F1000Research

Background and aims- Patients for interventional pulmonary procedures (IPP) are inherently high risk due to various comorbidities as well as the procedure being variable in duration and adverse events. Incomplete muscle reversal can delay rapid recovery and lead to adverse events in the postoperative period. Sugammadex as a reversal agent, may offer distinct advantages when residual neuromuscular blockade is poorly tolerated. Limited data is available on use of suggamadex in high risk IPP regaurding extubation times and adverse events. Studies on pulmonary complications and anaphylaxis in this subset of pulmonary patients is controvertial. Moreover in the Indian setup optimizing the turnaround time to justify the cost of suggamadex for IPP is yet to be determined. In this retrospective study we will compare the advantages of using Sugammadex over the conventional reversal agent Neostigmine for time to extubation and time to shifting the patient to PACU in patients undergoing IPP. The hemodynamic parameters and adverse events will also be noted. Materials and methods-After ethics approval from institute (EC/OA- 48/2025) we conducted a retrospective cohort study of 70 adults (18-60yrs) for a duration of 6 months in our institute who underwent IPP under general anaesthesia ( tracheal dilation, tracheal biopsy, EBUS TBNA,BAL etc) . They were categorized into two groups: Group A- suggamadex vs. Group B- neostigmine. TOF monitoring was recorded and time to extubation and shift to PACU was noted along with hemodynamics and adverse effects. The statistical software SPSS version 16 was used for the analysis. Results-A total of 70 patients were included. Patients in Group sugammadex showed less time to extubate (5.80+/-0.96 vs 13.26+/-1.88 ,P value 0.0001) and discharge from PACU (10.49+/-1.44 vs 28.57+/-3.34 min, P = 0.000003) than in Group neostigmine. The difference between heart rate , blood pressure and respiratory rate and adverse events were not statistically significant. Conclusion-Sugammadex shortens the time to extubate and discharge from PACU in patients undergoing IPP, accelerating recovery and turnaround time. No additional adverse events or hemodynamic instability were noted with suggamadex in this subset of patients. No coughing irritable airway.

This study aimed to evaluate the motivations and concerns related to preprint use among Brazilian health researchers. A mixed-methods online survey of all 1,596 holders of CNPq Research Productivity Grants in seven health fields was conducted in 2025. The questionnaire was adapted from a survey of bioRxiv authors, translated into Portuguese, and pilot-tested. Closed-ended responses were analyzed descriptively, and free-text responses were grouped by similarity. Overall, 178 researchers accessed the survey (11.2%), and 143 answered items on preprints and were included in the final analysis (9.0% effective response rate). The mean age was 55.9 years, and 88.0% were affiliated with public institutions. Regarding corresponding-author publications over the previous five years, 62.2% of respondents had deposited no preprints, while 37.8% had deposited at least one. Among preprints users, 79.2% agreed that deposition was freely decided by the authors. The main motivations were rapid sharing of findings (69.8%) and obtaining feedback (49.1%). Few reported benefits in terms of citations (17.3%) or online dissemination (16.9%). Among those who had not deposited preprints, the main reason was not wanting to deposit them (57.6%), followed by being unaware of the option (35.3%). Of the 22 free-text responses, 19 reflected an informed decision not to deposit, most commonly because peer review was considered necessary before public dissemination. Preprint use was limited mainly by a lack of intention to deposit rather than a lack of awareness. Faster dissemination and feedback were the main motivations for using preprints.

Aims: Our primary aim was to determine the immediate effects of using a supported stepping device on the real-time locomotor behavior of pre-walking infants with Down syndrome (DS). Our secondary aim was to characterize the role of the caregiver in facilitating infant locomotor behavior by quantifying infant-initiated and caregiver-initiated walker movement, and to test whether walker movement encourages stepping behavior. Methods: Pre-walking infants with DS played with their caregiver in two conditions--with and without assistance from a wheeled suspension walker. To examine changes across development, we recorded infants across one to four sessions from 10 to 19 months of age. Results: Across developmental stages, we found that suspension walkers robustly increased infants' locomotor behavior: The walker increased upright time, percent time stepping, stepping rate, upright bout rate, percent time locomoting, and total bout rate. Most walker movement was initiated by caregivers, and infants stepped more while the walker was moving compared to stationary. Conclusions: Even without practice, pre-walking infants with DS were able to take advantage of the suspension walker to increase their locomotor behavior. Caregivers facilitated infants' activity by moving the walker. Future work will examine the potential of overground suspension walkers for home-based intervention.

Kajiado County ranks eighth in the country for adolescent pregnancy, with one in five teenagers between the ages of 15 and 19 (21.8%) likely to be pregnant or have begun having children. The objectives of the study were to establish the dietary practices and nutrition status of pregnant adolescents in Kajiado County. The study employed a cross-sectional analytical design in a target population of 196 pregnant adolescents living in Kajiado West, Ewauso and Keekonyoike wards which were randomly selected. Qualitative data was gathered through key informant interview guides with facility nurse in charge and head teacher/principal. Dietary data was collected using a 24-hour dietary recall questionnaire.Dietary diversity was established using the minimal dietary diversity questionnaire for women of reproductive age (MDD-W). Nutrisurvey software was to analyze dietary data. Married respondent was at 41.8% (40.8 users and 44.1% non-users) of ANC with a p-value of 0.212. Dietary energy intake was 1086.82 {+/-} 90.57kcals having RDA of 29.0% (users at 1105.72 {+/-}95.43 and RDA 29.6%, non-users 1070.12{+/-}8.36 with RDA of 28.4%). The Minimum Dietary Diversity (MDD-W) for Women of Reproductive Age 98.4% users was 68.3% of women who utilized antenatal care (ANC) services consumed foods and beverages from 5 or more food groups on the previous day, compared to only 31.7% non-users having a p-value 0.24. Respondent having (MUAC < 22 cm) indicates potential malnutrition or nutritional risk at 31.2% (users at 30.8% and non-users 32.2%) with a p-value 0.534.Overall mean hemoglobin level is 12.35g/dl with a standard deviation of 0.93g/dl having low ranges of < 11.5g/dl (users at 30 and non-users at 12) total of 42 adolescent. These findings underscore the urgent need for targeted interventions at increasing nutrient intake and dietary diversity among pregnant adolescents towards improved nutrition status.

Scientific computing has become a central component of modern scientific discovery. Yet many computational tools are developed by small, specialized teams under incentives that encourage the release of rapidly prototyped tooling without commensurate attention to engineering concerns, including performance and maintainability. These gaps are particularly visible in the life sciences, where the advent of high-throughput sequencing and molecular profiling has made the production and processing of datasets routine at scales that strain reliability and cost. Recently, LLM-based agents have become increasingly capable, with publicly available systems possessing both significant domain knowledge in many scientific fields and the ability to autonomously operate over complex and specialized codebases in pursuit of well-defined goals. Together, these developments create a practical opportunity for scientific computing. Many of the persistent weaknesses of the scientific computing ecosystem stem from technical debt and a shortage of sustained engineering labor and expertise. Here, we examine coding agents as a potential way to address these weaknesses: we present an exploratory field report of eight early case studies in the application of LLM agents to scientific computing across a range of project scopes, from lightweight maintenance tasks to full performance-oriented rewrites of scientific libraries, with a focus on the life sciences. Each of these case studies is accompanied by reflections from the individual or group responsible for the work, including lessons from the process. Overall, we find that the use of coding agents in scientific computing holds great promise for accelerating scientific research and increasing the reliability of critical systems, but that outstanding concerns remain, including responsibility and ownership for such projects, and we suggest collaboration and stewardship with existing maintainers when feasible.

Sepsis is a global health problem. Patients in the Intensive Care Unit (ICU) are at risk of having sepsis because of their vulnerability and use of invasive medical devices. Emerging antimicrobial-resistance complicates treatment. Understanding bacterial profiles and antibiotic sensitivity patterns in the ICU plays an important role in managing sepsis, optimizing antimicrobial use, and improving patient outcomes. The aim of this study was to show bacterial profiles and antibiotic sensitivity patterns among patients who were admitted to the ICU at Mbeya Zonal Referral Hospital for 12 months. This was a prospective cross-sectional study among 187 sepsis-suspected patients. Data analysis was performed using SPSS Version 27. Categorical data were summarized by frequency and percentage. Fishers exact test, chi-square test, and modified Poisson regression were used to show the association between patients clinical variables and culture positivity at a 95% CI. Statistical significance was set at a p-value < 0.05. Out of 187 samples, 41.7% were culture positive. Gram-negative bacteria were commonly isolated (65.4%, with Klebsiella pneumoniae and Escherichia coli being commonly isolated. Commonly isolated Gram-positive bacteria were Coagulase-negative Staphylococcus species (19%). 100% of gram-positive bacteria and 96% of gram-negative bacteria were Multi-Drug Resistant (MDR), respectively. In multivariable analysis, patients who were intubated and mechanically ventilated (aPR = 2.208, 95% CI: 1.133-4.305, p = 0.020) and post-laparotomy patients (aPR = 3.241,95% CI: 1.320-7.958, p = 0.010) independently had a higher proportion of Gram-negative bacteria. The study reveals a high level of resistance to commonly used antimicrobials in our setting, necessitating strengthening of the antimicrobial stewardship program and routine surveillance of antimicrobial resistance patterns.

Purpose The direct effect of iStent inject on intraocular pressure (IOP) in patients with glaucoma is difficult to quantify in pragmatic trials where rates of post-surgical IOP-lowering therapy differ between intervention groups. We aimed to quantify the causal effect of iStent inject on unmedicated IOP at 12- and 24-months post-surgery. Methods Adults with mild-to-moderate glaucoma were 1:1 randomised to receive cataract surgery with iStent inject or cataract surgery alone at an Australian hospital (2017-2020, NCT03106181). IOP-lowering medications were prescribed as per clinician discretion. An exploratory analysis was used to estimate the controlled direct effect of iStent inject on IOP, analogous to the effect expected if all participants had undergone medication washout prior to assessment. Results Ninety-five eyes from 80 people were included (67.4% male, mean age 73.0 years, mean baseline IOP 17.1 mmHg). IOP-lowering medication was required for 53% of eyes in each group at 12 months (n=76); at 24 months (n=86) it was required for 43% and 64% in the active and control groups, respectively. Mean IOP was similar between intervention groups at each outcome visit. The controlled direct effect favoured the iStent inject group at 12 months (-2.1-mmHg difference, 95% CI -4.0,-0.3) but was attenuated at 24 months (-0.5 mmHg-difference, 95% CI -2.6,1.6). Conclusion Although the iStent inject was estimated to have an effect on lowering unmedicated IOP at 12 months, this effect had largely disappeared by 24 months. Medication washout is recommended when safe and practical in future trials to estimate these direct effects with more certainty.

Questions What is the effectiveness of a prenatal educational physiotherapy intervention in reducing the prevalence of positional occipital plagiocephaly (POP) and POP-associated disorders in infants at 3 months of age? Design Two-arm assessor-blind multicentre, randomised controlled trial. Participants 400 pregnant women Intervention The experimental group received specific physiotherapy educational session on POP prevention strategies during the regular antenatal education class meeting. The oblique diameter difference index (ODDI) is the primary outcome. Secondary outcomes included musculoskeletal POP-associated conditions. Results Three hundred twenty-eight newborns completed the study. The ODDI scores showed no statistically significant difference between the groups at 3 months (mean difference -0.28 [95% CI: -0.72 to 0.17; p = 0.218]). The prevalence of POP did not differ between the two groups (21.1% in the intervention group, 22.2% in the control group), which is lower than data reported in the literature (37.8% - 46.6%). No statistically significant between-group differences were found in secondary outcomes, except for spinal postural asymmetry (aRR = 0.95; 95% CI: 0.90 to 0.99; p = 0.031). There were no significant differences in the caregiving strategies adopted during the first three months of life. Conclusion A low POP prevalence was observed, with no statistically significant differences between groups, as both groups adopted preventive strategies. The lack of superiority of the structured education may suggest a shift in parental education. With more health information on social media and the global ease of sharing, parents have relied on digital self-treatment, reducing the intervention's impact; thus, the face-to-face model for low-risk infants may be outdated.

Objective: The ocular surface is an integral unit of the visual system. Its smooth and wet surface which is maintained by the tear film, is the most important refractive interface of the visual system. This study compared ocular surface alterations among glaucoma subjects living with and without diabetes mellitus in a Owerri, Imo State, Nigeria Methods: Subjects diagnosed of glaucoma living with and without diabetes mellitus were included in the study. Ocular surface assessment included the Ocular Surface Disease Index (OSDI) questionnaire, and tear break-up time (TBUT). Descriptive statistics, independent samples t-test and Chi-square test were used to examine the data at 0.05 level of significance. Results: Considerable shorter tear break-up time (11.3 +/- 9.0s) was seen among glaucoma subjects living with diabetes mellitus than those living without diabetes mellitus (16.0 +/- 10.6s; p = 0.003), demonstrating the higher tear film instability. This was similarly reflected by the mean OSDI score, which was considerably higher in glaucoma patients living with diabetes mellitus (40.0 +/- 23.4) compared with those without diabetes mellitus (28.1 +/- 21.8; p = 0.001) showing a larger ocular surface symptom load. However, although the frequency of severe OSDI symptoms was greater in glaucoma subjects living with diabetes mellitus, the relationship between diabetes status and OSDI severity categories was not statistically significant ({chi} 2 = 7.584, p = 0.055). Conclusion: Diabetes mellitus significantly impacts the health of the ocular surface in glaucoma subjects. The combination of glaucoma and diabetes may result in more rapid tear film instability, increased ocular pain, and decreased quality of life and adherence to long-term glaucoma medication. Keywords: Glaucoma, Diabetes Mellitus, Tear Break Up Time, Ocular Surface Disease Index, Ocular surface symptoms

We used Scopus data on 243949 top-cited scientists to map scientific cosmopolitanism defined as having at least two different countries that contribute alone at least 10 percent of an author published record as indexed in Scopus. 20.4 percent of the top-cited authors were cosmopolitan based on this definition. Based on current author affiliation, rates varied widely from 9% to 76% across countries with at least 250 top-cited authors. Countries with few top-cited authors had almost always high rates of cosmopolitanism. The proportion of top-cited authors who are cosmopolitan has steadily increased over time in younger generations among those who started publishing after 1965 reaching 43% recently. Large differences were also seen across scientific subfields from 1% in General Psychology and Cognitive Sciences to 46% in Econometrics. Across the 30 country pairs that were most over-represented, countries shared borders, languages, most common religion pairs, or any of these features in 15, 19, 26, and 29 cases, respectively. The map of cosmopolitan authors reveals a large and increasing proportion of the most influential scientists who share two or more scientific homes that each has made a substantial contribution to their career. Cosmopolitanism among scientists requires better study to help facilitate its potential positive contributions not only to individual scientists but to science and society more broadly.

Introduction: The incidence of postoperative delirium (POD) is high in frail elderly patients who have undergone gastrointestinal surgery, and POD significantly increases the risk of complications and medical burden. Opioid-free anaesthesia (OFA) involves a multimodal analgesic strategy, which may help to reduce the risk of POD. However, relevant studies focusing on frail elderly patients are still limited. This study aims to investigate the effect of OFA on the occurrence of POD in frail elderly patients after gastrointestinal surgery. Methods: This single-centre, prospective, randomized controlled trial (RCT) will be conducted at the First Affiliated Hospital of Shandong First Medical University, China. A total of 44 frail elderly patients aged 65 years or older who plan to undergo elective gastrointestinal surgery (modified frailty index (mFI > 0.27) will be randomly assigned to either the OFA group (receiving dexmedetomidine, esmolol, and ketamine) or the opioid-based anaesthesia (OBA) group. The primary outcome is the incidence of POD within 7 days after surgery or at discharge. Secondary outcome measures include the perioperative stress response, inflammation, intraoperative haemodynamics, postoperative 30-day all-cause mortality, intraoperative haemodynamic changes, 15-item quality of recovery (QoR-15), and postoperative complications during hospitalization. This study focuses on frail elderly individuals (a high-risk population) and aims to investigate the potential benefits of the OFA strategy in reducing the incidence of POD by reducing exposure to opioids through multimodal analgesia. If positive results are obtained in this study, they may provide new evidence for optimizing the perioperative management of such patients. This study is a single-centre, prospective RCT, and the results can provide preliminary evidence for subsequent studies to be performed on a larger scale. Discussion: This study focuses on frail elderly individuals (a high-risk population) and aims to investigate the potential benefits of the OFA strategy in reducing the incidence of POD by reducing exposure to opioids through multimodal analgesia. If positive results are obtained in this study, they may provide new evidence for optimizing the perioperative management of such patients. This study is a single-centre, prospective RCT, and the results can provide preliminary evidence for subsequent studies to be performed on a larger scale. Trial registration: NCT07603596.

Background: An estimated 826 million people have avoidable near vision impairment (NVI) due to lack of access to near vision glasses for presbyopia. Glasses use, uptake and replacement is essential to sustained NVI correction. Here we explore the uptake of second and subsequent pairs of near vision glasses and the willingness to pay. Methods: In this cross-sectional survey, 276 individuals who received near vision glasses through eye health screening programs in Punjab province, Pakistan from 2020 to 2022, were surveyed between February and July 2025, i.e. 3-5 years later. Results: 92.0% (n=254) of respondents were still using near vision glasses: a purchased replacement (41.3%, n=114), a free replacement (30.8%, n=85), or the original pair (19.9%, n=55). Male gender, higher age, and personal income were strongly associated with purchasing additional pairs, while women and those economically dependent on others relied more on free provision (all p values <0.05). Accessibility, indicated by shorter travel times and awareness of supply sources, also played a significant role in sustained replacement. Over 98% of participants expected to obtain (purchase or receive) a new pair of glasses in the future, and over 94% of participants expected to purchase their next pair. The mean willingness-to-pay (WTP) was 353 PKR (95% CI: 327-379) // 1.25 USD (95% CI: 1.16-1.34), while the average reported price paid was 416.67 PKR // 1.47 USD (95% CI: 351.39-481.94)). Conclusion: Sustained use of near vision glasses remained high 3-5 years after initial provision. Many recipients had purchased replacements, and willingness and ability to pay were high among participants, suggesting potential for sustained demand beyond initial subsidized distribution.

At-home sampling can address obstacles to participation in transcriptomics research. We previously developed the homeRNA and homeRNAmax platforms; these custom-designed tubes containing RNA stabilizer interface with a blood tube compatible with upper-arm blood collection devices, allowing for blood collection and RNA stabilization to occur from a participant's home. In this work we introduce homeRNAdrop, an insert for a commercially available blood tube (BD Microtainer) that divides the tube into two compartments: the top compartment holds 200 L blood and the bottom compartment holds ~590 L liquid stabilizer (RNAlater). By combining blood collection and RNA stabilization into the same tube, homeRNAdrop streamlines sample preparation for participants and allows for more compact sample storage for the lab. In a remote pilot study, n=25 participants from across the United States tested the homeRNAdrop kit. The n=23 samples successfully received by the lab show that samples collected using homeRNAdrop are of sufficient RNA quality (all RINs > 6, a common cutoff for analysis) and yield (mean yield=1.44 g) for downstream gene expression analysis. Almost all participants who successfully collected blood using the Tasso Mini device found the homeRNAdrop device easy to use (n=23/24). Overall, this work adds a simplified, user-friendly platform to the growing suite of tools for remote blood RNA stabilization.

Abstract Objective: Glaucoma is a chronic disorder that impairs ocular health and may exacerbate ocular surface disease leading to tear film instability, dry eye symptoms and decreased quality of life. This study compared changes in tear quantity among glaucoma subjects living with and without diabetes mellitus, attending an eye clinic in Nigeria. Methods: A comparative cross sectional research design was used. 157 subjects which comprised 74 glaucoma subjects living with diabetes mellitus and 83 glaucoma subjects living without diabetes mellitus participated in the study. Tear quantity assessment included the Schirmer I test and tear meniscus height (TMH) measurement. Descriptive statistics, independent samples t-test and Chi-square test were used to examine the data at 0.05 level of significance. Results: Glaucoma subjects living with diabetes mellitus showed substantially decreased tear production (11.4 +/- 6.8 mm) compared with glaucoma subjects living without diabetes mellitus (19.6 +/- 9.6 mm; p < 0.001). Tear meniscus height in glaucoma subjects living with diabetes mellitus (0.8 +/- 0.3 mm) was significantly greater than in subjects living without diabetes mellitus (0.7 +/- 0.3 mm; p = 0.034). Conclusion: Diabetes mellitus dramatically deteriorates the ocular surface function in glaucoma subjects by decreasing tear production, altering the tear meniscus height and increasing the severity of ocular surface symptoms. Routine glaucoma care, especially in patients with diabetes mellitus, should include a full ocular surface evaluation including Schirmer I test, TBUT, TMH, and OSDI assessment to allow early detection and management of ocular surface disease, better treatment adherence, and improved visual outcomes. Keywords: Glaucoma, Diabetes Mellitus, Tear production, Tear Meniscus Height, Ocular Surface Disease.

Background Given the close anatomical proximity of the eye and its adnexae to the cranium, ocular injury frequently coexists with head trauma. However, specific factors predisposing patients with head injury to ocular involvement in Uganda remain poorly defined. Objective This study aimed to determine the factors associated with ocular injury among patients with head injury at Mulago National Referral Hospital (MNRH), a tertiary referral facility in Kampala, Uganda. Methods We conducted a cross-sectional study among 383 adult patients admitted with head injury to the Accidents and Emergency Department of MNRH from 15/05/2025 to 30/07/2025. All participants underwent a standardized ophthalmic evaluation. Bivariable and multivariable Poisson regression analyses were used to identify factors associated with ocular injury, reported as adjusted prevalence ratios (APR). Results Ocular injury was identified in 268 of 383 patients (70.0%; 95% CI: 65.1-74.5). On multivariable analysis, age 26-44 years (APR 1.18; 95% CI: 1.11-1.43; p=0.013), commercial motorcyclist (boda-boda rider) occupation (APR 1.25; 95% CI: 1.06-1.47; p=0.007), road traffic accident mechanism of injury (APR 1.19; 95% CI: 1.02-1.38; p=0.03), severe head injury (APR 1.70; 95% CI: 1.44-2.01; p<0.0001), and the presence of facial fractures (APR 1.61; 95% CI: 1.44-1.81; p<0.0001) significantly increased the likelihood of ocular injury. Conversely, intracranial hemorrhagic lesions were inversely associated with ocular injury (APR 0.80; 95% CI: 0.68-0.93; p=0.004). Conclusion Ocular injuries are common among patients with head injury. Patients aged 26 to 44 years, commercial motorcyclist occupation, road traffic injury, severe head injury, and facial fractures have a higher risk of ocular injury. We recommend prioritizing ophthalmic evaluation of for patients admitted with head injury to minimize preventable visual impairment.

Background: Epigenetics, the study of reversible changes in gene expression without altering the underlying DNA sequence, is increasingly applied in medical, commercial, and policy contexts. Yet, little is known about how this emerging science is communicated to the public. The purpose of this study was to examine communication strategies, sources, and modalities in epigenetic-related videos on YouTube- the most accessed platform for informal science education. Methods: We conducted a mixed-methods content analysis of 294 YouTube videos on epigenetics by conducting a keyword-based search on October 17, 2023. Video transcripts and meta-data were coded using a codebook developed both deductively and inductively. Qualitative analysis examined how communication strategies were used within videos and identified emergent themes (RQ1). Quantitative analyses examined the frequency of video and channel characteristics (RQ2), and presentation modalities (RQ3). Results: Findings reveal poor alignment with science communication best practices (RQ1): over 92% of videos failed to acknowledge scientific uncertainty, the comprehensibility level exceeded the recommended 8th-grade level (e.g., average readability grade 10.7), and professional research organizations were notably absent. Narrators were mostly male (56.7%) and white-presenting (73.7%) (RQ2). The majority of the videos used multi-modal strategies (e.g., visual texts mixed with animation and voice-over narration) to communicate epigenetic information (RQ3). Conclusion: Findings highlight the need for professional research organizations to be more proactive in public epigenetic communication efforts. Increasing narrator demographic diversity could broaden audience reach. Evidence-based communication tools are needed for health or science communicators discussing epigenetics on social media.

BACKGROUND: Postoperative increases in cerebrospinal fluid (CSF) to plasma albumin ratio (CPAR), a blood-brain barrier dysfunction marker, have been associated with postoperative delirium (POD) and prolonged hospital stay. However, the contributions of plasma versus CSF albumin changes remain unclear. AIM: To determine whether 24-hour postoperative changes in plasma and CSF albumin are independently associated with POD and hospital length of stay. METHODS: Plasma and CSF albumin concentrations were measured before and 24-hours postoperatively in older non-cardiac surgery patients. Multivariable logistic and negative binomial regression models evaluated associations between albumin changes and POD or hospital length of stay, adjusting for age, baseline cognition, surgery type, and fluid administration. RESULTS: Of 240 patients, 31 (13.3%) developed POD. From before to 24-hours after surgery, both plasma albumin (median 3.95 to 3.43 g/dL, p<0.001) and CSF albumin decreased (median 22.68 to 20.43 mg/dL, p<0.001). Greater plasma albumin decreases (per 0.43 g/dL) were independently associated with POD (OR 2.14, 95% CI 1.28-3.58; p=0.004) and longer hospital stay (mean ratio 1.44, 95% CI 1.26-1.64; p<0.001). In contrast, CSF albumin changes (per 5.8 mg/dL higher) were not associated with POD (OR 0.97, 95% CI 0.60-1.58; p=0.91) but were modestly associated with longer hospital stay (mean ratio 1.17, 95% CI 1.04-1.32; p=0.01). CONCLUSIONS: Plasma and CSF albumin decreased postoperatively, but only plasma decreases were associated with POD. These results suggest that associations between CPAR increases and POD may be due to postoperative plasma albumin decreases and highlight limitations of CPAR as a standalone marker of postoperative BBB dysfunction.

Background: Dietary supplements (DS) are extensively used in Pakistan, frequently in conjunction with prescription medicines. Pharmacists are well positioned for patient counsesling due to their accessibility. However, their ability to provide evidence-based counseling remains uncertain due to their varying knowledge and training, especially in low- and middle-income countries (LMICs), including Pakistan. The study assessed pharmacists' knowledge, attitudes, and practices (KAP) regarding DS counseling and identified gaps requiring intervention. Methods: A cross-sectional study was conducted among 256 registered pharmacists in Lahore, Pakistan. Data were collected using a validated, self-administered questionnaire assessing knowledge, attitudes, and counseling practices concerning dietary supplements over a period of six months i.e., July to December 2025. Statistical analyses were performed using SPSS version 27. A p-value of < 0.05 was considered statistically significant. Results: Mean age was 31.0 {+/-} 6.2 years, with male predominance (56.3%), Doctor of Pharmacy degree (75.0%), community pharmacy practice (62.5%), and 1-5 years of experience (48.4%). Mean knowledge score was 6.18 {+/-} 1.71, with most (76.6%) exhibiting moderate knowledge. Mean attitude score was 7.01 {+/-} 1.94, with 91.4% demonstrating positive attitudes. Mean practice score was 7.91 {+/-} 2.93, with 68% exhibiting good counseling practices. Knowledge scores were significantly higher among female pharmacists (6.96 {+/-} 1.52 vs. 5.57 {+/-} 1.61, p=0.001), urban residents (6.39 {+/-} 1.61 vs. 4.37 {+/-} 1.30, p<0.001), and clinical pharmacists (7.10 {+/-} 1.68, p=0.001). Conclusion: Pharmacists practicing in Lahore, Pakistan demonstrated positive attitudes but moderate knowledge and inconsistent counseling practices. Key gaps were identified in drug-supplement interaction knowledge and counseling practices. These findings underscore the need for organized education, continued training, and regulatory supervision to improve counseling practices of dietary supplements.

Frailty assessment is important while awaiting lung transplantation (LTx), as frailty is associated with disability and death before and after LTx. We assessed known risk factors and/or frailty indicators in frail, pre-frail, and non-frail patients according to the Short Physical Performance Battery (SPPB) and the Frailty Instrument for primary care of the Survey of Health, Ageing and Retirement in Europe (SHARE-FI), and evaluated the value of SHARE-FI as a proxy to detect frail patients. Frailty was assessed using SPPB and SHARE-FI in 82 patients on a waiting list for LTx. Demographic, anthropomorphic, and clinical variables were collected, and patients underwent respiratory/cardiorespiratory, biochemical, and quadriceps muscle performance assessments. The mean age was 57.3 {+/-} 9.4 years. Chronic obstructive pulmonary disease (COPD) (41.5%) and interstitial lung disease (ILD) (30.6%) were the most common indications for LTx. Four (4.9%), 13 (15.9%), and 65 (79.3%) patients were classified as frail, pre-frail, and non-frail by SPPB, respectively. These figures were 26 (31.7%), 41 (50%), and 15 (18.3%) with SHARE-FI. SPPB found differences between frail/pre-frail and non-frail patients in physical performance (6-minute walking distance) and muscular assessment, while SHARE-FI found differences in age, 6-minute walking distance, and oxygen saturation, and a trend in muscular strength. For COPD and ILD, frailty discrimination was better with SPPB. Concordance between the two measurements was weak, although all SPPB-frail ILD patients were detected by SHARE-FI. In patients awaiting LTx, SPPB showed better discrimination than SHARE-FI for COPD and ILD. SHARE-FI seems appropriate as a preliminary screening instrument for patients with ILD.

Background Perioperative Patient Blood Management (PBM), a patient-centred, evidence-based approach to improve outcomes by preserving and optimising a patient own blood, remains unimplemented in most low- and middle-income countries. Few studies have assessed health-system readiness for PBM implementation, anaemia management, or transfusion practices in sub-Saharan Africa. This study provides a pre-implementation baseline assessment of perioperative PBM readiness in Ethiopia. Materials and Method A mixed-methods approach evaluated 12 public hospitals in Addis Ababa, with the PBM Facility Assessment Tool to determine readiness scores. Data from 1,236 surgical patients assessed anaemia, transfusions, and predictors. Interviews with clinicians, blood bank staff, and policymakers explored decision-making and barriers. Findings were integrated through triangulation. Results The composite PBM-FAT score was 6.6 (SD, 0.7) (range 5.5-7.5); however, this reflects general perioperative and transfusion-service infrastructure rather than PBM-specific capability. Domain analysis revealed critical gaps: 75% of facilities lacked intravenous iron, viscoelastic testing was absent in all, and 66.7% lacked point-of-care haemoglobin testing. Fibrinogen and haematinic tests were rarely available (66-92% never tested). Preoperative anaemia was documented in 7.1% of patients, a minimum estimate reflecting detection failure due to non-systematic haemoglobin testing, and perioperative transfusion occurred in 2.4%, more consistent with supply rationing than with optimised clinical practice. Independent transfusion predictors included cancer surgery (AOR 11.28, 95% CI 3.00-42.36) and blood loss greater or equal to 500 mL (AOR 9.76, 95% CI 3.94-24.17). Interviews revealed blood shortages, the absence of national PBM governance, transfusion as the default treatment for anaemia, and highly variable thresholds. Conclusion Ethiopian hospitals have functional transfusion services but lack the anaemia management pathways, diagnostics, therapeutics, and governance structures required for Patient Blood Management. PBM is not yet operationalised as a patient-centred, preventive care strategy. Priority implementation steps, aligned with the WHO 2024 PBM guidance, include systematic preoperative haemoglobin screening, access to intravenous iron, blood utilisation governance, and a national PBM framework to improve patient outcomes. Keywords: Patient blood management; anaemia; blood transfusion; perioperative care; Ethiopia, health system