon fossa and progression into the posteromedial compartment. Changes in elbow ROM were assessed at each intraoperative step, and ROM at final follow-up was also evaluated. ResultsAll patients demonstrated improvement in elbow ROM at final follow-up. Intraoperative ROM improvement did not occur in a continuous manner but rather in a stepwise fashion. Gradual improvement was observed with establishment of the posterior and posteromedial working spaces, followed by the most substantial increase in ROM immediately after release of the soft tissue attached to the posterior aspect of the humeral medial epicondyle. Although the maximum ROM achieved intraoperatively was not fully maintained at final follow-up, no patient experienced deterioration to preoperative ROM levels. ConclusionsIn arthroscopic release for severe elbow stiffness, improvement in elbow ROM occurs in a stepwise rather than continuous pattern. Release of the posteromedial structures attached to the posterior aspect of the humeral medial epicondyle may represent a critical turning point contributing significantly to ROM improvement.

OBJECTIVE This study investigates the long-term impacts of childhood exposure to voiding cystourethrogram (VCUG), a diagnostic procedure for vesicoureteral reflux. Primary outcomes include long-term health outcomes, mental health disorders, healthcare avoidance, and participation in risky behaviors compared to a control group. METHODS A 9-month retrospective cohort study was conducted with adults who received most of their medical care in the U.S. Respondents self-reported health metrics, behaviors, and outcomes via a 20-minute survey. Respondents were divided into two groups: those who remembered undergoing at least one VCUG in childhood (VCUG group), and those who did not (control group). RESULTS Of 334 respondents, 204 (61%) were in the VCUG group (mean age: 29, 70% female) and 130 (39%) were controls (mean age: 34, 70% female). Notable findings include: 47% of VCUG respondents were diagnosed with depression compared to 27% of controls. 15% of female-born VCUG respondents reported they would never visit a gynecologist compared to 2% of controls. 34% of VCUG respondents smoked regularly compared to 5% of controls, and 11% of VCUG respondents regularly missed work compared to 1% of controls. These findings highlight the need for further research and clinical consideration of VCUG's long-term consequences. CONCLUSIONS This study suggests that the effects of childhood VCUG extend into adulthood. Our findings underscore the need to reassess informed consent protocols and consider full-scale studies to minimize bias.

BackgroundSnakebite envenoming is a significant global health crisis that has been long neglected as a global health priority. It is a huge problem for rural communities of low and middle-income countries, India accounts for the largest proportion of snakebite deaths globally. Timely identification of venomous snakebite and its syndromic pattern is essential for effective administration of antivenom and supportive treatment. Expert identification of snake species and syndromes is not always available in peripheral healthcare settings. This leads to delays, unnecessary referrals, or improper treatment choices. Additionally, diverse snake species distribution and venom variations across regions pose challenges. AI-powered image classification methods can help overcome these barriers. We propose a clinically oriented deep learning pipeline for binary classification of venomous and non-venomous snake species of India using real-world imagery data. This pipeline would serve as a baseline step towards aiding snakebite management at peripheral healthcare setups with scarce resources. MethodsThe selected dataset consisted of 20 medically important Indian species. MobileViT-S, ConvNeXt-Tiny, EfficientNet-V2-S and ResNeXt-50 (32x4d) were trained under same conditions for comparison of results. Model interpretability was evaluated using Grad-CAM ++ to ensure that classification was not performed based on background but on features like head shape and stripes present on body. For reliable implementation we connected it to a web interface with human in loop expert verification. Experts can confirm or override predictions in real time. ResultsAmong the evaluated architectures, ResNeXt-50 (32x4d) showed the most reliable and consistent performance in classifying venomous and non-venomous snakes. It achieved the highest test accuracy, sensitivity, specificity, and F1-score. The model also had strong discriminative ability, with a ROC-AUC of 0.9950 and PR-AUC of 0.9959. These results indicate dependable performance in safety-critical screening situations. Grad-CAM++ visualizations confirmed that predictions were based on anatomically relevant features, especially in the head and body contour areas. This supports model interpretability and reduces background bias. ConclusionsAlthough the dataset size and single-institution source limit how widely the results can be applied, the proposed framework shows that its possible to create a clinically oriented, ready-to-use deep learning system for snakebite triage support. This system is intended as a scalable tool to help rural healthcare workers, emergency responders, and telemedicine platforms in areas where snakebites are common. Author SummarySnakebite is a major public health concern that disproportionally affects the rural population. Delays in identifying whether a snake is venomous often lead to delayed treatment, unnecessary use of antivenom, or inappropriate referrals. In many rural settings, access to expert snake identification is limited. To address this gap, authors have developed an artificial intelligence (AI)-based image classification system that distinguishes snakes into two clinically relevant categories: venomous or non-venomous. Unlike many previous studies that focused on ideal, high-quality wildlife images, our model was trained using real-world photographs captured in emergency situations, including images taken by patients and field responders under variable lighting and background conditions. This approach improves the models relevance to practical healthcare settings. The system achieved high accuracy and was further strengthened by visual interpretability tools and expert verification to ensure reliability. By combining AI-assisted classification with human oversight, this work provides a scalable decision-support tool that may improve early triage, rational antivenom use, and surveillance in snakebite-endemic regions

Synthetic food dyes (SFDs) have been associated with neurobehavioral symptoms in children, including hyperactivity, inattention, anxiety, and irritability. Although often associated with candy and snack foods, SFDs are also present in hydration beverages commonly consumed by children during illness and physical exertion. This study examined the prevalence of SFDs in hydration drinks by target age group and product type. Ingredient information was collected for 102 hydration beverages from a single retail in Carson City, Nevada in 2024. Products were categorized as pediatric-marketed, adult-marketed, or marketed to all ages. Of 24 pediatric-marketed drinks, 21 (87.5%) contained at least one synthetic dye, most commonly Red 40 (66.7%), Blue 1 (61.9%), and Yellow 6 (19.0%). Among six adult-marketed drinks, two (33.5%) contained dyes, primarily Blue 1 and Red 40. Of 72 all-age products, 20 (27.7%) contained synthetic dyes. Overall, 43 of 102 drinks (42.2%) contained at least one SFD, with Blue 1 (51.2%), Red 40 (44.2%), and Yellow 6 (23.3%) being most prevalent. Hydration beverages are often perceived as health-supportive and are frequently consumed during physiological stress. Given prior evidence linking SFDs to behavioral effects, the high prevalence of dyes in pediatric hydration products warrants clinical awareness.

ObjectivesTo develop and evaluate JADE, a proof-of-concept retrieval-augmented generation (RAG) diagnostic assistive system was designed to enhance large language model (LLM) reasoning for the assessment of jawbone lesions. This study examined whether integrating structured retrieval with GPT-5 improves diagnostic accuracy and stability compared with standalone LLMs. MethodsJADE was developed as a cloud-based application integrating GPT-5 with a curated oral radiology and pathology database using a hybrid semantic-keyword retrieval strategy. Clinical and radiographic characteristics were imported as a structured query to guide retrieval and support diagnostic reasoning. Performance was compared with standalone GPT-5, Claude Sonnet 4.5, DeepSeek-R1, and Gemini 2.5 Flash across 25 cases. Accuracy was analysed using Cochrans Q test with post-hoc McNemars tests and Bonferroni correction. Intra-model stability was measured using the majority agreement ratio, and response time was recorded to assess real-time usability. ResultsJADE showed the highest diagnostic performance, correctly identifying 20 out of 25 cases and outperforming all standalone LLMs. Significant differences were observed across models (Cochrans Q = 33.2, df = 4, p < 0.001), with post-hoc analyses confirming that JADE significantly outperformed GPT-5, Gemini 2.5 Flash, and Claude Sonnet 4.5 (p < 0.01). JADE also exhibited the greatest run-to-run stability (mean MAR = 0.90 {+/-} 0.18). The average prediction time of 6 {+/-} 0.5 seconds supported its feasibility for real-time clinical use. ConclusionsJADE improved diagnostic accuracy and stability over standalone LLMs, underscoring the value of RAG reasoning in jawbone lesion assessment and its potential for real-time clinical use.

BackgroundHand hygiene remains a cornerstone of infection prevention in surgical practice, particularly in orthopedic operating theatres where inadequate aseptic technique can increase the risk of surgical site infections and implant-related complications. Despite well-established recommendations from the World Health Organization (WHO) regarding proper surgical hand-scrubbing techniques, compliance in many healthcare settings remains inconsistent. Clinical audits provide a structured approach to evaluating adherence to such guidelines and implementing targeted improvements. This study aimed to assess baseline hand-scrubbing practices in an orthopedic operating theatre at a regional hospital in northern Pakistan and evaluate the impact of educational interventions on compliance with WHO standards. MethodsA prospective closed-loop clinical audit was conducted in the orthopedic operating theatre of Regional Headquarter Hospital Skardu, Pakistan, from December 1, 2025, to February 1, 2026. Approximately 40 healthcare personnel, including consultants, residents, nurses, and operating theatre assistants, participated in the audit. Baseline hand-scrubbing practices were observed during routine surgical sessions using a structured checklist based on WHO hand hygiene guidelines. Following the baseline assessment, educational interventions were introduced, including live demonstrations of correct hand-scrubbing techniques and placement of visual reminder posters in the scrub area. Post-intervention compliance was re-evaluated using the same checklist. Compliance rates before and after the intervention were compared using appropriate statistical analysis, with significance set at p < 0.05. ResultsBaseline observations revealed suboptimal compliance with recommended hand-scrubbing standards, particularly with regard to scrubbing duration, coverage of all hand surfaces, and proper drying technique. Following the educational intervention, significant improvements were observed across all evaluated components. Compliance with scrubbing duration of at least two minutes increased from 45% to 90%, coverage of all hand surfaces improved from 50% to 88%, proper antiseptic usage increased from 60% to 93%, and correct drying technique improved from 55% to 87%. Adherence to overall aseptic protocol also increased from 70% to 95%. All observed improvements were statistically significant (p < 0.001). ConclusionsThis prospective clinical audit demonstrates that structured educational interventions, including live demonstrations and visual reminders, can significantly improve compliance with recommended hand-scrubbing practices in orthopedic operating theatres. Regular audits combined with targeted educational strategies represent practical and cost-effective measures for improving infection control practices and enhancing patient safety in surgical settings.

We are pleased to submit our Original article entitled "Assessing medication-related burden and medication adherence among older patients from Central Nepal: A machine learning approach" for consideration in your esteemed journal. In this paper, we assessed medication burden using validated Living with medicines Questionnaire (LMQ-3) and medication adherence using Adherence to Medication refills (ARMS) Scale. In this paper we analysed our result through machine learning approach in spite of traditional statistical approach to identify the complex factors influencing both. Six ML architectures (Ordinary Least Square, LightGBM, Random Forest, XGBoost, SVM, and Penalized linear regression) were employed to predict ARMS and LMQ scores using various socio-demographic, clinical and medication-related predictive features. Model explainability was provided through SHAP (Shapley Additive exPlanations). Our study identified the moderate medication burden with moderate non-adherence among older adults. Requiring assistance for medication and polypharmacy were the strongest drivers for the medication burden and non-adherence. The high predictive accuracy by ML suggests the appropriate clinical intervention like deprescribing to cope with the high prevalent medication burden and non-adherence among older adults in Nepal.

PurposeMeasuring near vision provides clinicians with valuable insight into visual function. There is limited information on the accuracy of available reading charts frequently used in community practice. This study aimed to measure internationally available reading charts to determine how they compare to international standards, and develop a free chart, the UC/UWA Reading Chart, that conforms to these standards. MethodsCommercially and device manufacturer-provided reading charts were scanned at 600 dots per inch. Gaussian adaptive threshold was used to facilitate repeatable measurements. X-heights of letters were measured independently by three researchers. Other variables such as contrast levels and line spacing were also measured. Results for each chart were compared with ISO Standards. Intraclass correlation coefficient was used to assess intergrader agreement. ResultsOf the 19 reading charts that were measured, only one chart (5.26%) had text sizes that were all within tolerance. There was high variability in size observed between charts. Twelve charts (63.2%) used serif fonts and seven used sans-serif (36.8%). Text on serif charts tended to be smaller than required ({micro}=-9.65%) compared to sans-serif ({micro}=+4.96%). All charts met the line spacing requirements and minimum required contrast level; however, some charts were printed on laminated or satin plastic which does not meet the standard of using a matte surface. There was high interrater agreement (ICC(2,1) = 1.00), indicating a highly repeatable measurement technique. ConclusionThis study found that the tested reading charts displayed significant variability in text size. Although some charts had more lines of text within size tolerances than others, none met all the requirements of the International Standard. Clinicians and researchers should take care when interpreting changes in near reading acuity when multiple charts have been used, especially as part of shared care models or when monitoring progressive vision changes. Key pointsO_LINone of the measured reading charts met the requirements of the ISO 7921:2024 standard. C_LIO_LIThere is high variability in text size between reading charts. C_LIO_LIA new chart, the UC/UWA Reading Chart, has been developed to conform to the ISO standards. C_LI

Sexual abuse among adolescent girls is underreported in low and middle income countries including Nepal. This study aimed to estimate the prevalence of SA among school girls, examined associated sociodemographic and contextual factors describe the nature and reporting patterns of abuse and assess the relationship with nutritional status. A school based cross sectional study was conducted, among 330 female students (ages 14-19) were selected through simple random sampling from two schools. Data were collected using a validated self-administered questionnaire covering demographic characteristics, abuse experiences, psychosocial responses and reporting patterns. Anthropometric measurements were used to assess BMI-for- age and height-for-age Z scores calculated using WHO AnthroPlus. Logistic regression analysis was used to identify factors independently associated with sexual abuse and adjusted odds ratio with 95% confidence intervals were calculated. SA prevalence was 33.3%. Most perpetrators were male (61.5%) and known to the victim, 63.3% involved perpetrator use. Reporting was low (16.5%) due to fear (42.2%) and shame (22%). Significant predictors included lower maternal education (AOR=3.03) and living in joint families (AOR=2.34).After adjusting for confounders, SA was strongly associated with thinness (AOR=5.59; 95% CI; 2.54-12.26), severe thinness (AOR=18.81; 95% CI: 4.21-84.07) and stunting (AOR=3.79; 95% CI: 1.88-7.62). One in three girls experienced sexual abuse, which is strongly correlated with growth impairment and malnutrition. These findings suggest that anthropometric deficits may serve as clinical red flags for underlying trauma. Strengthening school-based nursing programs and primary care screening is essential for early identification and safeguarding.

BACKGROUND: Prostate cancer (PrCa) is the most commonly diagnosed cancer in men in many countries and is the most heritable of the common cancers. Precision medicine approaches to disease management are not routinely available to most men, yet we know that germline genetic testing can help identify those at high-risk of developing advanced or lethal disease and can influence selection of therapeutics. An integral part of healthcare delivery design is the inclusion of patients/consumers in the development of frameworks for managing health interventions that are tailored to meet their needs. METHODS: In Phase I, we undertook focus group discussions with men previously diagnosed with PrCa (n=20), to determine their opinions, perceptions and expectations of germline genetic testing for PrCa. Focus groups were tape-recorded, transcribed verbatim, coded and then thematically analysed using NVivo. In Phase II, themes were then used to design and development a Precision Medicine in Prostate Cancer Information Toolkit, which was reviewed by patients (n=14), their carers/family members (n=4) and healthcare providers (n=14). RESULTS: In Phase I, knowledge about precision medicine and genetic testing was generally low. The strongest motivation for undertaking testing was to identify family members' risk levels (n=7), and the biggest concern pertained to insurance discrimination (n=5). Phase II data revealed that generally healthcare providers (n=8) found the purpose of the toolkit to be clearer than patients (n=5). Though, patients found the task of imagining the usefulness of the toolkit at the time of diagnosis or beforehand when assessing genetic risk, quite difficult. Participants highlighted that information regarding life insurance, implications for their family and costs associated with testing were of concern. CONCLUSIONS: This study has revealed critical knowledge gaps, preferred communication/support needs, and concerns/risks associated with germline genetic testing in PrCa. Concerns pertaining to family members and insurance discrimination are obvious topics that need to be addressed. Our toolkit may be helpful in addressing knowledge gaps, but further testing is needed to ensure its accessibility across literary and cultural contexts.

BackgroundThe World Health Organization (WHO) defines self-medication as taking medicine by someone to treat a health problem on their own, without a professional or doctor consultation. Self-medication is a growing public health concern globally, including in Afghanistan. This study aims to assess the prevalence of self-medication and its associated factors among the residents of Kandahar city. MethodologyAn analytical cross-sectional study was conducted in 12 districts of Kandahar city. A total of 401 adults were randomly selected and interviewed at private pharmacies using a structured questionnaire. Data collection was done from June 22 to July 17, 2025. The data was analyzed using SPSS version 26, with descriptive and analytical analyses, considering a p-value below 0.05 as statistically significant. ResultsA high prevalence (71.1%) of self-medication was observed among the residents of Kandahar. More than one type of medication was used by 47.1% participants, with paracetamol being the second most commonly used (18%). More than half (54.1%) of medicines were used for multiple symptoms. The specific reasons for self-medication were high doctor fees (18.5%) and previous experience with similar symptoms (13.7%). Pharmacies were identified as the primary source of self-medication (69.8%). Statistically significant factors associated with self-medication were found to be lack of awareness about self-medication (p-value = 0.003), easy access to pharmacies (p-value = <0.001), and the presence of symptoms (p-value = <0.001). ConclusionSelf-medication was highly prevalent in Kandahar, with key associated factors such as lack of awareness, easy access to pharmacies, and the presence of symptoms. It is recommended to implement health education programs to increase awareness about the adverse effects of self-medication. Strict implication of rules and regulations is required to control the sales of medicines without prescription in pharmacies.

AimsThis study aimed to examine the prevalence of malnutrition and its associations with functional capacity and quality of life (QoL) in AL and ATTR cardiac amyloidosis patients. Methods and ResultsThis cross-sectional pilot study included 29 patients with confirmed CA (14 AL, 15 ATTR). Data were collected between January 2020 and September 2021. Nutritional status was assessed using body mass index (BMI), anthropometric measures, and the Subjective Global Assessment (SGA). Functional capacity was evaluated via handgrip strength and the 6-minute walk test, while QoL was assessed using the SF-36 and Kansas City Cardiomyopathy Questionnaire. Malnutrition, as determined by SGA, was present in 62% of patients, with no significant difference between AL and ATTR subtypes. In contrast, BMI according to WHO criteria failed to identify any cases of malnutrition, highlighting its limited utility in this population. These results suggest that conventional indicators may underestimate nutritional impairment in CA. Although overall QoL and functional capacity did not differ significantly between nutritional groups, malnourished AL patients showed notably lower QoL scores compared with well-nourished peers. ConclusionMalnutrition is highly prevalent in cardiac amyloidosis and seems to particularly affect the AL subtype. These findings underscore the importance of routine nutritional screening and targeted interventions, as early identification and management of malnutrition may improve patients quality of life and long-term outcomes.

IntroductionGlomerular filtration rate (GFR) is invasive to measure. Therefore, in clinical care, estimated GFR is derived from serum levels of endogenous filtration markers such as creatinine and cystatin C. Multiple studies from high income countries showed differences between estimated glomerular filtration rate based on cystatin C (eGFRcys) and creatinine (eGFRcr). This study aimed to assess the agreement between eGFRcys and eGFRcr in Ethiopian children and identify factors influencing higher eGFRcys and eGFRcr. MethodWe studied 350 Ethiopian children who were part of the iABC birth cohort study. At the recent follow-up (average age 10 years), serum cystatin C and creatinine were measured. Formulas by Berg (2015) and Hoste (2014) were used to estimate eGFRcys and eGFRcr, respectively, and Bland-Altman plots assessed their agreement. The difference in eGFR (eGFRdiff) was calculated and categorized as less than-15 mL/min/1.73 m{superscript 2} (higher eGFRcr), between-15 and <15 mL/min/1.73 m{superscript 2} (concordant), and greater than or equal to 15 mL/min/1.73 m{superscript 2} (higher eGFRcys). Multinomial logistic regression was used to identify factors associated with higher eGFRcr and higher eGFRcys. ResultEstimated glomerular filtration rate (eGFR) showed significant variation based on the estimation formula used. When using formulas by Berg (2015) and Hoste (2014), the median (IQR) eGFRcys and eGFRcr were 99.4 (90.0; 114.1), and 123.2 (110.3; 143.8) mL/min/1.73 m2, respectively. Overall, we observed a poor agreement between eGFRcys and eGFRcr, with only 94 (27.6%) children having concordant results compared to 220 (64.7%) with higher eGFRcr and 26 (7.6%) with higher eGFRcys. If the eGFRcys results are considered reliable, 27.5% of the children had eGFR below 90 mL/min/1.73 m{superscript 2}. ConclusionThere was very marked variation in the distributions of estimated eGFRs depending on which formulas for children were used. Agreement between eGFR estimated using cystatin C and creatinine was poor among Ethiopian children. Relative to eGFRcys, kidney function may be overestimated by creatinine-based equation as up to 30ml/min in Ethiopia. Ideally, a validation study with GFR measured by gold standard methods (Inlulin clearance) among children is required. However, because of its invasive nature and financial concerns, Iohexol clearance studies are recommended.

BACKGROUNDSotalol loading intravenously enables achieving blood levels of sotalol that are observed at maximal steady-state concentration (Cmax ss) in one-day permitting the measurement of maximum QTc effects. Rapid evaluation of the QTc effects permits determination of arrhythmic risk and thus permits discharge in 24-hours instead of the usual three-day oral load hospitalization. Given the expense of IV Sotalol an oral loading test strategy is presented that also achieves Cmax ss blood levels rapidly, permitting a one-day hospitalization for QTc evaluation. METHODPharmacokinetic parameters referred to in the literature derived from normals as well as patients was utilized for population pharmacokinetic modeling and simulation.to obtain the Cmax ss concentrations for patients with normal renal function, creatinine clearance (CrCl) > 90 ml/min), as well as for patients with a CrCl of 60-89, 30-59, and 10-29 ml/min). Using pharmacokinetic simulations, an oral loading dose, as well as a second oral dose were determined that would reach the estimated Cmax ss in each of the groups based on renal function. RESULTSFor target dosing of 120 mg oral sotalol BID in patients with a CrCl >90 ml/min an oral loading dose of 200 mg provides a peak sotalol level of 1,420 ng/ml in 3-4 hours post dosing. The Cmax ss target is 1,299 ng/ml resulting in a 9% overshoot. The Cmax ss concentration provides a means of evaluating QTc effects within 24-hours. Oral loading regimens are described for varying additional renal function levels (CrCl 60-90, 30-59 and 10-29 ml/min) along with the time to first oral dose and follow-up dosing. The initial test dose can be based on an 80 or 120 mg oral sotalol maintenance dosing strategy. CONCLUSIONSEmploying an oral loading strategy may permit QTc evaluation and one-day discharge, preserving the pharmacoeconomic advantage of a Cmax ss test strategy. Clinical PerspectiveO_ST_ABSWhat is Known?C_ST_ABSO_LIIntravenously loading of sotalol enables achieving blood levels that are observed at maximal steady-state concentration (Cmax ss) in one-day permitting the measurement of maximum QTc effects. C_LIO_LIRapid evaluation of the QTc effects permits determination of arrhythmic risk and thus permits discharge in 24-hours instead of the usual three-day oral load hospitalization C_LI What the Study AddsO_LIWith oral sotalol loading, the Cmax ss can also be achieved in one-day permitting the measurement of maximum QTc effects and discharge from the hospital in 24-hours instead of the usual three-day inpatient initiation of oral sotalol. C_LI