Journal of Family Medicine and Primary Care

BackgroundSedation is a medically induced state implemented to facilitate procedures or care of critically ill patients in the Intensive Care Unit (ICU). Nurses ensure safe sedation by applying agitation scales to reduce complications. There is sufficient research evaluating nurses knowledge, attitudes, and practices regarding sedation for critically ill patients in the ICU of Tanzanian tertiary Hospitals. MethodsThis hospital-based cross-sectional study assessed nurses knowledge, attitudes, and practices on sedation in ICUs of three referral hospitals in Dar es Salaam, Tanzania. A sample of 163 nurses was recruited using stratified sampling. Data were collected through structured questionnaires and checklists, then analyzed with SPSS version 25. Variables with p [&le;] 0.2 entered multivariate regression; significance was set at p < 0.05, 95% confidence interval. ResultsMost participants were female (60.7%) with a mean age of 34.6 {+/-} 6.48 years. Of 163 nurses, 68.1% had adequate knowledge of sedation, though males were 38% less likely to demonstrate this (AOR = 0.377, 95% CI: 0.181-0.787, p = 0.009). Unfavourable attitudes were reported by 76.7% (n=125), while trained nurses were nearly twice as likely to show favorable attitudes (AOR = 2.53; 95% CI: 1.015-6.422; p = 0.046). Poor adherence was noted in 81.6% of respondents. Nurses aged 25-35 were 34% less likely to report poor adherence than those aged 45 and above (AOR = 0.344; 95% CI: 0.129-0.912; p = 0.032). ConclusionThis study identified adequate knowledge but negative attitudes and poor adherence among ICU nurses. Strengthening training, mentorship, and standardized protocols is crucial for enhancing sedation care and improving patient outcomes.

BackgroundConsanguineous unions are defined as the matrimony between individuals who are blood relatives. Researchers in all over the world worked on this issue and they checked the ratio of prevalence and effects of consanguinity in different regions of world. This research was conducted in the District Faisalabad, upper Punjab. ObjectiveTo find rate of consanguinity, coefficient of inbreeding (F) and its impacts. MethodsThe data was collected from six tehsils of District Faisalabad by interviewing the subjects. The data collected within the time span of six months. Total of 2366 subjects were interviewed after their consent approval. ResultsThe rate of consanguinity was noted 41.83% with 0.03053 coefficient of inbreeding. High rate of consanguinity (23.36%) was noted among first cousins. The distantly related and not related unions were 35.64% and 22.56% respectively. The rate of consanguineous unions in six tehsils ranged from 33.99% in Jaranwala to 53.85% in Tandlianwala. Consanguineous marriages were noted high in Punjabi speaking subjects, in housewives, in reciprocal marital types, in grand-parents and one couple family types and Rajpoot castes. There was found no significant differences of consanguinity in rural and urban areas. The rate of still births was noted high (82.25%) in consanguineous unions while neonatal, post neonatal and child mortality was low such less as 6.45%, 8.06% and 3.22% respectively. The prenatal mortality was noted slightly high 44.94% in consanguineous unions as compared to non-consanguineous unions. The congenital malformation rate was 6.29% in all marital unions but this rate was high (59.06%) in consanguineous unions as compared to non-consanguineous unions (40.93%). This is a pilot study to analyze the potential of inbreeding coefficient (F) in the District Faisalabad.

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.

IntroductionSickle cell disease is a chronic hematologic disorder associated with significant physical and psychological challenges, including depression. Children with SCD experience recurrent pain crises, hospitalizations, and social limitations, which can contribute to mental health issues. This study aimed to determine the prevalence of depression and associated factors among school-age children with SCD at Jinja Regional Referral Hospital (JRRH), Eastern Uganda. MethodsA cross-sectional study was conducted among 200 randomly selected children aged 6-12 years receiving care at JRRH. Depression was assessed using the Childrens Depression Inventory (CDI). We assessed the association between depression and several factors including sociodemographic characteristics, clinical factors and health related quality of life. Multivariate logistic regression was used to identify factors that were statistically significantly associated with depression at a 95% confidence interval. ResultsMajority of the participants 55.5% (111/200) were female, 49.5% (99/200) were in pre-primary with a mean age of 6.7 (SD{+/-}1.4) years -The prevalence of depression among children with SCD was 43% (95% CI= 40-46%). Among these, 27.9% had mild depression, 58.1% had moderate depression, and 14.0% had severe depression. Factors significantly associated with depression included lack of assured income among caregivers (AOR=3.67, 95% CI=1.35-7.56, p=0.001), having more than one sibling with SCD (AOR=2.54, 95% CI=1.45-4.72, p=0.02), frequent hospital admissions (AOR=2.12, 95% CI=1.56-4.39, p=0.01), and frequent pain crises (AOR=2.10, 95% CI=1.56-4.67, p<0.001). ConclusionDepression is prevalent among children with SCD at JRRH, with socio-economic status of the caregiver, number of siblings with SCD, health facility admission frequency and frequent pain crises playing significant roles. Improving access to financial and social support for caregivers and ensuring adequate pain management are recommended.

BackgroundThe Intensive care unit (ICU) service is highly limited in sub Saharan Africa countries due to varying of quantities and qualities infrastructures. However, the burden of critical ill patient in low resource countries is higher and possibly increasing with urbanization, developing epidemics and access to hospitals service. The main objective of this study was to assess the outcomes of ICU admission and identify the areas of improvement in critical care. Methodsan institutional based retrospective cross sectional study design was conducted on eligible patients who were recorded at intensive care unit registration log book from January 1, 2019 to June 30, 2020. The data was entered, edited and analyzed in stata software (version14). We performed the adjusted survival analysis between ICU mortality and independent variables by using logistic regression. We also showed patients mortality in ICU by Kaplan-Meier (KM) survival analysis. ResultsFrom January 1, 2019 to June 30, 2020 data were taken from 454 cases at Tibebe Ghion Specialized Teaching Hospital ICU registered log book through prepared questionnaire. The overall ICU mortality was 31.3%. The common leading causes of admission to ICU were head injury (19.6%) followed by non-tuberculosis respiratory problems (11.89%), post abdominal surgeries (8.37%) and myocardial infarction (6.82%). In this study, 36.3% of ICU admitted patients were served by mechanical ventilation. The logistic regression analysis ICU mortality showed that patient stayed in ICU with odds ratio (OR = 1.37 [95% CI, 1.16 - 1.62]; P = 0.000),needs for mechanical ventilation(OR = 0.18 [95% CI, 0.12 - 0.28]; P = 0.000), days on mechanical ventilation (OR = 0.73 [95% CI, 0.61 - 0.87]; P = 0.001) and non-infection (OR = 0.45 [95% CI, 0.24 - 0. 69]; P = 0.000) were associated with risk of ICU mortality. ConclusionThe mortality rate of our adult ICU was 31.3% with the most common causes of admission and deaths being on head injury. The highly statistical significant predictors of ICU mortality were infection, needs for mechanical ventilation, ICU stay and days on mechanical ventilation.

BackgroundThe COVID-19 pandemic significantly changed the daily routines of frontline health workers (FLHW), particularly those directly caring for COVID-19 patients. This study explores the lived experiences and coping strategies of FLHW at a Zonal Hospital in Kilimanjaro, Tanzania MethodThe study used a qualitative exploratory descriptive design, to retrospectively capture psychological impacts, challenges, coping strategies, and professional dilemmas faced by FLHW. Participants were purposively sampled from KCMC Hospital departments directly involved in COVID-19 patient care. FindingsThe FLHW experienced considerable fear, stress, and stigma. The fear of infection and high mortality rates among patients and colleagues heightened their anxiety. Stress was exacerbated by long working hours, uncomfortable personal protective equipment (PPE), poor remuneration, and the emotional toll of witnessing numerous deaths. FLHW also experienced being stigmatized and discriminated against, both within their workplaces, within the family and in the broader community. Some FLHW considered quitting their jobs due to the overwhelming workload, fear of being infected, and emotional strain. Additionally, absenteeism and avoidance of COVID-19 duties were common, driven by fear and inadequate hospital capacity. Coping strategies among FLHW to manage their stress and maintain resilience included acceptance, faith, family support, rest, and, the use of recreational substances. ConclusionThe FLHW experienced considerable fear, stress, and stigma. The study highlights the need for better psychological support, improved communication, adequate training, and resources to support FLHW before, during, and post-pandemic. Enhanced resilience and confidence, along with a greater appreciation for protective measures and compassion for patients, were some of the key lessons learned from their experiences during the pandemic informing more effective preparedness care in future pandemics.

BackgroundMeasles is a highly contagious infectious disease and a leading cause of childhood morbidity and mortality worldwide. In developing country like Ethiopia, effective immunization is a proven strategy for reducing measles related illness and deaths. However, measles second dose vaccination drop out has become a major public health concern. In a densely populated city such as Addis Ababa drop rate tends to be higher than the minimum acceptable threshold, leading to increased number of cases and recurrent outbreaks. Despite of this limited evidence exists on the determinants of second dose drop out and the problem is not well investigated, as a result this study will try to identify determinants of measles second dose vaccination dropout among children 24 - 35 months of age. ObjectivesTo identify determinants of measles second dose vaccination dropout among children 24 - 35 months of age Addis Ababa, Ethiopia in 2025. MethodCommunity based unmatched case control study was conducted in Addis Ababa from September 1/2024 to October /2025 with a total of 636 participants, consisting of 212 cases and 424 controls. Data were collected using structured Quesionariie and entered into EpiData 3.1 then StataSE 18 was used for detailed analysis including Descriptive statistics. Model fitness was checked using Hosmer-Lemeshow and multicollinearity were assessed using variance inflation factor. Furthermore, Bivariable and multivariable logistic regression analyses was employed and Adjusted odds ratio with 95% confidence intervals was used to identify significant variables. ResultsA total of 620 mothers/caregivers participants respond to the study, comprising 206 (97%) cases and 414(97.6%) controls, yielding a total response rate of 97.4%. In this study, waiting time longer than 30 minutes (AOR= 3.34, 95%CI: 1.86-5.9), Lack of counseling (AOR = 2.63, 95% CI: 1.60-4.30), Lack of reminders (AOR = 2.86, 95% CI: 1.89-4.30), Previous adverse event following immunization (AOR = 2.00, 95% CI: 1.39-3.00), postnatal care visit (AOR = 0.58, 95% CI: 0.40-0.85) and family size of greater than 3 (AOR = 1.96, 95% CI: 1.29-2.98) were significantly associated with measles second dose dropout. Conclusion and recommendationIn study shows measles second dose dropout is found to be associated with long waiting time, lack of counseling, lack of reminder, history of adverse event following immunization and postnatal visit. Which suggests Strengthening Immunization Counseling, reducing waiting time, establishing effective reminding system, integrating Immunization with postnatal services and promptly addressing concerns about adverse event following immunization can help reduce measles second dose dropout.

BackgroundMillions of people worldwide suffer from thyroid dysfunction, and especially hypothyroidism, which is a prevalent endocrine disorder contributing extensively to systemic and metabolic illness. In hypothyroidism, triiodothyronine (T3) and thyroxine (T4), thyroid hormones that control metabolism in several organ systems, are insufficiently secreted. ObjectivesThe objective of this study was to determine the effect of anti-thyroid antibodies on thyroid function in Bangladeshi newly diagnosed patients with hypothyroidism. MethodsA cross-sectional analysis of adult patients with newly diagnosed hypothyroidism was carried out. Thyroid function tests (FT4, TSH), thyroid autoantibodies (anti-TPO, anti-Tg), symptoms, physical findings, and demographics were obtained and analyzed. ResultsThe average age of the study participants was 36.07{+/-}11.00 years, and 70.1% were female. 72.7% of the cases were rural. 89% of the patients were antibody-positive, 81.8% anti-TPO, 55.2% anti-Tg, and 48.1% both. Enlargement of the thyroid (p<0.001) and gain of weight (p<0.043) were associated with antibody positivity. Grade 1 goitre alone was highly predictive of antibody positivity (AOR 11.766, p<0.001). Neither FT4 nor TSH correlated significantly with antibody titers. A significant correlation, however, was noted between anti-Tg and anti-TPO titers. ConclusionRecently developed hypothyroid patients usually have a condition named especially anti-TPO positive, and it is usually accompanied by goitre and family history. Even if the thyroid function tests are not conclusive, early diagnosis and better understanding of the disease process can be made by screening for thyroid antibodies.

BackgroundHumanitarian settings in Pakistan face major gaps in mental health service delivery, with limited specialist resources and a high burden of untreated conditions. The WHO mhGAP-Humanitarian Intervention Guidelines (mhGAP-HIG) aim to strengthen the capacity of primary care physicians (PCPs) to identify and manage common mental health conditions in humanitarian contexts. However, the evidence for multidimensional training outcomes remains limited. This study evaluated the effectiveness of mhGAP-HIG training to improve outcomes in terms of knowledge, skills, attitudes and confidence among PCPs across different humanitarian contexts in Pakistan. MethodsAs part of implementing an evidence-based digital MHPSS service model, seven mhGAP-HIG workshops were held between September and November 2025 across two provinces and a federal area facing humanitarian contexts. We conducted a quasi-experimental, mixed-methods evaluation where a total of 149 PCPs completed standardized assessments of knowledge (mhGAP-HIG), therapeutic skills (ENACT), attitudes (MICA-4), and confidence. Paired sample t-tests and ANCOVA were used to assess within-group and between-group changes, respectively. Quantitative feedback on training quality was obtained and qualitative reflections on learning experiences were evaluated using thematic analysis. ResultsA modest improvement in attitude and significant improvements across all other domains were observed. The participants from KP showed greater gains in knowledge, while participants from GB showed greater gains in skills, as compared to other provinces. Participants expressed a high level of satisfaction in all workshops, and reported improvements in knowledge, confidence, and ability to identify, manage and refer people with common mental health conditions. ConclusionSystematic efforts to adapt and implement mhGAP-HIG may lead to significant improvements across multidimensional competencies of PCPs, including their knowledge, skills, attitudes and confidence.

ObjectivePsychological distress in cancer is associated with poorer quality of life, poorer treatment adherence and outcomes, and higher healthcare costs. The current study aimed to provide evidence on the effectiveness of the Progressive Muscle Relaxation program in female patients with breast cancer at Goa Medical College, Goa, a state in the Western part of India. This study will help to explore the level of anxiety, depression, and fatigue and provide suitable recommendations to reduce anxiety, depression, and fatigue among cancer patients. MethodsIt was a Randomised Controlled Trial. The study was conducted in Surgery Wards 106 and 109 at Goa Medical College. Adult women [&ge;] 18 years of age with a new diagnosis of breast cancer who have undergone surgery as their primary mode of treatment are included in the study. Sixty patients were randomly divided into two groups of 30 each, using a block randomization method with ten numbered sealed opaque envelopes. Fifty-eight people completed the study. The intervention entailed a 20-minute Progressive Muscle Relaxation (PMR) session, which started with Deep Breathing and Guided Imagery (GI) sessions given to one group. Both groups were evaluated for anxiety, depression, and fatigue levels using the Zung Anxiety Scale, Beck Depression Inventory, and Fatigue Scale at baseline and after the two-week intervention. ResultsFifty-eight people completed the study. The participants in both groups had similar sociodemographic characteristics and clinical profiles. After two weeks of intervention, the intervention group showed significant reductions in anxiety (51.71 {+/-} 2.89 to 38.52 {+/-} 6.32, p [&le;] 0.001), depression (11.48 {+/-} 2.93 to 6.16 {+/-} 2.98, p [&le;] 0.001), and fatigue (23.29 {+/-} 4.12 to 16.88 {+/-} 4.73, p [&le;] 0.001). ConclusionsThis study highlights the effectiveness of Progressive Muscle Relaxation (PMR) and Guided Imagery (GI) in reducing anxiety, depression, and fatigue in breast cancer patients. These nonpharmacological techniques serve as valuable complementary therapies, helping manage emotional distress and prevent symptom progression during treatment. Trial registration number and dateCTRI (Clinical Trial Registry of India) Registration was done in February 2021 from the Clinical Trial Registry of India, with Reg. number CTRI/2021/02/030996.

IntroductionHemophagocytic lymphohistiocytosis (HLH) is a serious condition induced by Dengue virus which becomes fatal if not detected early and treated appropriately. So objectives of the present study are to observe the different patterns of presentations, clinical features and outcome of HLH induced by Dengue. MethodsIn this observational study, 14 patients admitted and diagnosed HLH as per diagnostic criteria, were included after informed written consent. Study conducted in a period of six months from 01/07/2025 to 31/12/2025. All patients were followed up till discharge. After collection, all data were analyzed by Microsoft Excel 2010. Ethical clearance was taken from Ethical Review Board of the Medical College. ResultsAmong 14 cases, male were more affected then the female (78.6% VS 21.4%) and majority were in between 20 to 50 years age groups. Clinical data showed, all 14 cases had fever for >7 days, joint pain 3(21.4%), headache 11(78.6%), skin rashes 10(71.4%), retro-orbital pain 2(14.3%), vomiting 11(78.6%),bleeding 10(71.4%), cough 4(28.6%), loose motion 9(64.3%), abdominal pain 7(50.0%), anorexia 2(14.3%), Melaena 2(14.3%), jaundice 4(28.6%) and spleenomegaly 9(64.3%). One(7.1%) case had history of Hypertension. Laboratory data showed different level of Bi or Pancytopenia, high ferritin, high TG, low fibrinogen, raised liver enzymes and low sodium. Dengue RT PCR and serology results showed 8(42.9%) cases were both IG M and Ig G dengue antibody positive, 6 cases were RT PCR positive, 2 cases were IgM and another 4 cases were IgG positive. Outcome of patients revealed, among all 14 cases12(85.8%) patients improved uneventfully and 2 were shifted to ICU where one improved and one died. ConclusionDengue is prevailing for long time and different complications are evolving and HLH is a relatively newer incident among the dengue patients. Infection by different serotypes at different time or multiple dengue serotype infection may be related with HLH and it might be a future subject to explore and to evaluate.

BackgroundMedication non-adherence is a critical problem among patients with heart failure (HF). Current evidence has shown its association with increased morbidity, mortality and healthcare costs. Prescription discrepancy is a significant risk factor that can increase non-adherence and subsequently increases the risk of HF-related hospitalization and mortality. Current literature has not provided a clear understanding of the non-adherence problem or contributing factors among Saudi HF patients. Measuring the prevalence of non-adherence and its associated factors can direct clinicians to implement effective interventions to optimize pharmacotherapy benefits, and thus, improving outcomes. AimTo assess the Saudi Arabian population of HF patients for degree of adherence to their medications, the amount of medication discrepancies, and its association with re-hospitalization rate. MethodA prospective observational study conducted at a tertiary care hospital on eligible HF patients attending the ambulatory clinic from July 2023 through April 2024. All patients were followed for six months. Primary outcomes were percentage of patients adherent to their medications and number and type of prescription discrepancies. Secondary outcomes were degree of health literacy, prevalence of non-adherence risk factors, and HF-related re-hospitalization rate. Adherence was measured utilizing the Eight-item Morisky Medication Adherence Scale (MMAS-8). Three-item Brief Health Literacy Screen (BHLS) was used to measure health literacy. ResultA total of 202 patients were included in the study. Average age was 60 years, and 69% were males. For the primary outcomes, 43.5% of patients demonstrated high adherence, while 39.6% and 16.8% fell into medium and low adherence categories, respectively. Prescription discrepancies were identified in 51.5% of the patients. Causes of discrepancies ranged from patient generated, healthcare system generated, or multifactorial, generated by both, the patient and the system. Degree of health literacy was adequate in 23.8% of the patients, marginal and inadequate in 51.5% and 24.8%, respectively. Of potential non-adherence risk factors, polypharmacy, age [&ge;]65 years, and marginal and inadequate health literacy, were the most common. HF-related re-hospitalization occurred in 18 patients, all of which were either non-adherent or had prescription discrepancies. ConclusionAmong HF patients, medication non-adherence is a significant problem that is associated with increased morbidity and mortality. In our study, around half of the patients either experienced difficulties with adherence, prescription discrepancies, or both. Measuring the local prevalence of factors affecting non-adherence can be of use to identify strategies that suit our population the best, in order to mitigate their negative effect.

BackgroundThe prevalence of diabetes in low- and middle-income countries is rising, and the most important treatment is maintaining a healthy lifestyle. Good diabetes self-care management is associated with better outcomes, but barriers to adhering to its management are knowledge deficits and a lack of social support. Traditionally, diabetes self-care management education and support are conducted by health care workers (HCWs), but limited access to HCWs restricts this activity. Digital health interventions can help overcome some barriers. ObjectiveTo describe type 2 diabetic patients perception of using WhatsApp for diabetes education, as well as the barriers and enablers they experienced in their usage, in the Tigray region of Ethiopia. MethodThis study is a collaboration between researchers from Norway and a researcher from Ethiopia. A qualitative explorative and descriptive approach was adopted. The co-researcher in Ethiopia recruited the participants, and research assistants conducted 17 interviews with a semi-structured interview guide based on the technology acceptance model. The interviews were conducted in Tigrinya, transcribed and translated to English, and de-identified before analysis. The data were analysed using NVIVO 14 with reflexive thematic analysis. ResultsFrom the data, the following four themes were developed: experienced enhanced self-care, digital access to HCWs, digital support, and barriers and enablers. The participants perceived WhatsApp as highly useful. The participants said that they gained new knowledge and experienced social support and increased access to HCWs when using WhatsApp. ConclusionWhatsApp was perceived as easy to use, but some barriers were reported. This study indicates that WhatsApp may contribute to enhancing access to diabetes self-care management education and support.

IntroductionHyperferritinemia is a prognostic marker in critical illness, but its role in postoperative outcomes of pediatric congenital heart defects remains poorly defined, especially in resource-limited settings. This study evaluated early serum ferritin as a predictor of outcomes after congenital heart surgery and its association with the PIM 3 score. MethodsA single-center, prospective cohort study was conducted from April 2023 to October 2024 at a tertiary referral center in southeastern Brazil. Patients aged 29 days to 18 years, of both sexes, admitted to the PICU after congenital heart surgery were included and categorized as cyanotic or acyanotic. Statistical significance was defined as two-sided p < 0.05. ResultsA total of 105 patients were included. Median ferritin was higher in patients with PICU stays < 7 days (183 ng/mL; p = 0.004) and was significantly associated with a PIM 3 score [&ge;] 5% (642 ng/mL; p < 0.006). Cyanotic patients had longer PICU stays (11.0 vs. 7.2 days; p = 0.02), longer use of vasoactive drugs (3.8 vs. 2.6 days; p = 0.01), and accounted for all deaths (p < 0.001). Hemoglobin and hematocrit were also significantly higher in cyanotic patients (14 vs. 13 g/dL and 40% vs. 37%; p < 0.001). ConclusionsSerum ferritin may serve as a marker of secondary outcomes and aid early risk stratification in congenital heart defects patients in the PICU.

ObjectiveTo analyze the structure of mental disorders in children in the outpatient practice of a specialized mental health center for optimization of care organization for this patient category. MethodsA retrospective analysis of medical records of 23 children (out of 44 patients) at the Insight Mental Health Center (Dushanbe, Tajikistan) was conducted for the period from December 9, 2025, to January 8, 2026. Diagnosis was performed according to ICD-10 criteria using standardized instruments: M-CHAT-R, ADOS-2, and ADI-R for autism spectrum disorder (ASD); SNAP-IV for attention deficit hyperactivity disorder (ADHD); CGI; and pediatric versions of PHQ and GAD. ResultsChildren accounted for 52% of all patients. Primary school-age children (7-12 years) predominated at 43.5%. Disorders of psychological development (F80-F89) dominated the nosological structure at 82.6%, with ASD comprising 56.5%. ADHD was diagnosed in 30.4% of cases. Comorbidity was registered in 47.7% of patients. ConclusionThe structure of pediatric psychiatric pathology is characterized by a predominance of developmental disorders and high comorbidity levels, justifying the need for a multidisciplinary approach.

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.

Neurological health score (NHS), indicating the health of brain and nervous system, helps in identifying high risk individuals, and in recommending lifestyle modifications. In the present study, we developed NHS based on genetic, lifestyle and biochemical variables associated with eight neurological disorders - dementia, stroke, Parkinsons disease, amyotrophic lateral sclerosis, schizophrenia, bipolar disorder, multiple sclerosis and migraine. UK Biobank data from Caucasian individuals was used to develop the model, and the data from individuals of Indian ethnicity was used to validate the model. Logistic regression and XGBoost algorithms were used in selecting the significant variables for the disorders. NHS developed from the selected variables was found to be very significant after adjusting for age and sex (AUC:0.6, OR: 0.95). Higher NHS was associated with a lower risk of neurological disorders and better social well-being. Highest NHS group (top 25%) showed 1.3 times lower risk compared to the rest of the individuals. Results of our study help in developing a framework for quantifying the neurological health in clinical setting.

IntroductionSleep is a vital physiological process essential for memory consolidation, cognitive performance, and the regulation of cardiovascular functions. Students in health sciences programs constitute a population particularly susceptible to sleep disturbances due to heavy academic workloads, irregular schedules, and psychosocial stressors. ObjectiveTo investigate the relationship between sleep patterns, academic performance, and cardiovascular risk factors among health sciences students. MethodsA cross-sectional study was conducted involving 349 students enrolled in Medicine, Psychology, and Nursing programs. Participants completed a sociodemographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS). Anthropometric data, including weight, height, waist circumference, and blood pressure were measured. Statistical analyses comprised descriptive and inferential methods. ResultsA high prevalence of poor sleep quality and excessive daytime sleepiness was identified. Sleep quality was significantly associated with academic performance (p = 0.003). Male sex, smoking, and higher body mass index (BMI) were also correlated with poorer sleep patterns. ConclusionPoor sleep quality adversely affects academic performance and is associated with cardiovascular risk factors. The implementation of institutional strategies aimed at promoting sleep hygiene and providing psychosocial support is recommended to mitigate these impacts.

PurposeTo evaluate the performance of the pharmacists-providers collaborative iron deficiency treatment clinic in the heart failure service MethodsA single-center retrospective cohort study was conducted to evaluate the performance of the iron deficiency pharmacists-providers collaborative care clinic during the induction and maintenance phases of intravenous (IV) iron therapy. The study included patients who were seen by HF providers (advanced HF cardiologists or advanced practice providers) and received the IV iron consultation with HF pharmacists. The study included patients aged 18 years or older who were diagnosed with HF or PH and received at least one dose of either ferric carboxymaltose or iron sucrose in outpatient settings. It was managed by the pharmacists-providers collaborative IV iron clinic. The primary outcome was adherence to the IV iron appropriate use criteria, laboratory requirements, and dosing during the induction course. The primary and secondary outcomes were compared with those of the previously reported control group, which received the usual iron deficiency treatment care at the HF clinic prior to the implementation of the pharmacists-providers collaborative IV iron deficiency treatment clinic. The use of oral iron therapy was evaluated over four years. ResultsA total of 187 patients were included in the final cohort. The median follow-up period of the IV iron consulting team was 372 (176, 623) days. Compared to the pre-implementation group, the primary outcome was significantly higher in the post-implementation group (81.3 vs. 40%, p<0.001). The most common reasons for nonadherence were the absence of maintenance laboratory requirements (15.5%), failure to administer all induction doses (1.6%), inappropriate use (1.1%), and incorrect dose (0.5%). Ferritin, iron saturation, and hemoglobin values at cycle one were significantly increased after the IV iron induction course compared to baseline values and remained numerically stable throughout the follow-up periods. Serum phosphorus levels remained within the normal range throughout the follow-up period. Among 57 patients on oral iron therapy, the consulting team discontinued it in 19 patients (33.3%) during follow-up. ConclusionThe pharmacists-providers collaborative IV iron clinic significantly improved the performance of IV iron therapy in rural heart failure care settings compared to the usual care. These results highlight the importance of multidisciplinary care management for iron deficiency in the real-world heart failure practice.

BackgroundRisk stratification tools are essential for guiding care and allocating limited resources in intensive care units (ICUs). Evidence on the performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in Nepal is limited. We evaluated the association of APACHE II measured within 24 hours of ICU admission with mortality, ICU length of stay, and discharge disposition in a tertiary hospital in Nepal. Methods and findingsWe conducted a prospective observational cohort study of consecutive adult patients admitted to three multidisciplinary ICUs at a tertiary hospital in Kathmandu, Nepal. Patients with ICU stay <24 hours and those admitted to coronary or neonatal ICUs were excluded. APACHE II was calculated from the worst values in the first 24 hours. The primary outcome was ICU mortality; secondary outcomes were ICU length of stay and discharge disposition (home, ward, high-care/step-down, or in-hospital death). Discrimination for mortality was assessed using receiver operating characteristic (ROC) analysis. Associations with length of stay were examined using linear regression; discharge disposition was evaluated using multinomial logistic regression. Among 200 patients (54% male; mean age 54.7 {+/-} 21.0 years), ICU mortality was 23.0% (46/200). Non-survivors were older than survivors (mean difference 13.31 years; 95% CI 6.60-20.02; p < 0.001). The mean APACHE II score was 13.19 {+/-} 7.89 overall, higher in non-survivors vs survivors (19.85 {+/-} 7.14 vs 11.21 {+/-} 6.98; p < 0.001). APACHE II discriminated ICU mortality well (AUC 0.806); a cutoff [&ge;]14.5 yielded 76.1% sensitivity and 71.4% specificity. Mortality increased across APACHE II strata (trend p < 0.001). Glasgow Coma Scale scores were lower in non-survivors (10.85 {+/-} 4.43) than survivors (13.29 {+/-} 3.11; p < 0.001). Higher APACHE II scores were associated with in-hospital death versus ward discharge, but not with high-care versus ward (OR 1.063; 95% CI 0.994-1.136; p = 0.074). Limitations include the single-center design, modest sample size, and short study duration, which may limit generalizability. ConclusionsAPACHE II measured within 24 hours of ICU admission demonstrated good discrimination for ICU mortality and a modest association with ICU length of stay in a Nepalese tertiary setting, while being less informative for intermediate discharge dispositions. Together with Glasgow Coma Scale, APACHE II offers a pragmatic, cost-effective approach to early prognostication and resource planning in resource-limited ICUs. Multicenter studies are warranted to validate these findings across Nepal.