Conectar
To explore the impact of simulation-based training on communication and empathy skills among nurses working with elderly patients in the Abha region of Saudi Arabia. The study also aimed to identify the barriers and facilitators to applying these skills in real-world clinical practice.
A qualitative study.
Semi-structured interviews were conducted between June and July 2024 with 17 nurses from urban and rural healthcare settings in the Abha region. Data were analysed using both deductive framework analysis, guided by social support theory, and inductive thematic analysis to identify key themes related to communication, empathy, and the application of simulation-based skills in practice. We adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
The study involved 17 participants aged 22–50 years, with diverse educational backgrounds and work experience. The findings indicated that simulation-based training significantly improved nurses' confidence in delivering difficult news and their ability to empathise with elderly patients. Nurses working in urban settings with regular access to simulation training reported better outcomes compared to those in rural settings with less frequent training opportunities.
Simulation-based training has a positive impact on enhancing communication and empathy skills among nurses, but challenges in real-world application remain. Efforts should be made to improve the accessibility of simulation training and address the barriers preventing its effective implementation in clinical practice.
Healthcare practitioners and policymakers should prioritise simulation-based training in nursing education and professional development to improve the quality of care for elderly patients.
The Consolidated Criteria for Reporting Qualitative Research (COREQ).
The engagement and interview data from nursing participants provided valuable insights into the impact of simulation-based training on communication and empathy in elderly care.
by Mohamed Ahmed El Maghawry, Reham Abd Elkhalek, Fatima Altaher Taha, Amira A. A. Othman, Aliaa Mohamed Abd El Khalik Ahmed, Dina A. Abdelhady, Fatma M. Attia Elsayed
BackgroundReal-world evidence on therapeutic plasma exchange (TPE) from low- and middle-income countries remains limited. Egyptian data across multiple organ systems are scarce. This study aimed to evaluate the indications, safety, efficacy, and predictors of outcomes in patients undergoing TPE at a tertiary center in Egypt over 7 years.
Methods and FindingsThis retrospective cohort study included 221 consecutive patients who underwent TPE (2016–2022) at Zagazig University Hospitals, Egypt. Patients were stratified into renal, neurologic, hematologic, and metabolic groups. Primary outcomes were clinical response and all-cause mortality. Multivariate logistic regression, Cox proportional hazards models, and Kaplan–Meier survival analysis were performed. Among 221 patients (57.9% male; mean age 36.0 years), the most frequent indications were Guillain–Barré syndrome, thrombotic thrombocytopenic purpura, and myasthenia gravis crisis. ASFA category I indications constituted 77.8% of procedures, with response rates decreasing significantly across categories (p = 0.03). Overall response rate was 77.9% (complete remission in 93.0% of responders), with mortality 14.5%. Response rates exceeded 85% in autoimmune hemolytic anemia, hyperviscosity syndrome, and TTP. Neurologic indications achieved 81.6% response; renal indications showed lower response (73.2%) and highest mortality (21.3%). Adverse events occurred in 37.2% of patients, all mild-to-moderate with no session terminations. Independent mortality predictors included mechanical ventilation, creatinine >2.5 mg/dL, renal indication, hemoglobin <8 g/dL, while ASFA category I was protective (all aORs 2.67–5.22). In exploratory analyses, PLASMIC score ≥6 and time to TPE ≤ 2 days were associated with complete remission in TTP, while Hughes score ≥4 and time to TPE > 7 days were associated with poor functional outcome in GBS. These findings require external validation before clinical application. Diffuse alveolar hemorrhage (n = 9) demonstrated 100% mortality despite intervention, whereas SLE patients (n = 23) had 52.2% mortality, with 47.8% achieving complete remission or clinical improvement. A three-tier risk model stratified patients into high, intermediate, and low mortality risk groups. Independent predictors of clinical response included neurologic, hematologic, and metabolic indications compared to renal, ASFA category I, and ≥5 TPE sessions, while hemoglobin <8 g/dL and creatinine >2.5 mg/dL predicted poorer response.
ConclusionsThis single-center Egyptian TPE cohort demonstrates high efficacy and safety when aligned with ASFA guidelines. Neurologic and hematologic indications achieve optimal outcomes; renal indications and critical illness markers predict poorer prognosis. The PLASMIC score, treatment urgency in TTP and GBS, and the proposed three-tier model represent exploratory findings that, if prospectively validated, could become actionable prognostic tools. These findings suggest that evidence-based TPE expansion in resource-limited settings may be feasible, though multicenter validation is required.
by Md. Naziur Rahman, Abu Yousuf Hossin, Shahriar Mannan Imon Talukder, Mt. Sumaiya Siddika, Md. Harun-Ur-Rashid, Shahanaz Parveen, Md. Ridwanul Islam, Md. Yeamin Hossain, Mahfuj Ahmed, Brototi Chakraborty Dyuti, Zarin Tabassum, Ajoy Kumer
Non-small-cell lung cancer (NSCLC) remains the leading cause of lung cancer–related mortality, largely driven by aberrant activation of the epidermal growth factor receptor (EGFR). Despite the clinical success of EGFR tyrosine kinase inhibitors (TKIs), intrinsic and acquired resistance, coupled with safety concerns, highlight the need for novel, safer inhibitors. Natural products represent an underexplored source of structurally diverse bioactive compounds with favorable biocompatibility. In this study, a comprehensive in silico approach is used to evaluate phytochemicals from Adenium obesum as potential candidate EGFR-targeting compound. Initially, sixteen phytochemicals were first assessed for predicted antineoplastic activity using PASS. High-scoring molecules were docked against the EGFR kinase domain (PDB ID: 1M17), besides performed detailed protein–ligand interaction analysis, drug-likeness and ADMET profiling, toxicity prediction and 100-ns molecular dynamics (MD) simulations. PASS-based bioactivity prediction revealed strong anticancer potential among the sixteen screened compounds, with consistently high antineoplastic and antiproliferative activity probabilities (Pa > 0.79) and low inactivity scores, supporting their selection for subsequent docking, ADMET, and molecular dynamics analyses. Next, several phytochemicals exhibited strong docking affinities, with Cardenolide achieving the highest binding score (–9.9 kcal/mol) and forming stable interactions with key catalytic residues. A 100-ns MD simulation confirmed the structural stability, persistent binding, and dynamic integrity of the EGFR–Cardenolide complex under physiological conditions. Importantly, interaction mapping revealed that Cardenolide engages conserved and functionally critical regions of the EGFR kinase domain associated with catalytic activity and structural stability, supporting its mechanistic relevance as an ATP-competitive scaffold. Additionally, predicted pharmacokinetic and toxicity profiles further supported Cardenolide’s suitability as a drug-like candidate. Collectively, these results identify Cardenolide as a computationally prioritized candidate with favorable predicted EGFR-binding characteristics, structural stability, and physicochemical and toxicity profiles. However, as the present study is based entirely on computational analyses, these findings should be considered hypothesis-generating and do not establish EGFR inhibitory activity or therapeutic efficacy. Experimental validation, including biochemical kinase inhibition and cellular assays, is therefore required to determine the actual EGFR inhibitory potential and anticancer activity of Cardenolide. Nevertheless, the findings provide a rational basis for prioritizing Cardenolide for further experimental investigation and illustrate the potential of Adenium obesum phytochemicals as a source of candidate EGFR-targeting compounds for future NSCLC drug discovery.Diabetes has reached epidemic proportions in Pakistan. This study applied machine learning (ML) techniques to identify comorbidity-based and diabetic complications-based clusters in hospitalised patients with diabetes and examine their association with in-hospital mortality.
Retrospective cross-sectional study.
Aga Khan University Hospital, Pakistan.
Adult patients (≥18 years) with diabetes admitted between 2008 and 2021.
Diagnoses were extracted using International Classification of Diseases (ICD-9 and ICD-10) codes. Data was integrated from the Hospital Information Management Systems (HIMS). The K-Modes clustering algorithm was applied to categorical diagnostic data, with the optimal number of clusters determined using elbow curve and silhouette score analysis. Latent-Dirichlet Allocation and Term Frequency-Inverse Document Frequency were applied to identify frequent terms from each cluster followed by expert validation. Logistic regression was performed to assess the association between cluster membership and in-hospital mortality.
Among 78 271 patients, four clusters were identified with varying mortality risks: (1) cardio, tumour and tobacco (CTT), (2) renal complication cluster (RCC), (3) cardiovascular cluster (CVC) and (4) uncontrolled diabetes mellitus, hypertension, stroke and kidney (HSK). The within cluster mortality was highest in the RCC cluster (682; 18.1%), followed by CVC (543; 4.4%), HSK (1,379; 4%) and CTT (603; 2.2%). Compared with CTT, the unadjusted odds of in-hospital mortality were significantly higher in RCC (OR=9.9, 95% CI 8.9 to 11.2, p
Among hospitalised patients with diabetes, the RCC cluster demonstrated the highest mortality risk, comprising predominantly older patients with severe complications. These findings highlight the utility of unsupervised ML approaches for identifying high-risk clinical phenotypes and informing risk stratification in resource-constrained settings. Longitudinal studies are warranted to evaluate progression and long-term outcomes across clusters.
To explore gastroenterologists’ perspectives on the changing epidemiology of non-alcoholic fatty liver disease (NAFLD) in Pakistan and identify barriers to its diagnosis and management.
Qualitative exploratory study using face-to-face semi-structured in-depth interviews.
Public and private healthcare settings in Islamabad, Rawalpindi and surrounding regions of Pakistan.
22 consultant gastroenterologists and postgraduate trainees in gastroenterology registered with the Pakistan Medical and Dental Council, with over 2 years of clinical experience managing patients with NAFLD. Participants were recruited through purposive sampling.
Primary outcomes included physicians’ perceptions of epidemiological changes, risk factors, clinical presentation patterns and barriers to NAFLD care. Secondary outcomes included proposed strategies for prevention and management.
Five major themes emerged from thematic analysis: (1) changing epidemiology—alarming rises in prevalence, demographic shift toward younger adults (20–30 years), and increasing presentation with advanced disease; (2) multifactorial risk factors—poor diet, sedentary lifestyle, metabolic comorbidities including diabetes and obesity, hypertension and genetic-hormonal influences; (3) clinical presentation—asymptomatic early disease with incidental detection, non-specific symptoms, and distinct gender-occupational patterns (housewives, post-menopausal women, sedentary professionals); (4) significant barriers to care—profound patient unawareness, poor compliance with lifestyle modifications, diagnostic limitations (FibroScan unavailability) and financial constraints restricting access to advanced diagnostics and pharmacotherapy (pharmacotherapy including newer agents such as Resmetirom for metabolic dysfunction-associated steatohepatitis); (5) proposed strategies—public awareness campaigns, targeted screening programmes, lifestyle modification and multidisciplinary collaborative care models.
NAFLD in Pakistan represents a silent epidemic with alarming epidemiological shifts towards younger populations and advanced disease. Urgent implementation of multifaceted strategies including public awareness campaigns, targeted screening of at-risk populations and multidisciplinary collaborative care models is imperative.
Measurement-based care (MBC) is a framework supporting the systematic and repeated use of standardised outcome measures, including patient-reported outcome measures (PROMs), to improve communication between patients and healthcare providers. PROMs provide valuable insights into patients’ health status and treatment outcomes, particularly when effectively integrated into clinical workflows through electronic health record (EHR) systems. This integration is especially important in the management of chronic diseases, which require sustained and coordinated patient-centred care where significant gaps remain. Embedding PROMs within EHR systems may help scale MBC for chronic disease management by transforming patient-reported data into actionable information within clinical practice. The impact of this integration on clinical outcomes in patients with chronic illnesses remains unclear. The objective of this systematic review is to identify and summarise evidence of the impact of the collection and clinical integration of PROMs through the EHR on clinical care outcomes in chronically ill patients. The findings of this review will inform and guide the future implementation of PROMs in routine clinical care using EHRs.
The research team will search MEDLINE (OVID), Embase (OVID), CINAHL (EBSCO), APA PsycInfo (OVID), Cochrane Library (Wiley), Scopus (Elsevier) and Web of Science (Clarivate). Two pairs of reviewers will independently screen studies based on inclusion and exclusion criteria, with disagreements resolved by the third reviewer. Another two pairs of reviewers will extract data from the articles that will be synthesised narratively, summarised in tabular form and categorised according to the framework for individual-level clinical outcomes. The quality of the studies will be evaluated based on the Mixed Methods Appraisal Tool.
Ethics approval is not required as the proposed systematic review will synthesise data from published research. The results of this review will be disseminated through academic peer-reviewed journals and conference presentations.
CRD420261297619.
To examine the prevalence and disease-combination patterns of multiple long-term conditions (MLTCs) among adults in India and their associations with quality of life and healthcare utilisation.
Cross-sectional analysis of two nationally representative survey waves.
Community-based household survey conducted across six Indian states (Assam, Karnataka, Maharashtra, Rajasthan, Uttar Pradesh and West Bengal), part of the WHO Study on global AGEing and adult health.
9116 adults aged 18 years and older in Wave 2 (2015) and 7885 adults in Wave 3 (2019–2020).
Quality of life, assessed with the 8-item WHO Quality of Life scale (WHOQoL-8, range 0–100), was the primary outcome. Outpatient visits and hospitalisations in the preceding 12 months were the secondary outcomes. Associations with MLTC were estimated using Tobit regression for quality of life and Poisson regression for healthcare utilisation, adjusting for sociodemographic, socio-economic and behavioural factors.
MLTC prevalence rose from 19.2% to 24.4% between waves and was highest among adults aged 60 years and older, women, urban residents and the wealthiest quintile. Hypertension–cataracts, hypertension–arthritis and hypertension–diabetes were the most prevalent dyads. Depression–chronic obstructive pulmonary disease (COPD) and depression–stroke combinations had the poorest quality of life. Physical and functional domains declined most as MLTC increased, while the financial domain remained stable. Compared with adults without chronic conditions, WHOQoL-8 scores fell in a stepwise pattern with one, two and three or more conditions (–2.6, –5.1 and –6.7 points in 2015; –3.3, –5.6 and –7.9 in 2019–2020; all p
MLTC are rising in India and are associated with poorer quality of life and higher healthcare use. High-burden combinations, particularly depression–COPD, depression–stroke, COPD–stroke and depression–angina, warrant targeted interventions to improve quality of life and manage rising healthcare demands.
Idiopathic intracranial hypertension (IIH) is characterised by raised intracranial pressure (ICP) and typically affects young women with obesity. Patients are at risk of permanent visual loss due to papilloedema. Some require emergency intervention to rapidly reduce papilloedema and preserve vision. The international standard of care for patients with sight-threatening IIH is cerebrospinal fluid (CSF) shunting. However, dural venous sinus stenting (DVSS) is an emerging procedure that is offered at many neuroscience centres internationally as the primary intervention. Currently, there are no randomised controlled trial data supporting the efficacy of any interventional approach for preserving vision in sight-threatening IIH.
IIH Intervention is a UK-based two-arm, open-label, multicentre, randomised controlled phase IIb clinical trial with integrated health economic evaluation to compare CSF shunting with DVSS in patients who have confirmed IIH and are at risk of permanent visual loss due to severe papilloedema. The primary outcome is the global thickness of the peripapillary retinal nerve fibre layer (RNFL), an indicator of papilloedema, measured by optical coherence tomography (OCT) over a 6-month period. Secondary outcomes are global thickness of the RNFL over 12 and 24 months, as well as macular ganglion cell layer volume, perimetric mean deviation, headache outcomes, intervention reporting measures (including complications and revisions) and patient-reported outcomes over 6, 12 and 24 months.
The protocol was approved initially on 12 December 2022 by West Midlands-South Birmingham Research Ethics Committee (ref: 22/WM/0230). Participants will be required to provide written informed consent. The results of this trial will be disseminated through national and international presentations and peer-reviewed publications.
by Sobia Khan, Salman Khan, Afshan Afshan, Muhammad Arif, Humaira Gul, Muhammad Hamayun, Mamoona Rauf, Douglas Law, Bandar M. Almunqedhi, Mohamed A. El-Tayeb, Ahmed Othman Alsabih, Waheed Ahmad, Patricio R. De los Ríos-Escalante, Ayaz Ahmad
Abiotic stress factors, such as salinity and heavy metals (HM), significantly reduce okra (Abelmoschus esculentus L.) yield, an important vegetable crop cultivated globally. The symbiotic relationship between endophytic fungi and plants enhances plant growth and helps plants overcome such stresses. This study was designed to isolate and examine endophytic fungi from Ziziphus lotus roots for their growth-promoting potential under salt (250 mM NaCl) and cadmium (100 ppm Cd) stress. The growth of okra was significantly enhanced by inoculation with Aspergillus fumigatus (SOA), resulting in a 28.9% increase in plant height (33.24 cm vs. 25.79 cm in the control) and improved biomass, chlorophyll content, and phytohormone regulation. Chlorophyll A content rose by 108.4% in SOA-treated plants (4.894 mg/g FW) relative to control (2.348 mg/g FW), while shoot dry weight increased more than threefold (4.365 g vs. 1.42 g in control). Abscisic acid (ABA) content decreased in SOA-treated plants, indicating a reduced stress response, whereas enhanced gibberellic acid (GA) and indole-3-acetic acid (IAA) content promoted growth. Biochemical analysis revealed higher accumulation of lipids, sugars, phenols, and flavonoids, resulting in improved stress adaptation. Oxidative damage was reduced through high antioxidant enzyme activities (CAT and POD). SOA modulated cadmium uptake, thereby reducing heavy metal toxicity. These findings showed that endophytic fungi have the potential to enhance plants’ resilience and provide a promising controlled-environment approach to enhance crop productivity in metal- and salt-contaminated soils.by Osama Ahmed Elsabagh, Abdelbaset M. Elgamal, Heba A. Hassan, Naglaa M. Ammar, Zeinab A. El-Gendy, Mohamed A. El-Saied, Mawada Mohamed Ali, Reham S. Ibrahim, Ahmed H. El-Desoky, Emad M. Hassan, Mohamed A. Farag, Abdelsamed I. Elshamy
BackgroundGuazuma ulmifolia is traditionally used for liver disorders, but its protective mechanisms against heavy metal toxicity are poorly defined. This study evaluated the phytochemical profile and hepatoprotective mechanisms of G. ulmifolia butanol extract (Gul-BuOH) against cadmium-induced liver injury.
Methods and findingsGul-BuOH was chemically profiled by UPLC-PDA-ESI–qTOF-MS/MS. Cadmium hepatotoxicity was induced in rats, followed by Gul-BuOH treatment (100 and 200 mg/kg). Liver injury, oxidative stress, inflammation, gene expression (Let-7a, HOTAIR), histopathology, HO-1/Sirt-1 immunoreactivity, and serum metabolomic changes were assessed. Chemical profiling led to the annotation of 42 compounds, including mainly flavonoids and phenolic acids, highlighting the rich phytochemical composition of G. ulmifolia. CdCl2 exposure increased hepatic Cd accumulation and elevated ALT, AST, and ALP, reduced TAC, and increased NO and MDA. Gul-BuOH significantly reduced hepatic Cd levels by 2.6- and 3.2-fold, restored TAC by 38.3% and 83.2%, and decreased NO (56.3% and 63.4%) and MDA (45.4% and 54.6%) at 100 and 200 mg/kg, respectively. Inflammatory markers NF-κB-p and TNF-α were markedly suppressed, while miRNA Let-7a was upregulated and lncRNA HOTAIR was downregulated. Histological and immunohistochemical analyses revealed near-complete restoration of hepatic architecture and normalization of HO-1 and Sirt-1 expression at the high dose. Serum metabolomics’ OPLS-DA model performance indicators demonstrated strong reliability, with an R2Y (explained variance) of 0.991 and a Q2 (predictive variance) of 0.988). The model identified 36 significantly altered metabolites that were largely normalized by Gul-BuOH, implicating linoleic acid metabolism, amino acid biosynthesis, and ascorbate-related pathways.
ConclusionGul-BuOH affords dose-dependent protection against Cd-induced liver injury by modulating oxidative stress, inflammation, metal detoxification, and metabolic pathways, supporting the traditional use of G. ulmifolia and its potential as a multi-target hepatoprotective agent.
To explore how neonatal nurses in Level III (high-acuity) neonatal intensive care units recognise, interpret, and escalate early signs of clinical deterioration.
A qualitative interpretive description study underpinned by critical realism.
Twenty-two registered nurses were purposively recruited from four Level III units in the Jouf Region of northern Saudi Arabia using criterion-based maximum-variation sampling. Semi-structured interviews were conducted in Arabic or English and analysed in their original language. Situation awareness and invisible work scholarship served as sensitising lenses. Rigour was supported through member reflection, negative-case analysis, peer debriefing and an audit trail.
Four interrelated themes were identified: (1) ‘the infant tells you before the monitor does’, reflecting recognition of subtle deviation from the infant's baseline; (2) ‘building the case’, in which nurses tested and assembled evidence to make concern clinically credible before escalation; (3) ‘the escalation calculus’, describing how anticipated physician responses, hierarchy and previous dismissal shaped escalation and (4) ‘the unit works against you’, showing how alarm burden, documentation demands and staffing variability constrained vigilance. Recognition and escalation formed a cyclical, organisationally situated process rather than a single response to abnormal observations.
Escalation involved interpretive, relational and legitimising work before early concern became actionable. Participants' accounts suggest that timely response depends on clinical expertise and environments that protect bedside attention and legitimise early escalation.
Neonatal services should protect surveillance capacity through staffing and workload design, alarm reduction, simulation of ambiguous deterioration and constructive escalation feedback.
The study identifies case-building as a distinct stage between noticing deterioration and escalating concern and indicates how organisational conditions may constrain early nursing surveillance.
Consolidated Criteria for Reporting Qualitative Research.
Patients and the public were not involved.
To estimate the prevalence and incidence of incontinence-associated dermatitis in adults with incontinence across healthcare settings.
Systematic review and meta-analysis.
Observational studies reporting prevalence or incidence of incontinence-associated dermatitis in adults with incontinence were included. Risk of bias was assessed using a validated tool. Pooled estimates were calculated using random-effects meta-analysis. Subgroup and sensitivity analyses were conducted for prevalence studies and meta-regression examined heterogeneity.
MEDLINE, EMBASE and CINAHL were searched from database inception to 20 October 2025.
Twenty-eight studies including 270,719 adults with incontinence were identified across hospital, nursing home and community settings. Twenty studies reported prevalence. Among eight low-risk of bias studies, the pooled prevalence was 14.2%, compared with 22.7% across all prevalence studies. Eight studies reported incidence. Pooled analysis of studies in intensive care units showed a cumulative incidence of 33.1%, while one nursing home study reported 5.5%. Prevalence was similar in hospitals and community settings and lower in nursing homes. Prevalence was highest in faecal incontinence, followed by double and urinary incontinence.
Incontinence-associated dermatitis is common among adults with incontinence across healthcare settings. The high prevalence and incidence highlight the need for effective prevention and management strategies.
High occurrence rates highlight the need for systematic risk assessment, preventive skin care strategies and early management in nursing practice.
This study addresses the lack of epidemiological evidence on incontinence-associated dermatitis. Findings show the condition is frequent among adults with incontinence across care settings. Results are relevant for nurses responsible for continence care and skin integrity.
This review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
PROSPERO (CRD42024549106), registered 02/06/2024.
To determine the level and predictors of micronutrient intake inadequacy among pregnant women attending antenatal public health facilities in Bahir Dar City, Northwest Ethiopia.
A multicentre, cross-sectional study.
The study was conducted in public health facilities in Bahir Dar City, Northwest Ethiopia from January to March 2024.
About 420 pregnant women aged 18 years and older attending antenatal care at public health facilities in Bahir Dar. Pregnant women diagnosed with chronic diseases, sick and unable to communicate, and who had attended weddings, birthday celebrations or religious festivals within the past 24 hours were excluded.
Micronutrient intake inadequacy among pregnant women was measured using a single multiphasic 24-hour dietary recall. The Nutria-Survey Food Processor software, the Ethiopian food composition table and the World food composition table were used for the calculation of the nutrient value of micronutrients. The nutrient intakes were assessed by nutrient adequacy ratio and mean adequacy ratio. Data were analysed using SPSS V.26. Multivariable logistic regression analysis was done to identify the predictors of micronutrient intake inadequacy.
A total of 411 pregnant women were recruited in the study, yielding a 97.8% response rate. The overall prevalence of micronutrient intake inadequacy was 76.4% (95% CI 72.0% to 80.3%). The proportions of zinc, vitamin A, iron and calcium intake inadequacies were 48.2%, 66.7%, 14.8% and 74%, respectively. Having nutrition counselling (adjusted ORs (AOR)=3.5; 95% CI 2.00 to 6.48), having
Micronutrient intake among pregnant women was lower than the recommended levels. Therefore, strengthening community efforts to promote the consumption of a diversified diet for pregnant women, encourage nutrient-dense food production and enhance food security is essential.
To understand pregnant women’s perception of the quality of antenatal care (ANC) services in terms of service provision and experience in Sudan, a country with one of the highest rates of maternal deaths worldwide.
A cross-sectional facility-based study.
Public primary healthcare centres in Khartoum state, Sudan.
473 pregnant women attending ANC visits. Data were collected through face-to-face interviews using a standardised questionnaire.
The perceived quality of ANC services assessed across two continuous domains: service provision score and care experience score.
The mean score for service provision was 19.96±3.03 out of 56. The great majority of the participants did not have their height or weight measured at any ANC visits 85% and 64.5%, respectively. About 87.1% and 82.5% of the participants, respectively, had blood and urine tests during each ANC visit. However, only 52.6% of the women reported receiving tetanus injections. The percentage of women receiving ultrasound examination at each visit was 88.4%. The mean score of care experience was 58.68±8.22 out of 84. Three-quarters of the women (74%) understood the purpose of the tests performed. The majority felt free to ask questions (87.3%). But only half and a third of the women were told about the signs of pregnancy complications and where to go in case any complications occurred, respectively. In linear regression, being married and older age had significant positive effects on women’s perception of care provision (p=0.004 and p=0.003, respectively). Regarding the experience of care, older age affected care experience positively (p=0.038), while rural residency (p=0.044), being illiterate (p
Women’s perception of the quality of ANC in terms of service provision and care experience was below average. Several factors were associated with their negative perceptions. These factors need to be further investigated and addressed to improve the quality of ANC provided.
by Hansa Gul, Iram Zahra, Zahida Nasreen, Haris Ahmed Khan, Muhammad Naeem-ul-Hassan, Nouman Ahmad, Nasir Assad, Dawit Kifle, Lennin Garrido-Palazuelos
Antimicrobial resistance (AMR) in pathogenic bacteria, particularly Staphylococcus aureus, is an increasing global concern in veterinary medicine. The present study evaluated bioactive metabolites from P. arhizus as potential inhibitors of major S. aureus efflux pumps. The methanolic extracts of P. arhizus were profiled using GC–MS to identify the main constituents, and their antibacterial activity against S. aureus was evaluated using a well diffusion assay. The experimental results showed that the crude methanolic extract exhibited a 20 mm zone of inhibition with a MIC of 30 µg/mL. Furthermore, isolated metabolites, octadecanoic acid and compound tentatively identified by GC-MS as 3-(6-methyl-3-pyridyl)-1,5-diphenyl-2-pyrazoline (a pyrazoline derivative), (tentatively identified) demonstrated zones of inhibition of 19 mm each, with MIC values of 30 µg/mL and 40 µg/mL, respectively. In silico analyses, including molecular docking and molecular dynamics (MD) simulations, were performed to examine the binding and stability of 12 fungal metabolites with the major S. aureus efflux pumps NorA, NorB, NorC, and MepA. Binding-free energy estimation by MM-GBSA supported favorable interactions for selected compounds, with pyrazoline and octadecanoic acid showing the most promising profiles. Principal component analysis (PCA), dynamic cross-correlation matrix (DCCM) analysis, and ADMET predictions further suggested stable complex behavior and acceptable drug-likeness features. In general, these results indicate that the P. arhizus metabolites demonstrated antibacterial activity and showed a high binding affinity to efflux pumps in silico, suggesting that they merit further investigation as potential antibacterial agents with predicted interactions toward efflux pump proteins.The Developmental Origin of Health and Disease framework emphasises the intergenerational influence of both maternal and paternal factors on the perinatal and longer-term outcomes of offspring. Aboriginal and Torres Strait Islander communities have driven major advances in family and health research across Australia, including longitudinal studies grounded in community priorities. Despite this progress, few birth cohort studies have focused on Indigenous families and even fewer have examined the health and well-being of Indigenous fathers.
The Indigenous Queensland Family Cohort (I-QFC) study is a prospective, longitudinal birth cohort study that commenced in 2021, recruiting Aboriginal and/or Torres Strait Islander families from the Mater Mothers’ Hospital in Brisbane, Australia. This feasibility study forms part of the larger QFC study to understand the acceptability and practical considerations of including Indigenous families in a birth cohort study. Participants include pregnant individuals, their partners (where applicable), and their infants, followed from pregnancy to 6 weeks post partum. Data collection involved self-administered and researcher-facilitated surveys, alongside biological sample collection.
The study enrolled 103 pregnant participants and 64 partners and outlined the study design and baseline characteristics. Survey completion rates were high for antenatal and birth-related data collection when facilitated by Indigenous research staff (>94%). In contrast, completion declined substantially at later time points and among partners, with only 35 mothers completing the 6-week survey post partum and progressive participant attrition observed across the study period. Variation in biological sample provision and longitudinal follow-up provided important insights into cultural, logistical and relational factors influencing engagement in family-based cohort research. Biological sample collection was more limited, with few participants contributing across multiple time points. Participants were influenced by cultural considerations, including the spiritual significance of placental tissue, as well as perceptions among male partners’ belief that their involvement in perinatal research was unnecessary.
By adopting a family-centred approach, I-QFC provides insights into culturally grounded research with Indigenous families, with the potential to strengthen health and well-being across generations. As such, these findings are currently used to inform the development of a forthcoming co-design birth cohort study of Aboriginal and Torres Strait Islander families in Queensland, Australia.
by Abdeta Muktar Ahmed, Mohamed Abdilahi Ahmed, Abdulkadir Mohammed Nuh, Hamse Khalif Hassan
BackgroundMaternal mortality remains a major global health challenge, disproportionately affecting low- and middle-income countries. Despite international efforts, nearly 95% of maternal deaths occur in these regions, with Sub-Saharan Africa bearing the highest burden. Limited knowledge of obstetric danger signs is a key factor contributing to delays in seeking care, which in turn increases the risk of preventable maternal complications. Evidence on maternal awareness in Somaliland is scarce.
ObjectiveThis study aimed to assess the level of knowledge of obstetric danger signs and associated factors among pregnant women attending antenatal care in Hargeisa, Somaliland.
MethodsA facility-based cross-sectional study was conducted from July 2 to August 4, 2022, among pregnant women attending antenatal care services. A total of 222 participants were selected using a systematic random sampling technique from eight maternal and child health centers. Data were collected through face-to-face interviews using a pretested and structured questionnaire and analyzed with SPSS version 25. Bivariate and multivariate logistic regression was carried out.
ResultsAbout 35.6% had a good knowledge specifically about pregnancy related obstetric danger signs. Only 57 women (25.7%) demonstrated overall good knowledge of obstetric danger signs across pregnancy, childbirth, and the postpartum periods. Knowledge was highest for vaginal bleeding (65% − 67%), while less visible complications such as convulsions and blurred vision were less frequently mentioned. Multivariate analysis revealed that secondary level education or higher (AOR = 3.6, 95% CI: 1.8–7.3), access to and usage of media (AOR = 2.6, 95% CI: 1.2–5.6), and institutional delivery (AOR = 3.4, 95% CI: 1.6–7.2), were significant predictors of knowledge.
ConclusionMaternal knowledge of obstetric danger signs in Hargeisa was low. Targeted health education, broader use of mass media, and promoting institutional delivery are critical strategies to improve and reduce preventable maternal mortality.
by Mohamed Samy Abousenna, Nermeen G. Shafik, Sara E.A. El Sawy, Amal Abd El Moneim Mohamed, Heba A. Khafagy, Ehab El-Sayed Ibrahim, Wael Elfeil, Mohamed Ahmed Saad, Samir A. Nassif
Foot-and-mouth disease (FMD) remains endemic in Egypt, with periodic incursions of antigenically distinct virus lineages. In 2025, FMDV serotype SAT1/topotype I was detected in Egypt for the first time, creating an immunity gap in a livestock population previously vaccinated against serotypes O, A, and SAT2. This study aimed to evaluate the quality, immunogenicity, antigenic relationships, and protective efficacy of an emergency inactivated monovalent SAT1 vaccine and to assess potential cross-reactivity with SAT2 vaccine strains. An inactivated SAT1 monovalent vaccine was produced under emergency conditions and subjected to in-process and final product quality control testing, including sterility, safety, RT-qPCR verification, and 146S antigen quantification. Neutralizing antibody responses were measured by virus neutralization test (VNT) at 28 days post-vaccination. Antigenic relationships between SAT1 and SAT2 strains were assessed using r₁-value analysis. Protective efficacy was evaluated by homologous challenge in vaccinated calves. All vaccine batches met quality control criteria, with consistent viral titers and 146S antigen content. Vaccinated calves developed a mean homologous VNT titer of 2.175 log₁₀ TCID₅₀, exceeding the WOAH protective threshold (≥1.65 log₁₀ TCID₅₀). Following homologous challenge, 100% (8/8) of vaccinated calves were clinically protected. In contrast, heterologous VNT titers against SAT2 strains were low (0.26–0.30 log₁₀ TCID₅₀), and r₁-values ranged from 0.12 to 0.14, below the WOAH threshold for antigenic matching (0.3). The emergency SAT1 monovalent vaccine induced strong homologous immunity and complete protection against SAT1 challenge. Limited antigenic and serological cross-reactivity with SAT2 confirms the serotype-specific nature of FMD immunity and supports the need for dedicated SAT1 vaccination and ongoing antigenic surveillance.by Nimra Sageer, Areeb Nawaz, Riaz Hussain, Ghulam Mustafa, Laila A. AL Essa, Khalid M. Alsyaad, Ahmed Aljazzar, Yehia Hazzazi, Mari Sumayli, Sarmad Rehan, Khalid Mehmood
Pesticides play a crucial role in agriculture, public health management, and veterinary practice to control pests. However, the persistent use of pesticides poses a significant threat to aquatic ecosystems and non-target organisms, such as fish. The genotoxicity, oxidative stress, and erythrocytic toxicity were assessed in fish exposed to different sublethal concentrations (5, 10, and 15 µg/L) of thiram for 12 days. Blood and other tissues (gills and intestine) were obtained from each fish reared in each group at days 4, 8, and 12 of the experiment. Thin blood film/smear examination indicated significantly (P ≤ 0.05) increased morphological and nuclear changes in erythrocytes, such as the formation of micronuclei, notched nuclei, lobed nuclei, and tear-shaped erythrocytes in fish exposed to higher doses of thiram. The contents of antioxidant enzymes such as catalase (CAT), reduced glutathione (GSH), peroxidase (POD), and superoxide dismutase (SOD) were significantly (P ≤ 0.05) decreased and the oxidative stress biomarkers including reactive oxygen species (ROS) and thiobarbituric acid reactive substances (TBARS) were significantly (P ≤ 0.05) increased in gills and intestinal tissues of exposed fish. The results on genotoxicity determined using the comet assay technique revealed significantly (P ≤ 0.05) high levels of genomic instability in terms of DNA damage in isolated cells of the gills and intestine of fish reared in water containing higher concentrations of thiram. At the microscopic level, various sections of the gills of fish treated with higher doses of thiram unveiled moderate to severe histopathological ailments such as degeneration of cartilaginous core, degeneration and disruption of primary and secondary lamellae of gills, necrosis of lamellar epithelial cells, telangiectasia, and curling of secondary lamellae. The findings of this study indicated that extremely low doses of thiram lead to the induction of adverse effects in freshwater fish. Hence, there is a need to develop suitable control measures regarding the use of environmentally friendly chemicals and for the protection of aquatic environments.Antimicrobial resistance (AMR) poses a serious threat across human, animal and environmental health. The One Health approach emphasises multisectoral collaboration and is critical in addressing AMR. While One Health governance has gained recognition from international organisations, there remains limited understanding of how it can be effectively implemented across institutional, social, economic and political contexts. This scoping review aims to explore the design and implementation of One Health governance across contexts.
Scoping review
We searched PubMed, Scopus, Web of Science and grey literature sources in December 2024, updating our search in March 2026.
Eligible sources included empirical and conceptual work on One Health governance.
We searched for and screened documents and extracted data following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We then applied qualitative analysis to examine governance mechanisms; implementation contexts; conceptualisations of effectiveness; evidence of effectiveness and key barriers and facilitators.
We included 171 documents from over 50 countries. We explored six dimensions of One Health governance: participation, leadership, coordination, decision-making, resourcing and accountability. Existing governance structures and wider aspects of country context shaped One Health governance. While there was broad agreement on the goals of One Health governance—namely, to support disease prevention, detection and response—empirical evidence on effective approaches was relatively limited. Facilitators included strong political will and crisis-driven momentum, while barriers included siloed systems, sectoral dominance, limited accountability, inadequate funding and lack of institutionalisation.
This review highlights the range of approaches to One Health governance that exist and outlines how context may shape the design and implementation of One Health governance. Evaluative research should further explore which approaches to One Health governance are most effective in specific contexts. These insights are particularly relevant for AMR, where sustained cross-sectoral governance beyond outbreak-driven responses is essential to counter the ‘silent pandemic’.
FreshRSS 