Conectar
To explore nurses' experiences of the adoption, implementation, and use of digital technologies during the Covid-19 pandemic in the UK.
A qualitative descriptive study.
A qualitative study using two data sources: qualitative responses from 55 respondents to an online survey, and data from in-depth interviews with 21 individuals. The NASSS framework was used to guide data collection and analysis. Data were analysed using framework analysis.
Respondents reported using a variety of technologies including video conferencing applications, telemonitoring, systems to support care management and telecommunication systems. The analysis identified a range of reasons why technology had been introduced into services, and a recognition of its value in a situation where otherwise care may not have been able to continue. During the pandemic nurses were expected to change their work practices very rapidly, and we identified situations where organisational infrastructure either supported this effectively or created additional burdens for the nurses' work.
Nurses had to adapt to new ways of working rapidly, with digital technology being one of the primary means through which communication and care were delivered. The Covid-19 pandemic provided a unique set of circumstances where layers of governance and many of the existing barriers to technology introduction were reduced.
It is important to learn from these experiences, to understand how to sustain innovations that have proved to be successful, as well as the factors that enable nurses to work effectively in this new environment.
This study adheres to the guidance for publishing qualitative research in informatics.
A public contributor was involved from the beginning of the study conceptualization. They had input into the study approach, were part of the team that acquired the funding for the study and gave input at various stages into the processes for data collection, analysis and writing up the findings. The public contributor is a co-author on this paper and has been involved in the writing and editing of this report.
This study aimed to explore and describe the experiences and perceptions of mothers of children with leukaemia regarding the transition of care from hospital to home.
A qualitative content analysis with a conventional approach was employed, and this report follows the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
Thirteen mothers of children with leukaemia were recruited using purposive sampling from two Iranian paediatric hospitals. Data were collected through in-depth, semi-structured interviews conducted between 2023 and 2024 and analysed using conventional qualitative content analysis.
Drowning in the Vortex of Fear and Doubt emerged as the central theme, encapsulating the shared experiences of mothers of children with leukaemia. This overarching theme comprised five categories: (1) Fear of Unpredictable and Life-Threatening Complications, (2) Paradoxical Concerns About Discharge, (3) Doubts and Hopelessness About Treatment Effectiveness, (4) Stress Regarding the Child's Future Life Trajectory and (5) Sense of Helplessness in Alleviating the Child's Suffering.
The findings underscore the need to provide comprehensive supportive services for parents of children with leukaemia. Policymakers and healthcare teams should prioritise initiatives that enhance parental awareness, deliver psychosocial support and empower families to navigate the arduous path of care and treatment with greater trust and confidence.
Ensuring the well-being and comfort of both the child with cancer and the parents throughout the treatment process is essential for improving care outcomes.
The study is reported according to the COREQ.
Mothers of children with leukaemia participated as interviewees and contributed to ensuring the rigour of the study through data validation.
This study aims to review case reports/series on West Nile virus (WNV) infection-associated cranial nerve (CN) neuropathy to explore the associated patterns and characteristics.
A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.
We reviewed the literature in PubMed/Medline, Google Scholar and ScienceDirect databases to retrieve relevant case reports.
Case reports published in the past 25 years on CN neuropathy in WNV-infected patients, with no language or geographic restrictions.
Retrieved data included patient demographics, disease presentation and treatment outcomes. Descriptive statistical analyses were performed to describe frequency and characteristics of CN neuropathies. Cross tabulation was performed to calculate statistical significance of association between patient characteristics, disease factors and treatment outcomes. Risk of bias was assessed using the JBI Critical Appraisal Tool for case reports.
A total of 30 case reports satisfied inclusion criteria. These studies described 42 cases that developed CN neuropathies as an outcome of WNV infection. Patients were in the main males (54.8%) and had a mean age of 52.5±15.5 years. The most frequently affected CNs were, in descending order, optic (n=21, 50.0%), facial (n=14, 33.3%) and abducent nerves (n=8, 19.0%). Age was significantly associated with optic nerve neuropathy (≥51 years) and facial palsy (
CN neuropathy represents an important subset of neuroinvasive disease caused by WNV. There is a slight male preponderance among the patient population who are mostly middle aged. Optic and facial nerves are mostly affected. Most patients show complete recovery, particularly in the absence of chronic diseases. The role of systemic antivirals in improving disease outcomes should be further investigated. Early detection of CN neuropathies is recommended by routine CN screening and use of specific tools such as MRI and neurophysiological tests.
by Cindy Xinyu Ji, Majid Sorouri, Mohammad Abdollahi, Omalbanin Paknejad, Ali R. Mani
Network physiology is a multidisciplinary field that offers a comprehensive view of the complex interactions within the human body, emphasising the critical role of organ system connectivity in health and disease. This approach has the potential to provide pathophysiological insights into complex and emerging diseases. This study aims to evaluate the effectiveness of physiological network mapping in predicting outcomes for COVID-19 patients, using data from the first wave of the pandemic. Routine clinical and laboratory data from 202 patients with COVID-19 were retrospectively analysed. Twenty-one physiological variables representing various organ systems were used to construct organ network connectivity through correlation analysis. Parenclitic network analysis was also employed to measure deviations in individual patients’ organ system correlations from the reference physiological interactions observed in survivors. We observed distinct features in the correlation network maps of non-survivors compared to survivors. In non-survivors, there was a significant correlation between the level of consciousness and the liver enzyme cluster, a relationship not present in the survivor group. This relationship remained significant even after adjusting for age and degree of hypoxia. Additionally, a strong correlation along the BUN–potassium axis was identified in non-survivors, suggesting varying degrees of kidney damage and impaired potassium homeostasis in non-survivors. These findings highlight the potential of network physiology as a valuable tool for uncovering complex inter-organ interactions in emerging diseases, with applications that could support clinicians, researchers, and policymakers in future epidemics.The expenses associated with cancer treatment are increasing at a rapid pace. The financial strain of providing care is experienced worldwide, but is particularly pronounced in low and middle-income countries (LMICs). This has resulted in a growing acknowledgement of the importance of value-based cancer care. Choosing Wisely Africa (CWA) is an initiative aimed at reducing the excessive use and expenses associated with cancer treatment. In this study, we assessed adherence to CWA recommendations for the treatment of breast cancer in three high-volume cancer centres in Sub-Saharan Africa (SSA).
A cross-sectional study across Rwanda, Ghana and Tanzania was conducted, involving a review of medical records to assess adherence to five measurable CWA practices in breast cancer care. The study used inferential statistics, such as 2 tests, to compare adherence among these countries.
This study was conducted in three cancer centres (Ocean Road Cancer Institute, Rwanda Military Hospital and Korle Bu Teaching Hospital) in three countries (Tanzania, Rwanda and Ghana, respectively).
A total of 542 patients were recruited. Eligible patients were those with a breast cancer diagnosis and complete data as pertaining to five CWA recommendations.
A total of 542 participants with a mean age of 51 years were included. Participants were well distributed across Ghana (37%), Rwanda (34%) and Tanzania (29%). Female patients represented 97% of the study cohort. Half (51%) of the participants had some form of insurance. The study observed high adherence to cancer staging (94%) before treatment and histological confirmation (91%) before breast lump removal across all sites. Hypofractionation was used in 0% of cases in Rwanda, 42% in Ghana and 70% in Tanzania.
This study provides critical insights into the implementation of CWA recommendations in breast cancer care in SSA. It highlights the disparities in adherence to CWA recommendations across different centres, showing the need for policy-driven changes and healthcare infrastructure improvement to standardise cancer care practices in LMICs.
by Soha Albeitawi, Mohammad Talal Al-zubi, Anas Aljaiuossi, Murad Shatnawi, Ahlam Al-Kharabsheh, Fadi Sawaqed, Emad Aborajooh, Walid I. Wadi, Randa Mahasneh, Benjamin Rowland Colton, Mohammad AlQudah, Tamara Kufoof, Fida Asali, Ahmed Sheyyab, Monther A. Gharaibeh, Motasem Al-latayfeh, Enas Al-Zayadneh, Eman Badran, Yaser M. Rayyan, Kais Al Balbissi, Raed Al-Taher, Asma Basha, Rola Saqan, Ashraf Omar Oweis, Wafa Taher, Shadi Hamouri
BackgroundClinical preceptors serve as vital educators, so it is essential to enhance their effectiveness by developing a competency-based development program. In this study, we explored the challenges faced by preceptors and students, and measured the educational needs of preceptors, to inform the design of a syllabus for a preceptor development program.
MethodsThis was a sequential multi method study utilizing a structured questionnaire survey and focus group discussions among a representative sample of medical students in their fourth, fifth, and sixth years in addition to preceptors from the six public medical schools in Jordan.
ResultsThematic analysis of focus group discussions revealed six themes: admission policy, training environment, curriculum gaps, trainers and mentorship, learners, and dissemination. The most important training needs documented by preceptors were teaching in the clinical setting, mentoring skills, simulation, assessment in the clinical setting, and providing feedback. Accordingly, a competency-based preliminary syllabus was developed.
ConclusionIt is essential to enrich the skills of preceptors regularly based on a needs assessment. Further long term studies are required to investigate the effectiveness of the proposed syllabus after implementation.
by Dwi Sisca Kumala Putri, Kencana Sari, Nur Handayani Utami, Nazarina Nazarina, Tiara Amelia, Nadira Yuthie Salwa, Ning Sulistiyowati, Adindra Vickar Ega, Muhammad Azzumar, Rika Rachmawati, Salimar, Mieska Despitasari, Donny Kristanto Mulyantoro
BackgroundMobile Health (mHealth) Applications offer a promising approach to promote the adoption of healthy nutrition and behavior among adolescent girls. A tailored mobile app, Teen ‘n Fit, was developed to support adolescent girls in Indonesia to assess their nutritional status, physical activity, and eating behavior; as a nutrition education media; and as a reminder of iron folic acid consumption. However, it is essential to measure the app’s usability prior to the release.
ObjectiveThis study aimed to measure the usability of a mobile application designed to promote nutrition and healthy behavior of adolescent girls by modifying the mHealth App Usability Questionnaire (MAUQ).
MethodsA cross-sectional usability study was conducted on 64 adolescent girls aged 15–18 from a public high school in Depok, Indonesia. Participants completed app-based tasks and filled out a post-task usability questionnaire. The usability questionnaire was adapted from a validated MAUQ for a standalone mHealth app. The exploratory factor analysis was conducted to determine the items constituting each component in the modified MAUQ. Mann-Whitney analysis was employed to analyze the difference in usability score means based on participants’ characteristics.
ResultsThe modified MAUQ demonstrated strong reliability (Cronbach’s alpha = 0.945). The app achieves a strong usability score, 6.0 ± 0.8 out of 7, with 79.7 percent of participants reporting no prior mHealth experience. The score among participants who occasionally used mHealth applications was higher (p = 0.046) than those who had never made prior use.
ConclusionThe findings indicate strong usability potential of Teen ‘n Fit as a digital health promotion tool for adolescent girls; however, future efforts in conducting effectiveness tests and maintaining user engagement are needed.
by Koorosh Nikaein, Zahra Kanannejad, Mohammad Amin Ghatee
The COVID-19 pandemic has had a devastating impact worldwide, with Iran being one of the hardest-hit countries in the Middle East. Understanding the factors that influence the spread of the virus is crucial for developing effective mitigation strategies. This study aims to investigate the geographical and climatic risk factors associated with COVID-19 incidence in the Kohgiluyeh and Boyer-Ahmad Province of southwest Iran during the 2020−2021 epidemic period. The study involved mapping the residential addresses of 15,585 patients with COVID-19 during 2020–2021. Geographical Information System (GIS) evaluated the effects of geographical and climatic determinants, including temperature, rainfall, humidity, evaporation, elevation, slope, and land cover, on COVID-19 occurrence. The data were analyzed using univariate and multivariate binary logistic regression. In the univariate model, significant climatic factors affecting COVID-19 susceptibility included elevation (pby Rana Muhammad Amir Latif, Tahir Iqbal, Ismaeel Abdel Qader, Atif Ikram, Hadeel Alsolai, Bayan Alabdullah, Fatimah Alhayan, Taher M. Ghazal
Urban air pollution remains a critical challenge for public health and environmental sustainability. This study investigates the predictive capabilities of five machine learning (ML) models: Linear Regression (LR), Decision Tree (DT), Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Support Vector Regression (SVR) for forecasting the Air Quality Index (AQI) using the widely adopted Air Quality dataset from the UCI ML Repository. Although collected in 2004–2005, the dataset continues to serve as a benchmark in recent literature and provides a reproducible testbed for methodological evaluation. After structured pre-processing, feature engineering, and chronological train–validation–test splitting, models were rigorously tuned and assessed using Root Mean Squared Error (RMSE), Mean Absolute Error (MAE), and coefficient of determination (R2), with 95% bootstrap confidence intervals and corrected resampled t-tests confirming statistical significance. Ensemble models achieved the best performance, with Random Forest obtaining the lowest RMSE (12.48) and MAE (9.35), and XGBoost achieving the highest R2 (0.89). Feature importance analysis identified NOx, PM2.5, and CO as the most influential predictors. We incorporated Shapley Additive exPlanations (SHAP) analyses and case-level visualizations to support interpretability, providing transparent insights for practical decision-making. While the study is limited by the absence of external validation and genetic variables (e.g., APOE), it establishes a reproducible, interpretable, and computationally efficient ML framework for AQI forecasting. The findings highlight the continuing relevance of benchmark datasets for reproducible evaluation and demonstrate the potential of interpretable ML-based approaches for smart city air quality management and public health policy.Use of synthetic drugs for the treatment of burn wounds has decreased due to adverse effects, and they are gradually being replaced by compounds obtained from natural products, especially medicinal plants. This review focused on pre-clinical and clinical studies examining the efficacy of medicinal plants in promoting burn wound healing. This systematic review was performed congruent with the guidance delineated in the PRISMA statement. Databases such as PubMed, Scopus, Embase and Web of Science, along with the search engines Google Scholar and Google, were utilised to retrieve published literatures from 2000 to 2023. Articles were screened according to the determined criteria and appraised using primary evaluation checklists. A total of 108 published articles met the eligibility criteria and were selected for discussion. Of these, 72 were in vivo studies, 28 were in vitro studies and 8 were clinical trials. Various medicinal plants discussed in this review improve the burn wound healing process due to the presence of diverse biological compounds with antioxidant, anti-inflammatory and antibacterial properties. These plants affect the four phases of wound healing. These plant species and their compounds could be potentially used for the development of effective natural remedies against burn wounds.
by Fiza Noor, Humera Nawaz, Ameer Khan, Muhammad Yousaf Shani, Muhammad Azmat, Syed Mohsin Abbas, Iqra Arshad, Robina Aziz, Muhammad Saleem, Francesco De Mastro, Muhammad Yasin Ashraf, Gennaro Brunetti, Claudio Cocozza
Salinity stress severely hampers wheat productivity by impairing growth, photosynthesis, and metabolic balance. Potassium nutrition, however, can mitigate these effects by supporting physiological and biochemical stability. This study assessed the impact of foliar potassium application (0, 200 and 400 ppm) on two wheat cultivars, Galaxy-13 and Uqab-2000, exposed to normal (0 mM NaCl) and saline conditions (100 and 150 mM NaCl, respectively). Salinity significantly reduced root and shoot growth, biomass, chlorophyll content, photosynthetic rate, and stomatal conductance. Potassium supplementation, particularly at 400 ppm, alleviated these reductions, with Galaxy-13 showing a 32.01% increase in shoot length and a 45.11% increase in shoot dry weight compared to Uqab-2000. Biochemical analyses revealed that Galaxy-13 sustained higher nitrate and nitrite reductase activities (6.23 and 3.63 μmol NO2 g-1 FW h-1, respectively) and total soluble proteins (10.1 mg g-1 FW), whereas Uqab-2000 accumulated more soluble sugars and free amino acids under stress (9.8 and 19.8 mg g-1 FW, respectively). Oxidative stress indicators (malondialdehyde and hydrogen peroxide) rose under salinity, but potassium reduced their levels, with Galaxy-13 exhibiting stronger antioxidant regulation. Nutrient profiling further demonstrated that Galaxy-13 maintained higher N, P, and K contents and minimized Na uptake, unlike Uqab-2000, which showed severe ionic imbalance. Multivariate analyses (PCA, heatmap, and correlation) highlighted strong positive associations of potassium, especially K400, with biomass accumulation, photosynthetic efficiency, and nutrient homeostasis. The findings establish that Galaxy-13 possesses superior salinity tolerance and responds more favorably to potassium nutrition. This study provides novel evidence that cultivar-specific potassium management can enhance wheat resilience in saline environments, offering a practical strategy for sustaining yield under stress.This prospective, double-blind controlled trial was conducted to determine the effect of silicone gel in the reduction of postoperative scar after bilateral inguinal varicocelectomy. Thirty-four patients were enrolled in this study; the right-side inguinal scar was treated with silicone gel and petroleum jelly (Vaseline) applied on the left side as a placebo for 60 consecutive days. Scars were evaluated using the Vancouver Scar Scale, pruritus and pain. The result of this study showed that silicone gel was effective in the regression of postoperative scar after microscopic inguinal varicocelectomy in five key parameters, including vascularity, pigmentation, pliability, height and pruritus in comparison to placebo application (p < 0.05), while its effect on pain was insignificant (p > 0.05). The study showed that silicone gel had a considerable effect in the treatment and management of postoperative scar management. Varicocele is a condition that is considered the most common cause of male infertility. While microscopic inguinal varicocelectomy is considered a gold standard in the management of varicocele, its postoperative complications, such as scar formation remain a concern. Recent studies show that silicone gel can be an effective non-invasive treatment for scar regression. Accordingly, we designed this trial to evaluate the effect of silicone gel after microscopic inguinal surgery. A prospective double-blind controlled trial was conducted on 34 patients who had microscopic bilateral inguinal varicocelectomy (their age ranged from 19 to 41) at Namazi hospital. Two weeks after surgery, each patient received two identical tubes for application on the scars, the first tube containing silicone gel and the second one dispensed with petroleum jelly (Vaseline). The right side was treated with silicone gel, and the left side with Vaseline twice daily for 60 days. Then, patients were evaluated three times: firstly 2 weeks after surgical repair; second appointment after 2 months and third one after 6 months after surgery, using the Vancouver Scar Scale, pruritus and pain score. The collected data were analysed in SPSS 26, using the chi-square and Mann–Whitney U tests. The significance level was defined at p < 0.05. This study showed that silicone gel was highly effective in scar parameters, including pliability, height, vascularity pruritic and pigmentation. However, its effect on pain reduction was not significant (p > 0.05). The results of the study indicated that silicone gel effectively improved scar characteristics following microscopic inguinal varicocelectomy, while its efficacy against pain was not significant.
To enhance the quality of surgical care, complications need to be minimised. Consequently, comprehending the occurrence and risk elements for postoperative complications is essential. Subsequently, we will apply machine learning (ML) algorithms to build risk factor prediction models that will assist surgeons in identifying the risk factors associated with the development of postoperative complications after general surgery.
This research will take place at a tertiary referral medical centre located in Bandar Abbas, Hormozgan, Iran. The inclusion criteria are (1) individuals aged 18 years or older who have any type of general surgery and (2) hospitalised from September 2025 to September 2026. Individuals with insufficient data will be excluded. The main outcomes of the study are complications within 30 days of surgery. Patients will be divided into two groups based on whether they develop complications or not. The predictors are classified as (1) patient-related factors, (2) surgery-related factors and (3) postoperative factors. We intend to detect postoperative complications following general surgery using four distinct supervised ML techniques: (1) logistic regression, (2) decision trees, (3) random forests and (4) extreme gradient boosting. Accuracy, precision, recall and F1 score will be used to evaluate the performance of ML models.
With approval from the Hormozgan University of Medical School Research Ethics Board (IR.HUMS.REC.1404.137), we will carry out a forward-looking analysis of the medical records of patients undergoing general surgery. We will obtain informed consent, and all information will be collected and examined anonymously. The findings of this research will be released in appropriate scientific publications.
This study aimed to determine the characteristics of acute poisoning patients.
This was a prospective cohort study.
The study was conducted for 1 year (1 July 2023 to 30 June 2024) at a tertiary care hospital in Sindh, Pakistan.
From the patients who arrived at the emergency department due to poisoning, 1404 were registered and included in the study.
The data were collected on demographics (gender, age, residential area, education, employment) and poisoning characteristics, prehospital care, treatment, and services at the hospital, and treatment outcomes (survived and died). A 2 test was used to find the association between independent variables and treatment outcomes. A multivariate logistic regression model was used to determine the predictors of death at a 95% CI.
The majority of patients were male (57.1%) and aged ≤30 years (77.6%). The poisoning was primarily intentional (67.5%), and pesticides (56.1%) were commonly involved in the poisoning. The patients were managed mainly by symptomatic treatment (98.1%) and gastric lavage (65.1%). Multivariate logistic regression indicated that delayed reporting (adjusted OR (AOR)=2.00; 95% CI 1.20 to 3.36; p=0.008) and non-existence of antidote (AOR=1.81; 95% CI 1.08 to 3.03; p=0.025) increased the odds of death while unintentional poisoning (AOR=0.27; 95% CI 0.14 to 0.51; p
The study found that the intentional pesticide poisoning within uneducated, young populations in rural areas was significantly prevalent, and early identification and management of severe cases and extended hospital stays influenced survival.
To explore the process of how nurses experience and deal with workplace violence based on nurses' perceptions and experiences in Iran.
An exploratory qualitative study was conducted using grounded theory approach. Participants included 17 nurses working in 4 hospitals in 2 urban areas in Iran with at least 1 year of clinical experience in emergency departments and intensive care units. Data were collected through in-depth, semi-structured individual interviews conducted between August 2024 and March 2025. The constant comparative analysis approach was used for data analysis. This research method was carried out in five stages: open coding to identify concepts; development of concepts in terms of their characteristics and dimensions; contextual analysis; integration of the process to data analysis; and final category integration.
The main concern of participants in dealing with workplace violence was a ‘multidimensional security threat’. ‘Perpetrator response to nursing care’ (at the individual level) and ‘organisational inefficiency’ (at the organisational level) provided the context for this threat. A general theme entitled ‘tensive adaptation’ was the core category in this research and included four main categories: ‘tolerant reactions’, ‘seeking help’, ‘passive reactions’ and ‘hostile reactions’. ‘Organisational damage’, ‘nurse damage’ and ‘patient damage’ were the outcomes.
The theoretical model of ‘tensive adaptation’ provides a new perspective on ‘what’ and ‘how’ nurses experience and manage workplace violence. Effective strategies for managing violence such as effective communication, empathy, providing appropriate care, anger management, self-care, effective teamwork and requesting support can be considered by nursing administrators and incorporated into training programmes for nurses and nursing students. The adverse consequences of nurses' exposure to workplace violence should receive greater attention, as the entire healthcare system is affected by this exposure.
Workplace violence leads to physical and psychological problems, reduced job satisfaction, diminished performance, negative effects on personal and family life and decreased quality of patient care. The main concern of participants in dealing with workplace violence was ‘multidimensional security threat’. This concept includes three characteristics: ‘psychological health threats’, ‘physical health threats’ and ‘professional position threat’. ‘Perpetrator response to nursing care’ (individual level) and ‘organisational inefficiency’ (organisational level) served as contextual conditions that expose nurses to workplace violence. In ‘tensive adaptation’, nurses attempt to respond to workplace violence through strategies such as ‘tolerant reactions’, ‘seeking help’, ‘passive reactions’ and ‘hostile reactions’. ‘Organisational damage’, ‘nurse damage’ and ‘patient damage’ are the consequences of nurses' exposure to workplace violence.
The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used to report this study.
This study did not include patient or public involvement in its design, conduct, or reporting.
by Mohammad K. Siddiqui, Shagufta Khan, Rinchenla Bhutia, Vivek Nair, Ashok Rai, Nirmal Gurung, Tseten Yamphel, Peggy K. Dadul, Debya S. Kerongi, Karma Doma Bhutia, Jagat Pradhan, Kabita Khati, Sreenivas A. Nair, Shamim Mannan, Kiran K. Rade, Dinesh Gupta, Pawan Malhotra, L. Masae Kawamura, Shikha Dhawan, Asif Mohmmed
BackgroundMonasteries in India house individuals from childhood to advanced age. These congregate settings amplify tuberculosis (TB) transmission and exposure when the disease is present, especially in the high burden areas like Sikkim, India. However, the prevalence of active-TB disease (ATB), tuberculosis infection (TBI), and their associated risk factors have not been studied. The diagnosis and treatment of TBI remain a major bottleneck in eradicating TB. ATB and TBI risk among residents living in the congregate setting of monasteries in Sikkim, India, a high-TB burden area, may be high due to high-density living quarters, public interaction and their frequent travel history but has never been illustrated.
MethodA cross-sectional screening of the monks and residents of Rumtek Monastery (Sikkim, India) was carried out to assess extent of ATB and TBI in a congregate setting. TrueNat MTB and GeneXpert MTB/Rif systems were utilized for ATB diagnosis, whereas QuantiFERON-TB Gold Plus (QFT-plus) Interferon-gamma release assay (IGRA) analysis was used for TBI detection. Follow-up sputum testing by TrueNat MTB was performed on IGRA-positive individuals to exclude ATB.
ResultsAmong the 350 inhabitants of the monastery, 7% (25/350) were found to be symptomatic for TB, whereas 93% (325/350) were asymptomatic. Out of them, 189 participants, including symptomatic cases, agreed to participate in the study and were screened for TBI; however, 15 participants were excluded from the study due to result discrepancies. None of the participant were diagnosed with active tuberculosis (ATB), although, 44.2% (77/174) were found to be positive for TBI; however, none of those with TBI progressed to ATB during one year follow-up. Risk factors for TBI included: advancing age, frequent travel history, family history of TB or having contacts with TB patients and abnormal Body Mass Index (BMI) ≤18.5- ≥ 25.
ConclusionThis study confirms the high prevalence of TBI among residents in the congregate setting of monasteries, and justify TB prevention strategies by targeted screening, TBI testing and preventive treatment in congregate settings of high TB burden areas.
by Nour Aboalhaija, Hala Abulawi, Rania Hamed, Mohammad Alwahsh, Fatma Afifi, Heba Syaj, Elham Abusharieh, Ismail Abaza
Chiliadenus montanus (Vahl) Boiss. (Asteraceae) is a pharmacologically significant plant with different potent pharmacological properties. This study aimed to evaluate the phytochemical and anticancer activity of C. montanus, and to develop nanoemulsions (NEs) to enhance pulmonary delivery for lung carcinoma treatment. For that ethanol and water extracts, along with petroleum ether, chloroform, ethyl acetate, and methanol fractions, were assessed for total phenol and flavonoid contents, antioxidant activity, and cytotoxicity against H1299 and A549 lung cancer cell lines. The results showed that ethyl acetate fraction exhibited the highest phenol (47.94 ± 0.32 mg GAE/g of DW) and flavonoid (20.34 ± 1.48 mg rutin/g of DW) contents, while the ethanol extract showed the most potent antioxidant activity (IC₅₀ = 322.1 µg/mL) and selective cytotoxicity (IC₅₀ = 641.2 µg/mL) against H1299 cells. Nevadensin, chlorogenic acid, and sorbifolin were identified as the major constituents of the ethanol extract using liquid chromatography-mass spectrometry (LC-MS) analysis. Gas chromatography-mass spectrometry (GC-MS) analysis revealed α-phellandrene, 1,8-cineole, and α-cadinol as the lead volatile constituents. The major volatile compound of the aroma profile of the aerial parts, determined by solid phase micro extraction (SPME) was 1,8-cineole. Spontaneous emulsification was used to formulate ethanolic NE (S1-S4 NEs) with varying concentrations of ethanol extract, surfactant, cosurfactant, and oil phase. The optimal S4 NE demonstrated thermodynamic stability, appropriate pulmonary pH, and droplet sizes below 100 nm. These findings highlight the promising potential of C. montanus NE as a stable pulmonary drug delivery system for lung carcinoma therapy.by Muluken Chanie Agimas, Mekuriaw Nibret Aweke, Berhanu Mengistu, Lemlem Daniel Baffa, Elsa Awoke Fentie, Ever Siyoum Shewarega, Aysheshim Kassahun Belew, Esmael Ali Muhammad
IntroductionMalaria is a global public health problem, particularly in sub-Saharan African countries. It is responsible for 90% of all deaths worldwide. To reduce the impact and complications associated with delayed treatment of malaria among children under five, comprehensive evidence about the magnitude and determinants of delayed treatment for malaria could be the solution. But there are no national-level studies in the Horn of Africa for decision-makers.
ObjectiveTo assess the prevalence and associated factors of delay in seeking malaria treatment among under-five children in the Horn of Africa.
MethodPublished and unpublished papers were searched on Google, Google Scholar, PubMed/Medline, EMBASE, SCOPUS, and the published articles’ reference list. The search mechanism was established using Medical Subject Heading (MeSH) terms by combining the key terms of the title. Joana Brigg’s Institute critical appraisal checklist was used to assess the quality of articles. A sensitivity test was conducted to evaluate the heterogeneity of the studies. The visual funnel plot test and Egger’s and Begg’s statistics in the random effect model were done to evaluate the publication bias and small study effect. The I2 statistics were also used to quantify the amount of heterogeneity between the included studies.
ResultsThe pooled prevalence of delayed treatment for malaria among under-five children in the Horn of Africa was 48% (95% CI: 34%–63%). History of child death (OR =2.5, 95% CI: 1.73–3.59), distance >3000 meters (OR = 2.59, 95% CI: 2.03–3.3), drug side effect (OR = 2.94, 95% CI: 1.86–4.67), formal education (OR = 0.69, 95% CI: 0.49–0.96), middle income (OR = 0.42, 95% CI: 0.28–0.63), expensiveness (OR = 4.39, 95% CI: 2.49–7.76), and affordable cost (OR = 2.13, 95% CI: 1.41–3.2) for transport were factors associated with malaria treatment delay among children.
Conclusion and recommendationsAbout one out of two parents in the Horn of Africa put off getting their kids treated for malaria. High transportation expenses, long travel times (greater than 3,000 meters) to medical facilities, and anxiety about drug side effects were major risk factors that contributed to this delay. On the other hand, a middle-class income was found to be protective of treatment delays. These results highlight how crucial it is to improve access to healthcare services, both financially and physically, to minimize delays in treating malaria in the area’s children.
Sepsis and antibiotic resistance constitute a deadly synergy, causing the loss of millions of lives across the world, with their economic and developmental consequences posing a threat to global prosperity. Their impact is disproportionately felt in resource-limited settings and among vulnerable populations, especially children. A key challenge is prompt diagnosis and timely commencement of appropriate antibiotic therapies. These challenges are compounded in low-income and middle-income countries by a lack of comprehensive epidemiological data, with Nigeria being one such country for which it is lacking. Kaduna is the third largest state in Nigeria, with over 10 million inhabitants, of whom more than half are children under 14 years old. While bacterial sepsis and antimicrobial resistance (AMR) are recognised as a growing problem in the state, there are huge gaps in the current understanding of their aetiology. This project employs a cross-sectional design to investigate the clinical and haematological markers of paediatric sepsis, alongside determining the bacterial cause and prevalence of AMR at four high-turnover hospitals in Kaduna State, Nigeria. Further, whole-genome sequencing of isolated bacterial pathogens will be performed to determine the genetic features of resistance. This project represents the largest surveillance study of paediatric sepsis in Kaduna to date. Additionally, we aim to use the clinical, haematological, microbiological and genomic data to derive predictive models for sepsis causes, treatment strategies and patient outcomes.
This is a hospital-based, cross-sectional study that will recruit up to 461 children with bacterial sepsis who were admitted at the two teaching and two general hospitals in Kaduna State, Nigeria. Children presenting with features of fever, subnormal temperature and body weakness would be recruited into the study and have their blood samples collected. The blood samples will be used for culture, complete blood count, HIV and malaria testing. Accordingly, we will capture clinical presentation, haematological characteristics, causative pathogen from blood culture and patient outcomes. Nutritional status, known congenital immunosuppressive diseases, HIV infection and malaria infection will also be determined and documented. The bacterial isolates will be phenotypically characterised for AMR and genotypically following whole genome sequencing. Known and potential confounders to the outcomes of bacterial sepsis would be assessed in all participants, and adjustment for confounding would be performed using logistic regression and/or stratification±Mantel-Haenszel estimator where applicable.
Ethical approvals were granted by the University of Birmingham (ERN_2115-Jun2024), the Ahmadu Bello University Teaching Hospital (ABUTHZ/HREC/H45/2023), Barau Dikko Teaching Hospital, Kaduna (NHREC/30/11/21A) and the Kaduna State Ministry of Health (MOH/AD M/744/VOL.1/1110018). The study will be conducted using the international guidelines for good clinical practice and based on the principles of the Declaration of Helsinki. The results will be disseminated via oral and poster presentations in scientific conferences and published in peer-reviewed journal articles.
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