Journal of Family Medicine and Primary Care

Background/Aims: In medical practice, the rising prevalence of infections in kidney transplant recipients (KTRs) is a notable concern. However, understanding the incidence and risk factors associated with infections in KTRs remains limited. This study aims to assess the incidence and factors associated infection among KTRs. Additionally, we also investigate the median time of each infection among KTRs. Methods: A retrospective cohort study was conducted from 1 January 2018- 31 December 2022 at Thailand's tertiary hospital. We performed univariable and multivariable logistic regression analyses to identify potential risk factors related infection and investigated for the incidence and median time of each infection among KTRs. Results: A total of 179 participants were included in this study. Our findings reveal the kidney from living donor was protective factor for infection among KTRs (aOR 0.063, 95% CI 0.005-0.792; p = 0.032). Urinary tract infections (UTIs)showed as the predominant pathogenic manifestation among KTRs (43%). The median time of UTIs, cytomegalovirus (CMV) infection and pneumocystis pneumonia (PCP) were 16, 57 and 94.5 days, respectively. Conclusions: Our study establishes that receiving a kidney from a living donor is a protective factor against post-kidney transplant infections. Particularly urinary tract infections were most common of infection. Monitoring urinary tract infections post-transplantation is recommended. Moreover, awareness of UTI, CMV infection and PCP should be concerned during 2-3 months after transplantation. However, due to a small sample size; we recommend to increase the number of particular participants in further investigations.

HIV infection significantly elevated the odds of cardiovascular diseases, including myocardial fibrosis. We aimed to determine the difference of late gadolinium enhancement (LGE), extracellular volume (ECV), T1, and T2 using cardiac magnetic resonance imaging (CMR) in patients living with HIV (PLWH) and healthy controls. The databases Scopus, Web of Science, Embase, and PubMed were searched systematically using relevant keywords. STATA version 17 was used for meta-analysis using random effect and fixed effect models for heterogeneous and non-heterogeneous analyses. An overall number of 13 studies were included in the current analysis involving 1425 PLWH and 766 healthy controls. PLWH showed significantly higher LGE (OR: 5.47, 95% CI: 1.90-15.64, p<0.001) and ECV (mean difference: 1.46, 95% CI: 0.21-2.71, p=0.02) compared to controls. However, differences in Left Ventricular Ejection Fraction (LVEF) were not significant (mean difference: -1.41, 95% CI: -2.81- -0.01, p=0.05). There were no meaningful disparities in pro B-type natriuretic peptide (BNP) values (mean difference: 8.67, 95% CI: 0.04-17.29, p=0.05) or T2 values (mean difference: 0.91 ms, 95% CI: -1.04-2.86, p=0.36), but T1 values were significantly higher in PLWH (mean difference: 13.78 ms, 95% CI: 9.16-18.40, p<0.001). In meta regression, LGE was correlated with nadir CD4 (z=-3.41, p-value<0.001). In addition, ECV was correlated with white race (Z=-3.97, p-value<0.001), Hepatitis C (Z=-2.08, p-value=0.037), and smoking (Z=2.05, p-value=0.041). HIV is related to a significantly elevated rate of myocardial fibrosis, and factors such as lower nadir CD4, white race, hepatitis C, and smoking were correlated with hepatitis C. Keywords: Myocardial fibrosis, HIV, AIDS, Cardiovascular diseases, Heart failure

Objective: Hyperthyroidism and hypothyroidism related to iodine deficiency are major public health concerns in Afghanistan. This study aimed to assess the frequency of thyroid dysfunction among male patients referred for thyroid testing and its association with age, and to examine monthly trends in thyroid dysfunction at Asia Med Laboratory in Herat, Afghanistan, from July 2021 to January 2022. Methods: A retrospective analysis was conducted on 250 male patients aged 0-69 years. We measured Serum TSH, total T4, and total T3 levels, and thyroid status was classified using age specific reference ranges. In addition, the frequency of thyroid dysfunction was analyzed across age groups with monthly trends of thyroid state. Results: Overall, the euthyroid state consisted of 69.2% of participants, 24.8% with overt hypothyroidism, 3.2% with overt hyperthyroidism, and 2.8% with subclinical hyperthyroidism. Thyroid status differed significantly by age (p = 0.0135), with hypothyroidism increasing in older age groups and reaching its highest proportion among men aged 60-69 years (55.6%). Euthyroidism predominated in patients aged 10-39 years, while hyperthyroidism across age groups remained relatively infrequent. After September 2021, a threefold increase was observed in the total number of male patients referred for thyroid testing. During this period, the proportion of hyperthyroidism increased slightly, whereas hypothyroidism cases declined. Conclusion: In conclusion, hypothyroidism was more frequent with older age. The rise in absolute case numbers after September 2021 likely reflects increased patient referrals, underscoring the need for ongoing monitoring of thyroid function. The study may assist in the early management of thyroid disorders and in reducing their complications.

Background: Disaster medicine has been a formal curricular recommendation in German health professions education since 2006, and comparable recommendations exist internationally. Evidence on implementation is confined almost entirely to human medicine, rests on faculty self-reports or small student samples, and measures delivery rather than retention. Whether curricular exposure is associated with willingness to serve has not been adequately examined in interprofessional samples. Objective: We aimed to characterize disaster medicine education across 7 health professions in Germany, distinguishing delivery from retention, to identify profession-specific gaps and training priorities, and to examine how educational and experiential factors relate to willingness to serve. Methods: We conducted an anonymous nationwide online cross-sectional survey of students and trainees across 7 health professions in Germany between July 9 and August 25, 2026, recruited through institutional distribution lists. The interprofessionally developed instrument comprised 48 items. We assessed delivery and retention of 12 disaster medicine topics (4-point scale), self-rated confidence in 22 clinical and nursing skills (6-point scale), desired content, formats, motivators and barriers, and formal and spontaneous willingness. For all rating scales, higher values denote the more favorable level. We derived a delivery-retention gap and a want-deficit index, examined the dimensional structure of the competence battery, tested for differential item functioning by prior civil protection engagement, and modeled willingness with a cumulative link model. Results: Of 8133 respondents (completion rate 87.5%), 33.1% had never been taught disaster medicine and 25.0% only in passing; 22.1% had comprehensive teaching including practical exercises. Across the 12 topics, the proportion able to retrieve content confidently never exceeded 23.9%; the delivery-retention gap reached 47.3 percentage points. More than half (54.6%) had never taken part in a practical exercise. Competence formed more than 1 dimension: 18 acute-technical items loaded 0.54-0.86 on the first factor, 4 relational and nursing items 0.14-0.28. Prior civil protection engagement was associated with higher confidence on every acute-technical item (Cliff delta 0.26-0.55) and lower confidence on all 4 relational items (-0.22 to -0.09). Willingness was high and homogeneous across groups (78.7% formal, 84.1% spontaneous), whereas competence varied by about 2 scale points. Adjusted, active civil protection engagement (odds ratio 2.49, 95% CI 2.12-2.94) and practical exercise experience (odds ratio 1.78, 95% CI 1.54-2.05) were the strongest predictors; curricular exposure contributed weakly (odds ratio 1.06 per SD, 95% CI 0.99-1.14). Conclusions: Two decades after the curricular recommendation, disaster medicine is largely absent from health professions education in Germany, and what is delivered is not retained. Willingness is nevertheless high and largely decoupled from competence, so qualification and recruitment require separate instruments. Curricula should be prioritized by the coincidence of demand and deficit rather than by coverage, built for retention, and should treat relational and nursing competence as a distinct learning objective.

Introduction: Thyroid diseases are major health problems and among the most common endocrine disorders worldwide, including in Ethiopia. They are characterized by alterations in hormone secretion, enlargement of the thyroid gland, or both. Fine needle aspiration cytology is an important initial screening tool, and histopathologic examination is essential for the definitive diagnosis of thyroid disease. This study aimed to compare the diagnostic accuracy of fine needle aspiration cytology with histopathology in identifying thyroid diseases. Methods: A cross-sectional study was conducted at three health facilities in Hawassa City, Ethiopia, involving 304 patients who underwent both thyroid fine needle aspiration cytology and histopathologic examination of the same site between 30th October 2024 and 29th October 2025. FNAC results were classified using the Bethesda system, with histopathology as the gold standard. Data were entered into Kobo Toolbox, exported to SPSS version 27, and analyzed using cross-tabulation and chi-square ({chi}{superscript 2}) tests to determine diagnostic accuracy. Result: 304 patient records were included in the study. The fine needle aspiration cytology was determinate/diagnostic in 81.6% of cases. The study revealed the sensitivity and specificity of fine needle aspiration cytology to be 88.2% (CI 77.6-95.1%) and 94.4% (CI 90.6-97.1%), respectively. The false negative and false positive rates in this study were 2.4% and 4.4%, respectively. The positive predictive value was 80.3% (CI 68.7-89.3%), and the negative predictive value was 96.8% (CI 93.8-98.7%). The accuracy of fine needle aspiration cytology in differentiating benign from malignant thyroid lesions was 93.1%. Conclusion: FNAC demonstrated strong agreement with histopathology and remains a reliable, cost-effective first-line diagnostic tool for thyroid disease, particularly in resource-limited settings. Strengthening sample handling, ultrasound guidance, and adherence to Bethesda criteria may further improve diagnostic precision

Background: Hepatitis E virus (HEV) is highly endemic in several African countries with high mortality rate among pregnant women. The prevalence of HEV in Niger among pregnant women is unknown. We hereby aim to report the prevalence and risk factors of HEV among pregnant women in Niamey, Niger. Methods: Blood samples were collected from pregnant women attending antenatal consultation in three selected Health centers in Niamey. Data were collected for socio demographic characteristics using a structured questionnaire. Samples were tested using ELISA and qRT-PCR for anti- HEV IgM and RNA detection respectively. HEV associated risk factors were determined using multivariate logistic regression models. Results: A total of 491 pregnant women were enrolled with mean age of 26.5 years. The prevalence of anti-HEV IgM antibodies was 17.1%, while HEV RNA was detected in 3.46% of participants, indicating recent and active HEV infection. Anti-HEV IgM seropositivity was more frequent among women aged 26-30 years and those in the third trimester of pregnancy. Gravidity was significantly associated with HEV RNA positivity (p = 0.032). In multivariable analysis, the use of well water was independently associated with HEV infection (aOR = 75.70; 95% CI: 1.23-4643.20; p = 0.039). Conclusion: In view of the high seroprevalence of HEV among pregnant women, preventive measures including hygiene sensitization should be prioritized. Further studies should be conducted to assess the real impact of HEV infection on maternal and fetal health.

Globally, Hepatitis C Virus (HCV) infection is a leading cause of chronic liver disease and remains a significant public health threat in Ghana. However, there is a paucity of data on the prevalence and awareness of HCV among market sellers and informal workers in Ghana. This study sought to determine the prevalence and awareness of HCV among this population. This was a cross-sectional study conducted among 397 sellers and workers at Kejetia market from December 2024 to January 2025. HCV was diagnosed using the One Test Hepatitis C Virus Test Strip (Qingdao Hightop) for the qualitative detection of HCV antibodies. Data were analysed using SPSS version 26 and GraphPad Prism version 8.0. A p < 0.05 was considered statistically significant for awareness of HCV. The prevalence of HCV in this study was 4 (1.0%). Awareness of HCV was low at 112 (28.2%). Residence (p=0.021) and age group (p=0.040) were significantly associated with HCV awareness. Age 41-50 years was almost three times more likely to be aware of Hepatitis C infection compared to [&le;] 30 years. Although the prevalence of HCV was low, awareness of the infection was also limited; this highlights the need for public health authorities to implement targeted HCV education programs in major markets to effectively reach informal sector workers who are often overlooked by conventional campaigns.

Background: Antimicrobial resistance (AMR) is a growing global health threat, and India's high antibiotic consumption makes public knowledge, attitudes, and practices (KAP) a critical determinant of stewardship outcomes. Existing Indian KAP evidence is drawn from small, localised cohorts, leaving a gap in nationwide, digitally-sourced data. This study aimed to describe antibiotic-related knowledge, attitudes and self-reported practices among users of a digital healthcare platform in India, examine demographic and regional variation, and identify potential areas for future stewardship interventions. Methods: A cross-sectional survey was conducted among adult users of the Tata 1mg platform (December 2025-February 2026), with participants invited via an in-app banner. Knowledge and attitude were each scored on a 0-4 scale (4 items); practice was scored as a percentage of applicable items answered favourably, with scoring adjusted for branching logic based on antibiotic-access route. Of 10,726 respondents who started the survey, 4,883 completed it (45.5%). City of residence was mapped to one of six regions (India's five statutory Zonal Council zones plus a North-Eastern region) for 4,187 respondents. Associations with demographic characteristics were assessed using multivariable linear regression, and regional differences were assessed using one-way ANOVA. A parallel survey of 256 physicians was conducted to enable patient-provider comparison. Results: Mean scores were: knowledge 2.28 (SD 1.19), attitude 0.91 (SD 1.14), practice 44.9% (SD 33.4); attitude, not knowledge, was the weakest domain. Older age was associated with higher scores across all domains (practice: B=12.52, p<0.001 for age [&ge;]65 vs. 18-34); city tier was independently associated with lower knowledge and attitude (Tier 3 vs. Tier 1: p=0.010 and p<0.001, respectively). Regional differences were non-significant for knowledge and practice but significant for attitude (F=2.56, p=0.026, ^2=0.003), driven by lower scores in the North-Eastern region. In the parallel physician survey, 55.5% of respondents estimated that more than half of their patients self-medicated before consultation. Conclusion: In this platform-based sample, attitudes were the weakest domain, not knowledge, and 42.0% said their last antibiotic did not come on a doctor's recommendation. The findings may inform digital stewardship touchpoints, such as point-of-purchase guidance and prescription verification, in line with India's National Action Plan on Antimicrobial Resistance 2.0. As a cross-sectional survey of platform users, it cannot establish the relative contributions of knowledge, beliefs and access pathways to antibiotic use.

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.

Objective: Mindfulness is a robust predictor of mental health, yet the psychometric properties of the short-form Five Facet Mindfulness Questionnaire (FFMQ-15) have not been examined in Iranian populations. This study evaluated the psychometric properties, factor structure, and diagnostic utility of the FFMQ-15 among medical sciences students. Participants: A total of 348 students (178 females, 170 males) from Kermanshah University of Medical Sciences participated. Methods: Participants completed the FFMQ-15, Penn State Worry Questionnaire (PSWQ), Difficulties in Emotion Regulation Scale (DERS), and Emotion Regulation Questionnaire (ERQ). Data were analyzed using exploratory and confirmatory factor analyses, composite reliability, and ROC curve analysis. Results: Both EFA and CFA supported the five-factor model, revealing a culturally unique item loading pattern. The FFMQ-15 demonstrated strong convergent and discriminant validity. ROC analysis indicated acceptable diagnostic accuracy for distinguishing high- and low-worry groups (AUC = 0.72, 95% CI: 0.66-0.78). Conclusions: The FFMQ-15 demonstrated acceptable psychometric properties in Iranian medical students. The non-reactivity facet exhibited cultural variability, suggesting that cross-cultural adaptation is essential. The instrument shows promise for screening in high-stress educational settings.

BackgroundAtypical antipsychotics (AAPs) are increasingly prescribed for paediatric patients with autism spectrum disorder (ASD). However, pharmacovigilance data from Saudi Arabia remain scarce. The aim of this study is to detect and characterise signals associated with AAPs and assess gender- and age-related ADR reporting patterns. MethodsA retrospective cross-sectional study with disproportionality analysis was conducted on paediatric patients (0-19 years) using the Saudi Food and Drug Authority (SFDA) database (2021-2024). Disproportionality analyses were performed using the reporting odds ratio (ROR), proportional reporting ratio (PRR), and Bayesian confidence propagation neural network (BCPNN). Age and gender were assessed using odds ratios (ORs), with Firth penalized logistic regression to confirm associations. ResultsOverall, 701 ADR reports were analysed. Most involved males (59.91%) and children aged 0-9 years (82.88%). Olanzapine had the highest proportion of serious reports (44.44%). At the system organ class (SOC) level, signals included nervous system disorders with risperidone (ROR 32.61 [16.62-64.00]; PRR 3.49 [2.22-5.47]; IC025 0.08); cardiac and general disorders with quetiapine; haematological, metabolic, and psychiatric disorders with olanzapine; and gastrointestinal disorders with aripiprazole. Gender-adjusted analyses indicated significant variation in selected ADR signals across age groups, while no significant differences were observed by gender. ConclusionsThis study highlights disproportionality signals associated with AAP use in paediatric patients. Age-related ADR variation supports consideration of age-specific ADR monitoring within current paediatric recommendations. While these findings do not establish causality, they generate hypotheses for further evaluation. Regional pharmacovigilance may complement international paediatric safety monitoring frameworks.

BackgroundIn Ethiopia as other Sub-Sharan African countries malaria in pregnancy is a major public health threat particularly in the rural communities. Immunosuppression during pregnancy increases the risk of placental malaria; this, in turn, leads to anemia, low birth weight, preterm delivery, and stillbirth, causing severe complications that pose a life-threatening risk to both the mother and fetus. Hence, this study is aimed to assess the prevalence of malaria, and associated factors among pregnant women attending antenatal clinics in Damot Gale district, South Ethiopia. MethodAn institutional-based cross sectional study was conducted from March 1 to May 30, 2024. A multistage sampling technique and pre-tested semi-structured questionnaires were used for data collection. Using standard parasitological methods, blood samples collected from 389 participants were analyzed through microscopic examination of Giemsa-stained thick and thin blood films. Logistic regression was used to assess factors associated with malaria. Adjusted odds ratio with 95% confidence interval was calculated and P-value < 0.05 was considered statistically significant. ResultsIn this study the prevalence of malaria among pregnant women was 10.5% (95% CI: 7.7-13.6%). Among the malaria-positive pregnant women (9%) were P. falciparum infected, followed by P. vivax (1.3) and mixed infections (0.2%). In the multivariate analysis, multigravdae (AOR = 0.358; 95% CI: 0.14-0.92), utilization of LLINs (AOR = 0.286; 95% CI: 0.119-0.687) and use of IRS (AOR = 0.068; 95% CI: 0.027-0.172) were significantly associated with malaria among pregnant women. ConclusionMalaria is still a public health problem among pregnant women in Damote-gale district. The present study indicated that adequate distribution and proper utilization of bed nets In addition seasonal proper spray of IRS might be helpful to prevent and control malaria.

People from UK South Asian communities experience barriers to accessing dementia care. Evidence suggests that evidence-based psychosocial dementia interventions can be successfully adapted for different cultural contexts, but further evidence is needed on how adaptations are developed and refined in practice. We aimed to adapt GRACE-family (Goal diRected, Accessible and Evidence-based Care), an evidence-based, manualised post-diagnostic dementia intervention, comprising 4-8 sessions for family carers and where possible, people with dementia, for Bengali-speaking communities. In a theory-informed process, a co-adaptation group encompassing lived, academic and clinical/professional experience developed consensus regarding which intervention functions were core. They then explored how adaptation might, while retaining these, account for cultural and linguistic contexts, informed by focus groups with memory service and Bengali community organisation staff (n=14). We developed a prototype adaptation, then piloted it with four Bangladeshi families supporting a person with dementia. Post-intervention, participants were asked about goal attainment, intervention acceptability, and qualitatively interviewed. Pilot data and a focus group with Sylheti-speaking family carers informed further refinements (n=6). Across data sources, two themes informed adaptation: (1) stigma, trust and community networks shaped access to dementia support; (2) flexible delivery was needed to respond to diverse language, communication and cultural needs. 3/4 pilot families completed the prototype intervention, which was in English as initial consultation cautioned against developing a written manual in a predominantly spoken language. Participants reported improvement on 7/8 personalised goals set, and all considered the intervention acceptable. Pilot delivery identified challenges using English-language materials during interpreter-mediated sessions. Iterative refinements added standard Bengali materials and spoken Sylheti audiovisual resources to broaden delivery options and facilitator training for culturally responsive and interpreter-mediated delivery. Our co-adaptation approach enabled stakeholders to advise from different, including experiential perspectives. It may inform future approaches to cultural and linguistically adaptations of psychological interventions for minoritised communities.

ABSTRACT Background: Poliomyelitis remains a major public health concern where population immunity is incomplete and circulating vaccine-derived poliovirus (cVDPV) persists. Although Nigeria interrupted wild poliovirus (WPV) transmission in 2020, cVDPV cases continue to pose challenges, particularly in parts of northern Nigeria. Modern control strategies require a synergy of routine immunization, supplementary campaigns, disease surveillance, and community trust. Methods: This multicentre descriptive cross-sectional study evaluated community knowledge and attitudes towards polio immunization across 37 Local Government Areas (LGAs) in 20 states and the Federal Capital Territory (FCT). A multistage sampling strategy was utilized to select 1,850 adult respondents (50 per LGA) spanning rural, semi-urban, and urban settlements. Results: Overall, 40.4% (n = 747) of respondents demonstrated good knowledge, while 58.4% (n = 1,080) displayed positive attitudes towards polio immunization. A striking disparity was observed across residence classifications: respondents in urban/semi-urban LGAs exhibited significantly higher levels of good knowledge (51.7%, 569/1,100) compared to those in rural LGAs (23.7%, 178/750; {chi} = 144.00, df = 1, p < 0.001). Main sources of information were Questionnaire responses (53.6%) and community and Traditional leaders(17.2%). Conclusion & Recommendations: Substantial knowledge deficits persist in rural northern Nigerian communities despite generally favorable attitudes. Interventions must prioritize localized risk communication, involvement of traditional/religious leaders, strengthening routine primary healthcare integration, and targeting zero-dose children in hard-to-reach areas. Keywords: Poliomyelitis, Oral Polio Vaccine, Vaccine Hesitancy, Northern Nigeria, Community Health, Routine Immunization.

Preeclampsia is a multisystem hypertensive disorder of pregnancy that emerges after 20 weeks of gestation, and remains a leading cause of maternal and perinatal morbidity and mortality globally, yet evidence on its predictors and outcomes in Kenya remains limited. This prospective cohort study compared pregnant women with and without preeclampsia who attended selected hospitals in Kiambu County, to determine the predictors of preeclampsia and its associated maternal and neonatal outcomes. The results indicated a very strong statistical association between preeclampsia and the following i.e parity, time taken to reach the hospital, hypertension and diabetes mellitus (p-value <0.001) and religion (p-value <0.013). Women with preeclampsia had nearly twice the risk and six times the odds of delivering low-birth-weight infants compared with women without preeclampsia (RR = 1.97; OR = 6.25). A strong statistically significant association was observed between multiparity and prematurity (RR = 5.3, OR = 8.4, p < 0.001). Multiparous women with preeclampsia had approximately 5.3 times the risk and 8.4 times the odds of experiencing a premature birth compared with women without preeclampsia. In conclusion preeclampsia significantly increased adverse maternal and neonatal outcomes, highlighting the need for early high-risk pregnancies identification and strengthened antenatal care to improve both maternal and neonatal outcomes.

Japanese Encephalitis Virus (JEV) belongs to the Flavivirus family, and the RNA dependent RNA polymerase (RdRp) domain located at the C terminus of non structural protein 5 (NS5) regulates de novo viral genome synthesis. The conserved priming loop inserted in the thumb domain of RDRP initiates de novo genome synthesis. Interestingly, the reported replication process initiates with an interaction between NS5 (methyltransferase/RDRP) and NS3 (protease/helicase), and inhibiting this interaction directly correlates with the inhibition of viral replication. The function of the priming loop in the context of the NS5 NS3 interaction is not yet known. In this study, we studied the priming loop function in the NS5 NS3 interaction and viral replication. Using a structure based drug design approach, we screened the Maybridge compound library against the RdRp priming loop and identified 15 candidate compounds based on binding energy. Among them, DSHS00151 showed significant dose dependent inhibition of the NS5 NS3 interaction with an IC50 of 3.5 micromolar in the mammalian two hybrid assay, inhibited viral infectivity with an IC50 of 2.54 micromolar, and reduced viral RNA load with an IC50 of 2.9 micromolar, compared to CD10712. Molecular Dynamics (MD) simulations revealed that DSHS00151 exhibits stronger and more stable binding with the priming loop residues (790 to 812) compared to CD10712. The molecular mechanism suggested by the docking of the NS5 and NS3 proteins showed that the priming loop tends to rotate toward the NS3 protein to stabilize the complex, and compound binding restricts this loop rotation, thus compromising the stability of the NS5 and NS3 complex and affecting viral replication. Overall, our study validated the function of the NS5 priming loop as an allosteric site, and compounds binding to this allosteric site belong to the Non Nucleoside Reverse Transcriptase Inhibitors (NNRTI) class of inhibitors, which disrupt the NS5 and NS3 interaction and could be developed as novel anti JEV therapeutics.

Cognitive and psychological difficulties are frequently reported by patients undergoing haemodialysis, yet these experiences are rarely explored within routine clinical assessments. The aim of this study was to examine self-perceived cognition and psychological well-being as patient-reported outcomes in adults with chronic kidney disease undergoing maintenance haemodialysis, and to explore the relationships between these outcomes and sociodemographic, clinical, and biochemical variables. Adults receiving maintenance haemodialysis were recruited from a hospital-based dialysis unit as part of the GoodRENal project, which focuses on developing educational approaches for people on haemodialysis. Participants completed self-report measures assessing perceived cognitive functioning and psychological well-being. Sociodemographic, clinical, and biochemical data routinely collected in dialysis care were obtained from medical records. Associations were examined between self-perceived cognition, psychological well-being, and the available data. Seventy-eight patients took part in the study. Perceived cognitive difficulties were more closely related to indicators of kidney disease severity and metabolic imbalance, whereas psychological well-being showed stronger associations with social and emotional factors. The patients' subjective experiences could not be fully explained by objective clinical indicators alone, suggesting a gap between physiological measures and patient-reported outcomes. Self-perceived cognition and psychological well-being provide clinically relevant information that could complement routine clinical indicators in haemodialysis care.

Objective. To identify antimicrobial stewardship targets by triangulating provider knowledge and practice, government-facility prescribing indicators and patient-reported treatment experience in three districts of Chhattisgarh, India. Methods. We analysed three independently sampled cross-sectional components: a provider survey (171 providers), a World Health Organization and International Network for Rational Use of Drugs assessment (600 encounters at 20 government facilities) and patient exit interviews (371 consultations). We used descriptive indicators and multivariable ordinal or binary logistic regression. Findings. Among providers, 149 of 163 (91.4%) recognized antimicrobial resistance, but 131 of 163 (80.4%) reported providing antibiotics for colds or sore throats to at least some patients. Guideline familiarity was not associated with less frequent provision (adjusted common odds ratio [aOR], 1.13; 95% confidence interval [CI], 0.57-2.24; P=0.725). Government facilities prescribed antibiotics in 329 of 600 encounters (54.8%), with a facility range of 16.7-80.0%. In exit interviews, 131 of 142 informal-provider consultations (92.3%) involved a reported injection; informal providers accounted for 131 of 181 reported injections (72.4%). Clear or very clear instructions were associated with satisfaction (aOR: 13.66; 95% CI: 6.37-29.28; P<0.001). Conclusion. High awareness coexisted with frequent self-reported antibiotic provision, wide facility variation and sector-specific injection exposure. Stewardship programmes should diagnose local drivers before selecting interventions and prospectively evaluate adapted decision support, audit and feedback, independent drug information, informal-provider engagement and communication training.

Background Cardiac amyloidosis is an increasingly recognized cause of heart failure in older adults, yet Colombian data, and data from the southwest of the country in particular, remain scarce. We describe the clinical, diagnostic, imaging and outcome profile of patients with cardiac amyloidosis at two high-complexity institutions in Cali. Methods Observational, descriptive, retrospective, two-center study. Patients were identified in the institutional registries of both centers using ICD-10 codes for amyloidosis, and clinical data were abstracted manually from medical records. Continuous variables are reported as median (interquartile range) and categorical variables as counts and percentages over the number of patients with available data. Results Thirty-two patients were analyzed (median age 77 years; 68.8% men). Heart failure (90.6%), atrial fibrillation (46.9%) and carpal tunnel syndrome (31.2%) were frequent. The etiological classification depended on the test considered: bone scintigraphy was positive (Perugini 2-3) in 23 of 26 patients studied (88.5%), but a monoclonal protein was screened for in only 22, and the full non-invasive criteria for ATTR were met in 16 of 32 (50.0%). Genetic testing was positive in 9 of 18 tested, and the variant was Val142Ile in all 8 patients in whom it was characterized. The working diagnosis was ATTR in 26 patients (81.2%) and AL in 6 (18.8%). Tafamidis was used in 37.5%. Eleven of the 31 patients with known vital status died (35.5%), and NT-proBNP was markedly higher among those who died (6640 vs 1186 pg/mL; p=0.003). Conclusions In this southwestern Colombian cohort, cardiac amyloidosis presented as the classic transthyretin phenotype, with the Val142Ile variant in all 8 patients in whom it was characterized. Bone scintigraphy was frequently positive, but screening for a monoclonal protein was often omitted, so only half the cohort met the full non-invasive criteria for ATTR. Mortality was high and closely associated with NT-proBNP.

Introduction Preventing tuberculosis (TB) through TB Preventive Treatment (TPT) is an essential component of TB control and elimination. In recent years, many countries including Bangladesh, have revised their national programs to extend TPT to household contacts of TB patients. However, coverage remains well below the target, and evidence remains limited on context-specific barriers and facilitators. This study aimed to explore the barriers and facilitators to TPT uptake among household contacts in Bangladesh. Methods This study followed an exploratory qualitative approach. The setting was Moulvibazar district, Bangladesh. Qualitative data were collected through key-informant interviews with health providers and in-depth interviews with household contacts, and participants were selected through purposive sampling. Thematic analysis was used to explore the factors influencing TPT uptake. Results Perceived lack of need for treatment among household contacts and side effects of TPT medicines emerged as major barriers. Stigma associated with TB and resource shortage at the health facility level further hampered uptake. Counseling on the importance of TPT and its possible side effects, along with public awareness campaigns, facilitated TPT uptake by addressing household contacts concerns. Perceived risk of TB, free TPT services, support from family members, and health providers positive attitudes also supported uptake. Conclusion Addressing household contacts concerns about the need for treatment and potential side effects, along with strengthening health facility capacity, is required for improving TPT uptake. Both individual counseling and mass awareness campaigns can help address these concerns and facilitate uptake. These strategies may help increase TPT coverage in Bangladesh and beyond, contributing to global TB elimination efforts.