Journal of Family Medicine and Primary Care

Bangladesh is experiencing emerging burden of Non-Communicable Diseases (NCDs). Non-communicable diseases (NCDs) are the emerging as major cause of morbidity and mortality, accounting for 61% of deaths in Bangladesh. The study aims to describe the prevalence of NCDs among pregnant women in teagardens in Moulvibazar district. Three teagardens of Sreemongol upazila in Moulvibazar district was selected randomly. The pregnant women were considered for collecting the NCD related information. A sample size of 86 was purposively selected based on relevant literature review. Data was collected by conducting face to face interview with the respondents through pre-tested semi-structured questionnaire. Data was analyzed with the help of SPSS Version 24 Software. For effective use of limited resources, an increased understanding of the shifting burden and better characterization of risk factors of NCDs including Hypertension is needed. Average age of the women attended for screening test was 23 (15-45) years. More than 47% women were found with Gravida 1. The mean duration of pregnancy was found 18.8 weeks. Above 24% percent of GDM women were found at low blood pressure but 2% were identified at high blood pressure. 28% were found underweight with BMI calculation but 11% were identified with overweight. The challenges tests for blood sugar findings of women were found 12.7% GDM positive (7.8-<11 mmol/L). About 16.5% had complications during pregnancy including anaemia, eclampsia, edema, diarrhoea etc. A community based NCDs surveillance model could be developed through participation Government health managers, experts and stakeholders, which were taken by local health system for implementation.

Background: Nursing documentation is an essential component of nursing practice that has a potential to improve patient care outcome. Poor documentation of nursing care activities among nurses has been shown to have negative impacts on the health care quality. The aim of this study was to assess documentation practice and associated factors among nurses working in Felege Hiwot comprehensive specialized hospital from August 1 to August 30, 2025. Method: Institutional based cross sectional study design was employed. The data was checked for completeness, coded and entered in epi -data version 3.1 and analysis was made by STATA version 14. Binary logistic regression analysis was computed to assess associations of factors with documentation practice. Variables with p- value less than 0.25 in Bivariable analysis was entered to final model and P < 0.05 at 95% confidence interval was considered as statistically significant. Odds ratio was used to show strength of association. Result: Out of the 349 respondents, 209 (59.9%) were females. In this study 40.1% of nurses had good documentation practice. Educational level, MSc (AOR, 95%CI; 10.3(3.4-31.8)), attitude (AOR, 95%CI; 2.6(1.5-4.7)), number of patient care (AOR, 95%CI; 5.6(1.9-16.3)) and Knowledge (AOR< 95%CI; 3.7(2.1-6.2)) were statistically associated with documentation practice. Conclusion and recommendation: Poor documentation practice was due to the identified factors. So, it is better to put further effort toward improving documentation practice through providing training on standards of documentation and enhancing the favorable attitude of nurses toward documentation practice. Keywords: Documentation, Nursing care, nursing record of patient care.

IntroductionPressure sores are a major health problem in people with spinal cord injury resulting in ischaemic tissue lesions caused by prolonged pressure against a bony surface. Conventional therapies are often defective and fundamental researches on the healing process of pressure sores must be enriched in order to understand any novel therapies that may be applied. We focalize on pressure sores fibroblasts as dermal fibroblasts perform a critic role in wound healing by populating the wound site to produce extracellular matrix. After characterizing morphological and the genetic profile of healthy fibroblasts and fibroblasts from pressure ulcers, we conducted an analysis of fibroblast proliferation, migration and myofibroblastic differentiation capacity. Materials and Methodsafter acquisition of dermal explants and fibroblasts culture, we conducted histological analysis, an evaluation of gene expression by RT-qPCR and an assessment of fibroblasts proliferation and migration capacity through IncuCyte. A study of the differentiation of fibroblasts into myofibroblasts through the detection of Alpha-Smooth Muscle Actin (-SMA) expression by immunofluorescence was also conducted. Resultshistological analysis showed histological analysis showed dermal disorganization in pressure sore compared with health skin, differences in morphological aspects and density of fibroblasts. Pressure sore fibroblasts express less genes coding for ECM proteins, metalloproteases, collagen III, Connective tissue growth factor (CTGF) and ACTA2 coding for -SMA. Pathological fibroblasts appear to proliferate less quickly than healthy fibroblasts but no differences in migration capacity were found. After stimulation under TGF-{beta}, pressure sore fibroblasts lose their ability to differentiate into myofibroblasts compared to healthy fibroblasts and this could be in relation with a less expression of ACTA2. ConclusionAll of our results highlight a morphological, genetic and functional difference between healthy and pathological fibroblasts which have a modified phenotype, less effective for skin repair. This suggests that new therapies for chronic wounds must take into account the environment in which they are applied and that pathological cells do not necessarily respond to treatments in the same way as healthy cells. Our results are not statistically significant, although several trends emerge. This is explained by the heterogeneity of the patients medical history and requires repetition of the experiments.

Congenital heart disease contributes substantially to chronic morbidity, growth impairment, and repeated healthcare utilization among children. Evidence regarding nutritional burden and outpatient healthcare patterns among pediatric patients with congenital heart disease in Indonesia remains limited. This study aimed to evaluate clinical characteristics, nutritional status, healthcare utilization, and factors associated with malnutrition among pediatric outpatients with congenital heart disease at Adam Malik General Hospital, Indonesia. A retrospective observational study was conducted using medical records of pediatric outpatients treated between January and December 2024. Demographic characteristics, cardiac diagnoses, nutritional status, complications, and outpatient visit history were analyzed. Logistic regression analysis was performed to identify factors associated with malnutrition. A total of 606 pediatric outpatients were included. Non cyanotic congenital heart disease predominated the cohort, with ventricular septal defect representing the most common diagnosis followed by patent ductus arteriosus and atrial septal defect. Nearly half of all patients demonstrated underweight or severe underweight nutritional status, while pulmonary hypertension emerged as the most frequent complication. Younger pediatric age groups and higher cumulative clinical burden independently increased the odds of malnutrition. Children with congenital heart disease at this tertiary referral center carried a substantial nutritional and clinical burden. Early nutritional surveillance and integrated long term outpatient management may improve growth outcomes and reduce chronic disease burden in resource limited settings.

Depression remains a major public health concern globally, particularly in low resource settings where access to quality mental health care is limited and treatment outcomes are often suboptimal. In this context, the quality of the clinician patient relationship has been increasingly recognised as a critical determinant of therapeutic success. This study examined the influence of clinician patient therapeutic alliance and relational factors on treatment outcomes among patients with depression in Benue State, Nigeria. A crosssectional correlational design was adopted, involving patients diagnosed with depression and receiving care in selected health facilities. Data were analysed using Structural Equation Modelling to test hypothesised relationships among therapeutic alliance, relational factors, and treatment outcomes. The measurement model demonstrated strong psychometric properties, with all factor loadings exceeding 0.60, composite reliability above 0.90, and adequate convergent and discriminant validity. Results revealed that therapeutic alliance significantly predicted treatment outcomes, while relational factors also had a significant positive effect. Therapeutic alliance further significantly predicted relational factors. The model explained 61 percent of the variance in treatment outcomes. Mediation analysis indicated that relational factors partially mediated the relationship between therapeutic alliance and treatment outcomes, accounting for 29 percent of the total effect. The study concludes that therapeutic alliance, strengthened through trust, empathy, and collaboration, plays a central role in improving depression outcomes. Strengthening relational competencies in clinical practice is therefore essential for enhancing mental health care delivery in Nigeria.

Introduction-India's immunization initiatives are among the largest globally, characterized by a substantial birth cohort of 27 million children annually, and have achieved significant progress in increasing coverage through the UIP. However, there are still challenges that persist, and multiple determinants contribute to the existing challenges; parental migration is one of them. Migration has always been a key driver of socio-economic and demographic changes, particularly in low and middle-income countries (LMICs). Specifically, there is a need to better understand the vulnerabilities of immunization among recent migrants. To examine this, the study explores the association between a mother's recent migration and the full immunization coverage of children aged 12-23 months in India. Data & Methods-Our study utilized data from the National Family Health Survey-5 (2019-21). The outcome variable of interest in this study is the receipt of all basic vaccinations (full immunization) for children. The primary predictor variable in this study is the children's migration status. We used a series of multivariate logistic regression models to examine the relationship between full Immunization and recent migration of children, with some data restrictions in the models. Results - The results show a 17% difference in full immunization between migrant and non-migrant children. The odds ratios for children who had recently migrated were lower for full immunization (OR: 0.39, 95% CI: 0.35-0.43) compared to children who had not recently migrated. Even across the household wealth quintile and social groups, the recent migration of children was associated with being less likely to be fully immunized among children 12-23 months. Conclusion- The findings of this study provide significant quantitative evidence that recent migration (less than 3 years) of children is a key factor influencing Immunization coverage and is a predictor of full vaccination among children aged 12-23 months in India. The recent migration was consistently linked to a lower likelihood of full immunization coverage across different household wealth levels and social groups. This study suggests that recently migrated children are a vulnerable subgroup of the population at risk of not receiving all basic vaccinations by their first birthday.

Background Complementary and Alternative Medicine (CAM) contributes significantly to the utilization of healthcare services in mental health care in sub-Saharan Africa. However, there is limited evidence on the utilization of CAM in the particular setting of post-conflict northern Uganda. This study sought to establish the prevalence, forms, and socio-demographic determinants of CAM use among patients attending the Mental Health Unit at Gulu Regional Referral Hospital (GRRH). Methods This is a cross-sectional study conducted in a hospital setting from June to August 2025. Convenience sampling was employed to recruit 407 participants. A structured questionnaire was employed for data collection. Data analysis was done using STATA software version 18.0. Descriptive statistics were calculated, and bivariate analysis with Prevalence Ratios (PR) with 95% confidence intervals was employed to determine factors that are significantly associated with the use of CAM. Results The lifetime prevalence of CAM use was 63.4% (258/407), with 41.3% (168/407) using CAM currently. The most frequent CAM practices used were herbal medicine (50.4%), spiritual practices (33.7%), and traditional medicine (19.8%). For current users, spiritual practices were most frequent (88.7%). The reasons for using CAM were recommendations from others (84.8%) and cultural or religious beliefs (63.4%). Predictors of CAM use were primary education (PR = 1.36, p = 0.017), living in an urban area (PR = 1.23, p = 0.007), separated (PR = 1.39, p = 0.050), and having a mental health disorder for six or more months (PR range = 1.55-1.72). Catholics (PR = 0.72, p = 0.0007) and Protestants (PR = 0.76, p = 0.011) were less likely to use CAM than Born Again Christians. Conclusion The level of CAM use among patients accessing mental health services in GRRH of northern Uganda is significantly high, while the reporting of CAM use to healthcare providers is remarkably low. This is a challenge that requires urgent attention. Recommendations include integrating the use of CAM into medical practice, developing national policy guidelines on CAM, working in collaboration with traditional/spiritual healers, and conducting public education campaigns.

IntroductionOccupational stress among rescue workers is a major global public health concern. Rescue workers, including paramedics, firefighters, and disaster response teams, are consistently exposed to traumatic events, long working hours, physical hazards, and emotionally charged situations. These chronic stressors make them one of the most vulnerable groups to psychological distress, burnout, anxiety, depression, and post-traumatic stress disorders. In the local context of Pakistan, workplace mental health remains a neglected area. Despite stress and burnout being widely reported in these sectors, limited evidence-based interventions are available. Therefore, the study aims to develop and evaluate a locally tailored intervention to improve the mental health and psychosocial well-being of rescue workers. ObjectivesO_LITo develop a culturally appropriate stress management intervention to promote mental health for rescue workers in Rawalpindi. C_LIO_LITo validate the content and structure of stress management intervention for rescue workers C_LIO_LITo evaluate the effectiveness of stress management intervention for rescue workers in Rawalpindi C_LI MethodThe ethical approval of the study has already been obtained from the ethical review board of Health Services Academy (00013/HSA/PhD-2022) and Rescue 1122 District Headquarters, Rawalpindi. Data will be collected after obtaining informed written consent from relevant stakeholders. Data collection will start from April 2026 and will be completed in six months. Data compilation and results are expected by December 2026. Data collection will involve a scoping review to explore stress determinants and intervention components, and then a qualitative phase in which data will be collected through focus group discussions from potential Stakeholders (rescue workers, mental health experts, and program managers) to identify and validate stress determinants. Triangulation of data will be done to integrate qualitative findings with findings from the review. In the second phase, validation will be done by intervention development experts. The third phase aims to evaluate the effectiveness of the developed intervention using a quasi-experimental pre-post design. A total of 154 participants evaluated with the Perceived Stress Scale Score will be employed through a stratified sampling technique. The primary outcome is defined as remission from stress at 3 months, measured with the PSS. DiscussionIt is anticipated that the study will result in the development of a culturally appropriate and evidence-based stress management intervention for rescue workers, thus contributing to sustainable improvement in rescuers mental health and job performance.

Introduction: Cardiovascular diseases (CVDs) are the leading cause for death and disability worldwide accounting for 75% of deaths in low- and middle-income countries (LMICs) like Nepal. Urbanization and globalization remains the major cause of rise in CVDs among urban poor population along with growth in slum settlements. This study aims to assess the knowledge, attitude and practice (KAP) of CVDs and its risk factors among women of one such urban poor community in Nepal. Methodology: This cross-sectional study (n=388) in the Sinamangal-Minbhawan slum area was conducted using semi structured questionnaire based on STEPs survey and HARDIC study among the participants selected through convenient sampling. Descriptive analysis was done using SPSS version 21 and KAP scores were further categorized based on median score to perform multivariate logistic analysis. Additionally, Anthropometric and blood pressure measurements were also recorded and analyzed. Results: The median age (Interquartile range) of participants was 33 years (17) with majority of them being Dalit by ethnicity, housewives, with up to primary level education belonging to upper lower socioeconomic class. More than half (53.3%) of the participants were obese and over 23% were hypertensive. While half of the hypertensive women were aware of their status, only 3% had their blood pressure under control.The median knowledge, attitude and practice (KAP) scores were 12, 60 and 10 respectively. The KAP scores were positively associated with socioeconomic status of the participants. Conclusion: The study revealed low knowledge with high prevalence of behavioral risk factors of CVDs along with high prevalence of other metabolic risk factors like high body mass index, high waist hip ratio and hypertension among women of slum area with a positive attitude to prevent CVDs and its risk factors.

BackgroundHigh-demand sanitary crises, such as the COVID-19 pandemic, impose a high burden on healthcare professionals, increasing their risk of burnout. Healthcare postgraduate (HCP) trainees compound the general healthcare professional workforce and may face unique risks and challenges. This study aimed to evaluate the incidence of burnout and identify its predictors among healthcare postgraduate trainees during a high-demand sanitary crisis. MethodsA longitudinal observational study was conducted during the pandemic among healthcare postgraduate trainees from 67 Brazilian healthcare institutions. Participants were assessed at baseline (July to September 2020) and after an 18-months follow-up. Individuals with burnout at baseline were excluded. Several questionnaires, including the Oldenburg Burnout Inventory (OLBI) and the depressive disorder PHQ-9 scale were applied. Associations between baseline characteristics and the development of burnout were analyzed using chi-squared and t tests, and log-binomial regression. The study received ethical approval (CAAE: 33493920.0.0000.5558). ResultsA total of 313 participants were included; mean (SD) age: 28.2 (4.6) years; 80.1% (n=250) were biological females; 58.5% (n=183) whites; 51.1% (n=160) physicians; 12.5% (n=39) nurses; 36.4% (n=114) other HCP trainees; 47.9% (n=150) had depressed symptoms at baseline. Burnout incidence rate [95% CI] was 202.9 [166.5, 239.3] cases per 1000 person-years. In bivariate analyses, depressive mood at baseline predicted future burnout (relative risk [95% CI] = 2.14 [1.49, 3.08]; p<0.001), while older age (mean difference, MD [95% CI] = 1.10 [0.16, 2.09] years; p=0.029), higher autonomy (MD [95% CI] = 0.57 [0.10, 1.04] on a 10-point visual numerical scale, VNS; p=0.018) and adequate professional training (MD [95% CI] =0.85 [0.30, 1.40] on VNS; p=0.003) showed protective effects. Sex, race and weekly workload could not predict burnout. In multivariate analyses, depressive symptoms at baseline remained independently associated with higher risk of burnout (risk ratio, RR [95% CI] = 1.84 [1.26, 2.71]; p=0.002), while having adequate professional training showed a protective effect (RR [95% CI] = 0.61 [0.43, 0.87]; p=0.007). ConclusionsVery high incidence of burnout among HCP trainees was observed under a global sanitary crisis. Depressed mood at baseline was the most relevant predictor of subsequent burnout. Providing mental health support for HCP trainees in future widespread sanitary crises seems advisable to preserve the workforce.

BackgroundFerroptosis has emerged as a promising therapeutic target in IRI. However, it remains largely unclear how and when this iron-dependent regulated cell death manifests during IRI. Therefore, we explored malondialdehyde (MDA), a byproduct of lipid peroxidation, and glutathione peroxidase 4 (GPX4), as a marker of redox capacity, in multiple IRI models. With this explorative study, we aimed to uncover MDA dynamics in renal and hepatic IRI, which could provide valuable insights for future internal studies. MethodsHistorical plasma and tissue samples from rat and porcine models of renal and hepatic IRI were selected based on varying conditions of ischemic injury, reperfusion and perfusion. MDA was measured using a colorimetric assay with N-methyl-2-phenylindole, methanol, acetonitrile and hydrochloric acid and quantified at 595 nm. GPX4 protein concentrations were investigated using standard western blotting. ResultsIn rat clamping models, plasma MDA concentrations revealed no difference between control and IRI settings. However, an increasing trend could be observed in tissue samples after IRI. Similarly, a decrease in tissue GPX4 concentrations was observed after IRI. In porcine studies, MDA concentrations were increased during reperfusion of kidneys exposed to prolonged warm ischemia and livers exposed to short periods of cold ischemia. Dynamic preservation could attenuate MDA concentrations. ConclusionWe found that MDA and GPX4 are affected within the first hours after reperfusion, stressing the need for early sampling in studies focusing on characterizing ferroptosis. Moreover, MDA dynamics during organ perfusion revealed an increased vulnerability of ischemic organs to lipid peroxidation and a potential protective effect of dynamic preservation. These preliminary results should be confirmed in studies focusing on ferroptosis characterization, as notable observations regarding sample age and storage conditions and experimental design limit the validity of this study.

Background: Spotted fever is caused by spotted fever group rickettsiae (SFGR) belonging to the genus Rickettsia. Transmission to humans is primarily via the bite of infected ticks. Being a vector-borne disease, the occurrence of spotted fever is related to factors that allow the vector to thrive. This spatio-temporal analysis gives an insight into the distribution of cases and correlation with seasonality. Methodology: A suspected AFI patient was considered spotted fever positive if either serology (ELISA/IFA) or molecular assay (Nested PCR/qPCR) was tested positive. Demographic data of confirmed cases were included for the analysis. Results: In the 18-year dataset, a total of 2153 suspected patients were tested for spotted fever, of which 516 (24%) were positive. On spatio-temporal analysis, Vellore district reported 39.9% of cases, Chittoor 38.8%, Tirupattur 12.5%, Ranipet 4.5%, and Tiruvannamalai 4.3%. Maximum spotted fever cases were reported between the months of September to March, with a peak in January. Children below 10 years and housewives were at risk of spotted fever. Conclusion: The findings of this retrospective analysis highlight the importance of considering spotted fever group rickettsioses in patients presenting with acute undifferentiated febrile illness, particularly children aged <10 years, from areas with higher spatial clustering, during or following the monsoon season.

Schizophrenia (SCZ) and type 2 diabetes mellitus (T2DM) are common comorbid disorders that severely impair patient prognosis and quality of life. This study aimed to explore the association between the methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism and MTHFR promoter methylation in patients with comorbid SCZ and T2DM. A total of 120 participants were enrolled from Liaocheng Fourth Peoples Hospital between January 2025 and June 2025, comprising 30 subjects in each of the four groups: SCZ group, T2DM group, SCZ-T2DM comorbid (SCZ+T2DM) group, and healthy control (CTL) group. Corresponding primers were designed for genetic analysis, and methylation-specific PCR (MSP) was performed to detect the methylation level of the MTHFR promoter. Genotype distribution of the MTHFR C677T polymorphism was consistent with Hardy-Weinberg equilibrium (HWE) (p>0.05). The C677T polymorphism was significantly associated with an elevated risk of SCZ and T2DM comorbidity (p<0.05). Notably, the methylation rate of the MTHFR promoter in the SCZ+T2DM group (95.00%) was not significantly higher than that in the CTL group (90.00%) (p>0.05). In conclusion, the MTHFR gene may serve as a susceptibility gene for SCZ-T2DM comorbidity, whereas MTHFR promoter methylation is not associated with the pathogenesis of this comorbid condition. These results indicate that genetic variation in MTHFR, rather than promoter methylation, contributes critically to the comorbidity of SCZ and T2DM in the Han Chinese population. Our findings may provide novel molecular insights into their shared pathophysiology and inform future clinical strategies for patients with this complex phenotype.

Introduction: Rickettsial infections are vector borne diseases and seroprevalence shows regional and population based variation. This prospective study assesses the seroprevalence and factors associated with rickettsial infections in different geographical regions of Northern Tamil Nadu, India. Methods: A community based cross sectional study was performed among 2565 individuals in five districts in Tamil Nadu who consented and provided 4 ml blood samples. A semistructured questionnaire was administered to gather information on sociodemographic and environmental parameters. The serum IgG antibodies to scrub typhus (ST), spotted fever (SF), murine typhus (MT) and Q fever (QF) were detected by ELISA and the optical density (OD) recorded. EpiData was used for data entry and SPSS for analysis. Results: The seroprevalence of ST, SF, MT and QF was 14%, 9.1%, 3.7%, and 5.7%, among the study population. For ST, age >35, people living in rural and <1000 MSL, farmers, sleeping on the floor, lack of toilet at home, and grass near the home were associated with higher risk. For SF, people living at 501 to 1000 MSL elevation, no toilet at home and having pet animal were associated with higher odds. Females, 46 to 55 and >65 years, people residing in urban areas and elevation upto 500 MSL, those who sleep on the floor, not changing clothes daily and with pet at home were associated with higher odds of MT. Whereas Q fever was more likely to affect who sleep directly on the floor, residing in urban and do not have pets. Conclusion: Scrub typhus is the most common rickettsial infection followed by spotted fever in Northern Tamil Nadu. Factors associated with prevalence vary for different rickettsial diseases and include personal and lifestyle behaviors. The findings of this study need to be verified by multicentre cohort studies.

Emerging drug resistance against the malaria parasite is worrisome and necessitates the development of novel antimalarials. Himalayan Buransh (Rhododendron arboreum) is a well-known medicinal plant found in the northern states of India. In this study, we observed the pleiotropic antimalarial activities and immunomodulation exhibited by the aqueous extract of Buransh flower (AEBF). AEBF demonstrated significant IC50 values (16-29 {micro}g/ml) against the asexual stages of various P. falciparum strains (3D7, Dd2-chloroquine-resistant and C580Y-artemisinin resistant). The oral administration of AEBF (200 mg/kg) in mice, suppressed [~]80% P. berghei parasitemia, improved mean survival time (MST-23.5 days) and prevented splenomegaly. Notably, the combination of AEBF and artesunate not only cleared primary infection, but also conferred sustained immunity. This immunomodulatory effect, driven by protective IFN-{gamma} resulted in reduced parasitemia during a homologous challenge without the need for further treatment. It is important to highlight the malaria transmission blocking activity of AEBF, resulting in reduced sexual stage male gametocyte exflagellation. Furthermore, the virtual drug screening of selected bioactive constituents from Buransh flower demonstrated potent binding against multiple P. falciparum proteins, suggested a pleiotropic mode of action. Altogether, our results corroborated the first ever evidence of the multistage antimalarial potential of Buransh flower, supported by in vitro cell studies, in vivo rodent malaria model and in silico docking analyses. Based on our studys findings and the traditional use of Buransh juice as a medicinal beverage in Uttarakhand, India, we propose exploring it as an adjunct therapy for drug-resistant malaria, subject to further clinical validation.

Hemoglobinopathies are inherited disorders of hemoglobin, most notably sickle cell anemia and thalassemia. These conditions result from mutations in the globin genes, leading either to structural abnormalities in the globin chains or to reduced synthesis of normal globin chains. Hemoglobinopathies is a worldwide health problem according to the World Health Organization; it affects mostly the indigenous Tharu groups in Nepal. Both the global and local rates of illness and death associated with these diseases are on the rise. The objective of this study was to assess the presence of hemoglobinopathies and common mutations of the beta-globin gene within the Tharu population in western Nepal. A cross-sectional study of 1,400 Tharu individuals was conducted among individuals obtained through hospitals within the Banke district, Bardiya district, and Kailali district in western Nepal. A thorough hematological analysis was done with the use of a Sysmex XN-350 analyzer. Hemoglobin variants were detected via high-performance liquid chromatography (HPLC). The molecular characterization of the seven most common mutations of {beta}-thalassemia was performed on a subset of 20 confirmed cases by using a real-time PCR kit.The total number of cases diagnosed with hemoglobinopathies was 14.43% (n=202 out of 1,400). Sickle cell trait (HbAS) was reported as the most prevalent type of Hemoglobinopathies (8.50% of population), followed by {beta}-thalassemia trait (4.00%). In addition to these disorders were sickle cell disease (HbSS), HbE trait, and compound heterozygous states. Hematological parameters differed significantly across types of hemoglobinopathies, and the patterns of microcytic, hypochromic, and hemolytic anemia were also distinct. Commonly documented symptoms included fatigue and joint pain (42.5% and 23.1%, respectively). Molecular characterization of {beta}-thalassemia cases demonstrated that most individuals were compound heterozygotes with IVS1-6 (T>C) as the most prevalent variant. The research identified that the Tharu population in western Nepal has a significant burden of hemoglobinopathies (especially sickle cell trait and {beta}-thalassemia), highlighting the requirement for appropriate screening programs, genetic counseling and public health strategies to help manage and prevent these conditions within this particular region.

BackgroundDengue virus infection remains a significant public health concern in India, with changing serotype dynamics influencing disease epidemiology. Understanding local serotype distribution and clinical characteristics is crucial for effective disease management and surveillance. ObjectivesTo determine the prevalence of dengue virus serotypes and analyze their clinical characteristics among NS1-positive patients at a tertiary-care hospital in Gujarat, India. MethodsA cross-sectional study was conducted on NS1-positive dengue patients admitted to AIIMS Rajkot from September 2023 to November 2024. Real-time reverse transcription polymerase chain reaction (RT-PCR) was performed for serotype identification. Clinical and demographic data were collected and analyzed. ResultsNS1-positive patients (70) were confirmed by RT-PCR. DENV-2 was the predominant serotype (53 cases, 75.7%), followed by DENV-1 and DENV-3 (7 cases each, 10.0%), and DENV-4 (2 cases, 2.9%). One co-infection case (DENV-2 + DENV-3) (1.4%) was identified. The mean age was 27.7 {+/-} 14.4 years, with male predominance (58.6%). Young adults (19-35 years) were most affected (45.7%), followed by pediatric patients [&le;]18 years (32.9%). Severe dengue occurred in only one case (1.4%), while hospitalization was required in 25 cases (35.7%). All patients presented with fever, chills, headache (50%), rashes (56%), and malaise (56%), being the most common associated symptoms. ConclusionsDENV-2 showed clear predominance in the Rajkot region during the study period, with low rates of severe disease. The significant pediatric and young adult involvement highlights the need for targeted prevention strategies. These findings contribute to the understanding of regional dengue epidemiology and support evidence-based surveillance and control measures.

Abstract Background Peripheral artery disease (PAD) is a major contributor to morbidity and mortality, particularly among individuals with diabetes mellitus (DM), in whom its prevalence is markedly increased. PAD is often asymptomatic and under-diagnosed, especially in low-resource settings. This study aimed to determine the prevalence of PAD and associated factors among adults with DM in Eastern Uganda. Methods We conducted a hospital-based cross-sectional study at Mbale Regional Referral Hospital from 10th/12/ 2024 to 30th/4/2025. A total of 300 adult patients with DM were consecutively enrolled. Data on sociodemographic characteristics, clinical characteristics, comorbidities, and behavioural risk factors were collected using an interviewer-administered data tool. PAD was assessed using the ankle-brachial index (ABI), defined as [&le;] 0.90. Modified Poisson regression was used to identify factors associated with PAD. As a secondary measure for PAD, we administered the Edinburgh Claudication Questionnaire (ECQ) to capture symptomatic PAD. Results The majority of the participants had a low fruit intake (68%), physical inactivity (54%), and elevated low-density lipoprotein (60%). The prevalence of PAD as measured by ABI was 42.3% (127/300; 95% CI 0.38-0.48), while the magnitude of PAD as measured by ECQ, combining participants with possible claudication and definite claudication was 37.3% 95% CI 31.9 - 42.8). Out of participants with PAD, 15.8% (20/127) were classified as having severe PAD (ABI <0.4). Socio-demographic and clinical factors were assessed for association with PAD. We found no evidence of association between the examined factors such as age (aPR 1.24 95% CI 0.73 - 2.09), sex (aPR 1.46 95% CI 0.84 - 2.55), cholesterol level (aPR 1.39 95% CI 0.86 - 2.25), glycemic control (aPR 1.35 95% CI 0.72 - 2.53), and sedentary behaviour (aPR 1.28 95% CI 0.79-2.08) and PAD. Conclusion The prevalence of PAD was high among adults with DM in Eastern Uganda. Routine health education, and ABI screening of PAD should be done for patients living with DM. The absence of significant associations despite high prevalence of PAD may reflect unmeasured factors e.g. chronic inflammation that may be unique to this population, future prospective studies with larger sample size and more detailed objective measures e.g. inflammatory markers are needed to determine locally relevant modifiable risk factors.

Abstract Background: Heart Failure is a complex clinical syndrome of growing public health concern in sub-Saharan Africa, yet the data from Sierra Leone are absent. The aim of the study is to characterise the clinical profile, etiological and temporal trends of hospitalised HF patients at Choithrams Memorial Hospital (CMH), Freetown, Sierra Leone, to confirm specific management strategies. Methods: This single-center, retrospective observational cohort study analysed data on HF patients (>18years) admitted at the CMH between January 2021 to 31 December 2025. The clinical definition of HF was based on the Framingham criteria and the European Society of Cardiology (ESC) guidelines , including standard echocardiographic parameters. All variables, including patients demographics, HF. phenotype, aetiology, medical history and hospital outcomes were extracted from the digital record. Non-parameteric tests, multivariable logistic regression to identify variables associated with etiology, Wilcoxon rank-sum test to compare groups and Kruskal-Wallis test to analyse trends over time were utilised. Result: A total of 765 patients were included in the study, with a median age of 53 years (IQR 42-61) and male predominance of 55.3%. Patients with recurrent HF (60.9%) were more common than those with de novo HF (39.1%), were older (54 years vs 53 years), had a higher comorbidity burden (34% vs 4%, p < 0.001), and presented with a cold-wet hemodynamic profile (18.4% vs 8.4%, p < 0.001). HFrEF (61.3%) was the most predominant phenotype, though HFpEF increased with age. Dilated Cardiomyopathy (37.0%), Hypertensive Heart Disease (31.2%) and Valvular Heart Failure (17.1%) were the leading etiologies, while ischemic heart disease (6.3%) was relatively uncommon. A majority of the patients were referred (77.9%), and 50.8% presented with NYHA IV. The strongest independent predictor for HF was hypertensive heart disease [AOR = 17.81; C.I 95%: (3.13-48.76), p <0.001]. An analysis of the trends in etiologies and demographics over the five-year period demonstrated no significant changes (all p-values > 0.05 for age, sex, aetiology, and most comorbidities). Conclusion: HF affects the younger adult population in Sierra Leone and is mainly caused by DCM and HHD. The late case presentations, the high prevalence of recurrent HF, and the associated high burden of comorbidities emphasize an urgent need to develop and implement improved strategies for the prevention, early detection, and long-term management of HF within Sierra Leone's healthcare system.

BackgroundPerinatal mortality remains a major public health concern in Nigeria despite global progress in maternal and child health. Maternal education has been identified as a key determinant influencing perinatal outcomes through its effects on health literacy, service utilization, and decision-making. However, limited evidence exists on how maternal education directly impacts perinatal outcomes within the context of Delta State, Nigeria. This study therefore investigated the relationship between maternal education and perinatal outcomes, focusing on perinatal mortality, access to healthcare, and educational interventions that enhance maternal health. MethodsA quantitative cross-sectional study design was employed. Data were collected from 400 mothers who delivered in selected public and private health facilities across six Local Government Areas in Delta State, alongside secondary data on perinatal outcomes obtained from hospital records. A structured questionnaire and record extraction form were used to gather information on maternal education, healthcare access, and perinatal indicators. Data were analyzed using SPSS Version 26, applying descriptive statistics, Pearsons correlation, and regression analysis to determine associations between maternal education and perinatal outcomes. ResultsFindings revealed a strong inverse relationship between maternal education and perinatal mortality (r = -0.431, p < 0.01), indicating that mothers with higher education levels experienced fewer stillbirths and neonatal deaths. Similarly, maternal education was significantly associated with reduced low birth weight incidence (r = -0.362, p < 0.01) and improved neonatal survival (r = 0.415, p < 0.01). Regression results showed that maternal education accounted for 23.9% of the variance in perinatal outcomes (R2 = 0.239, p < 0.001). Women with tertiary education were more likely to attend antenatal care (94%), deliver in health facilities (91%), and receive postnatal care (89%) compared to those without formal education. ConclusionThe study concludes that maternal education plays a decisive role in improving perinatal outcomes in Delta State by promoting healthcare utilization, enhancing health literacy, and reducing preventable perinatal deaths. Strengthening womens education through formal schooling and community-based literacy programs is vital for achieving equitable maternal and neonatal health outcomes. The study recommends multisectorial collaboration between education and health authorities to integrate maternal health education into national curricula and community outreach initiatives as part of efforts to attain Sustainable Development Goals 3 and 4.