Category: Nevin Manimala

Afr J Prim Health Care Fam Med. 2025 Mar 20;17(1):e1-e10. doi: 10.4102/phcfm.v17i1.4781.

ABSTRACT

BACKGROUND: Preoperative assessment clinics play a critical role in identifying, evaluating and mitigating perioperative risks. Despite global data highlighting the importance of preoperative risk factors on surgical outcomes, there remains limited information on their impact on post-operative length of stay (LOS) in South African contexts.

AIM: This study aimed to describe the demographic and clinical profiles of patients referred to a preoperative clinic as well as factors associated with post-operative extended LOS.

SETTING: The preoperative clinic is based in the city of Johannesburg in South Africa.

METHODS: This was a prospective cohort study conducted between 2021 and 2022 at a private clinic in patients undergoing non-cardiac surgery. Data on demographics, co-morbidities, surgical procedures and clinical outcomes were collected. Statistical analysis was performed to assess relationships between preoperative risk factors, including ASA grading, Revised Cardiac Risk Index (RCRI), estimated glomerular filtration rate, diabetes mellitus, age, obesity and LOS.

RESULTS: A total of 214 patients were assessed, of which 75.7% were female, with a median age of 62.5 years. Common co-morbidities included hypertension (59.3%) and obesity (55%). The median LOS was 3.5 days, with 47.2% of patients staying more than 3 days post-operatively. Knee (33.2%) and hip surgeries (21%) were the most common procedures. A significant association was found between longer LOS and RCRI score ≥ 1 (p = 0.007), renal dysfunction in knee surgery patients (p = 0.027) and age in patients undergoing hip surgery (p = 0.049).

CONCLUSION: Findings note the need for targeted intereventions in preoperative care to reduce LOS, particularly for high-risk patients.Contribution: This study highlights the fact that preoperative information may play a significant role in patient’s outcomes post surgery. Further research is needed to validate these results across broader healthcare settings.

PMID:40171694 | DOI:10.4102/phcfm.v17i1.4781

Afr J Prim Health Care Fam Med. 2025 Mar 14;17(1):e1-e10. doi: 10.4102/phcfm.v17i1.4696.

ABSTRACT

BACKGROUND: Diabetes is one of the major non-communicable diseases. Diabetes self-management has been identified as a key strategy to reduce complications and to improve health outcomes.

AIM: This study aimed to investigate the diabetes self-management knowledge, attitude and practices among people with type-2 diabetes in Ghana.

SETTING: Two clinics for diabetes patients in the Ho municipality of Ghana were selected to conduct the study.

METHODS: An outpatient cross-sectional survey was conducted using a 57-item researcher-administered questionnaire based on the Information, Motivation, Behaviours Model adopted for Diabetes. A total of 321 patients with type 2 diabetes were randomly selected from the two outpatient clinics for diabetes in Ho, Ghana. Data were analysed using descriptive statistics and multiple linear regression modules were conducted to determine the predictors of self-management practices. Significance was set at p 0.05.

RESULTS: The average score for knowledge was 11.37/24 ± 3.40 or 47%, indicating poor levels of diabetes self-management knowledge. Moderately positive attitudes were found (2.83/5 ± 1.57) [95% CI -1.86 to -3.80] with poor self-management practices with a median of 3.00 per week (maximum 5.20, minimum 0.60 per week). Knowledge explained 20% of variation in self-management practice.

CONCLUSION: The findings from this study show an overall deficit in knowledge of diabetes with related low self-management practice. This suggests the need for robust self-management education programmes to improve access to diabetes self-management-related information.Contribution: This study highlights the important knowledge of diabetes in self-management.

PMID:40171692 | DOI:10.4102/phcfm.v17i1.4696

Afr J Prim Health Care Fam Med. 2025 Mar 12;17(1):e1-e8. doi: 10.4102/phcfm.v17i1.4773.

ABSTRACT

BACKGROUND: An ongoing challenge within the field of undernutrition is to identify children at risk.

AIM: The objective of this study was to investigate whether children who are living in households inhabiting a household member with a life-limiting illness are at risk of undernutrition.

SETTING: A comparative cross-sectional study was performed in Uganda.

METHODS: We collected anthropometric data on children under the age of five and information on household dietary diversity, food security and healthcare barriers. Study participants for the hypothesised high-risk group were recruited within households receiving home-based palliative care. The comparison group included neighbouring households.

RESULTS: Data collection from 145 paired households was performed from April to July 2021. There was no statistically significant difference in prevalence of undernutrition. For all continuous nutrition indicators there was a trend towards less undernutrition in the hypothesised high-risk group than in the comparison group. We found lower overall prevalence of acute malnutrition than expected. The hypothesised high-risk group was associated with higher food insecurity than the comparison group.

CONCLUSION: Lower overall acute malnutrition than expected may be because of the season variability. Stunting was higher than expected in both groups, which may suggest season variability in undernutrition. The results suggest a protective effect of receiving home-based palliative care on child nutritional status.Contribution: The study did not show a risk of child undernutrition in households inhabiting a household member with life-limiting illness. Future research may identify key elements responsible for the potential protective effects of home-based palliative care on child undernutrition.

PMID:40171691 | DOI:10.4102/phcfm.v17i1.4773

Afr J Prim Health Care Fam Med. 2025 Mar 26;17(1):e1-e6. doi: 10.4102/phcfm.v17i1.4749.

ABSTRACT

BACKGROUND: Psychological distress (PD) is a prevalent concern among undergraduate health science students globally. Despite this, data specific to Uganda is limited.

AIM: This study assessed the prevalence of PD among undergraduate health sciences students in Uganda.

METHODS: We obtained data on the psychological distress burden using self-administered DASS-21 questionnaires. Data were analysed using SPSS version 20.

RESULTS: We enrolled 398 participants, of whom 217 (54.5%) were males. The median age of the participants was 22 years (interquartile range [IQR], 21 to 24). Of the participants, more than half (57%) had moderate to severe symptoms of anxiety. Nearly half of them (42%) reported moderate to severe symptoms of depression, while 26% of the students had moderate to severe symptoms of stress.

LESSONS LEARNT: This study highlights significant psychological distress among health science students at Makerere University, with high levels of anxiety, depression and stress. It emphasises the need for improved mental health support in academic settings, aligning with the African Journal of Primary Health Care Family Medicine’s focus on contextual healthcare challenges.

PMID:40171688 | DOI:10.4102/phcfm.v17i1.4749

J Womens Health (Larchmt). 2025 Apr 2. doi: 10.1089/jwh.2024.0955. Online ahead of print.

ABSTRACT

Purpose: To evaluate how migraine impacts the risk for postpartum depression (PPD) in women of reproductive age as well as the effect of comorbidities on this risk. Methods: This is a retrospective observational study in a tertiary neurology center involving 6248 women with migraine and 4154 women without migraine between the ages of 18 and 45 seen from January 1, 2017, to January 30, 2024. The primary outcome was the odds ratio (OR) for PPD in migraine relative to women without migraine. Secondary outcomes included the OR for PPD in women with chronic migraine who also had comorbidities. Results: After adjusting for demographic factors and comorbid conditions, only chronic migraine, with and without aura, was associated with higher OR for PPD; chronic migraine without aura had the highest risk for PPD (OR: 2.13; 95% CI: 1.29 to 3.53, p = 0.003). In patients with chronic migraine, preeclampsia was associated with the largest OR for PPD, followed by depression, gestational diabetes, and premenstrual dysphoric disorder. Anxiety, advanced maternal age, endometriosis, and post-traumatic stress disorder were not associated with a statistically significant increase in OR for PPD. Conclusions: Chronic migraine, with and without aura, is associated with a higher OR for PPD relative to non-migraine controls. Patients with chronic migraine, preeclampsia, depression, gestational diabetes, and premenstrual dysphoric disorder were also associated with increased risk of PPD. These data support screening patients with both chronic migraine and these comorbidities for PPD with validated screening tools to connect them with optimal resources best.

PMID:40171673 | DOI:10.1089/jwh.2024.0955

J Clin Endocrinol Metab. 2025 Apr 2:dgaf133. doi: 10.1210/clinem/dgaf133. Online ahead of print.

ABSTRACT

CONTEXT: The relationship between initial changes in estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR), and their independent association with clinical outcomes in type 2 diabetes (T2D) patients receiving sodium-glucose cotransporter 2 inhibitors (SGLT2is), remains unclear.

OBJECTIVE: This study aimed to investigate the association between initial changes in eGFR and UACR with consequent cardiovascular and kidney outcomes in an Asian population with T2D following SGLT2i treatment in a real-world setting.

METHODS: Using a large multicenter medical database in Taiwan, we analyzed 8222 T2D patients with baseline and 3-month follow-up eGFR and UACR measurements, receiving SGLT2is between June 1, 2016, and December 31, 2021. We assessed risks of major adverse renal events (MARE), major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), and all-cause mortality using a Cox proportional hazards model.

RESULTS: After 3 months of SGLT2i treatment, patients were categorized based on early changes in eGFR (no decline, 0%-10% decline, > 10% decline) and UACR (no reduction, 0%-30% reduction, > 30% reduction). Among those with no initial eGFR decline (40.9%), 19.8% had no initial UACR reduction, 8.4% had 0% to 30% reduction, and 12.7% had greater than 30% reduction. For those with greater than 10% initial eGFR decline (21.5%), 6.5% had no UACR reduction, 4.3% had 0% to 30% reduction, and 10.7% had greater than 30% reduction. Patients with greater than 10% initial eGFR decline but no UACR reduction showed higher risks of MARE (adjusted HR [aHR]: 2.34; 95% CI, 1.32-4.15), MACE (aHR: 1.83; 95% CI, 1.01-3.29), and HHF/cardiovascular death (aHR: 1.93; 95% CI, 1.05-3.55) compared to those with modest early eGFR decline and UACR reduction.

CONCLUSION: T2D patients experiencing profound early eGFR decline without concordant UACR reduction while on SGLT2is represent a high-risk subgroup with worse clinical outcomes. These findings suggest the need for closer monitoring and potentially more aggressive therapeutic strategies for this patient population.

PMID:40171668 | DOI:10.1210/clinem/dgaf133

HIV Res Clin Pract. 2025 Dec;26(1):2484823. doi: 10.1080/25787489.2025.2484823. Epub 2025 Apr 2.

ABSTRACT

BACKGROUND: Mental health concerns among youth living with HIV are well documented. Given the interconnection between physical and mental health, behavioral health screening in medical settings is recommended to ensure patients are linked to mental health services. Unfortunately, COVID-19 disrupted medical and mental health services for people living with HIV, including youth. However, the extent of this disruption and its impact are not entirely known.

OBJECTIVE: We aimed to explore the impact of COVID-19 on psychosocial screening practices and outcomes among youth living with HIV aged 12-25 in an integrated care setting in the southeastern United States.

METHODS: Using existing program evaluation and continuous quality improvement data, we examined psychosocial screenings before and after the onset of COVID-19 (2019-2022).

RESULTS: Findings revealed decreased psychosocial screening of eligible youth living with HIV between 2019 and 2021, but an increase in 2022. The percentage of positive depression and anxiety screeners decreased between 2019 and 2020, increased in 2021, and decreased again in 2022. However, positive post-traumatic stress screeners increased between 2019 and 2020, decreased in 2021, and increased again in 2022. Substance use screening indicated a steady increase in alcohol and tobacco use between 2019 and 2021. In 2022, alcohol continued to increase, but tobacco use decreased.

CONCLUSIONS: Findings underscore the critical need for robust, adaptable psychosocial screening practices in integrated care settings to address the evolving mental health and substance use needs of youth living with HIV, especially during and after major public health disruptions.

PMID:40171647 | DOI:10.1080/25787489.2025.2484823

Pulmonology. 2025 Dec 31;31(1):2470566. doi: 10.1080/25310429.2025.2470566. Epub 2025 Apr 2.

ABSTRACT

INTRODUCTION: Evidence of an association between breathlessness and quality of life from population-based studies is limited. We aimed to investigate the association of both physical and mental quality of life with breathlessness across several low-, middle- and high-income countries.

METHODS: We analysed data from 19 714 adults (31 sites, 25 countries) from the Burden of Obstructive Lung Disease (BOLD) study. We measured both mental and physical quality of life components using the SF-12 questionnaire, and defined breathlessness as grade ≥2 on the modified Medical Research Council scale. We used multivariable linear regression to assess the association of each quality-of-life component with breathlessness. We pooled site-specific estimates using random-effects meta-analysis.

RESULTS: Both physical and mental component scores were lower in participants with breathlessness compared to those without. This association was stronger for the physical component (coefficient = -7.59; 95%CI -8.60, -6.58; I² = 78.5%) than for the mental component (coefficient = -3.50; 95%CI -4.36, -2.63; I² = 71.4%). The association between physical component and breathlessness was stronger in high-income countries (coefficient = -8.82; 95%CI -10.15, -7.50). Heterogeneity across sites was partly explained by sex and tobacco smoking.

CONCLUSION: Quality of life is worse in people with breathlessness, but this association varies widely across the world.

PMID:40171577 | DOI:10.1080/25310429.2025.2470566

BMC Res Notes. 2025 Apr 1;18(1):137. doi: 10.1186/s13104-025-07193-4.

ABSTRACT

BACKGROUND: Childbearing is a major concern for women living with HIV especially in low-middle income countries. There are fears about access to care, risk of vertical transmission, health challenges, maternal and child morbidity/mortality. Investigation of childbearing progression and its associated factors among these women will be useful for design of reproductive healthcare services of these women and ultimately address their multifaceted concerns. This study examined childbearing progression and its correlates another among women living with HIV in Ibadan.

METHOD: The study used a dataset from a cross-sectional study on childbearing progression among 933 respondents aged (18-49) receiving HIV care at the University College Hospital, Ibadan. Synthetic Relational Gompertz method was used to estimate fertility rate in the study population while a multistate model was developed to identify the factors associated with progression from one birth to the next.

RESULTS: The average age of participants was 38 years, with majority being Yoruba tribe (80.5%). Nearly all had at least basic education (93%), and about half had 1-2 children at the time of their HIV diagnosis (47.6%). The likelihood of progressing from the first to a second birth was 77%, though no specific factors were statistically significant. However, progression to a third birth was significantly less likely (86% lower), and associated with factors such as: Having 1-2 children at HIV diagnosis (59% less likely to progress). Having more than 2 children at HIV diagnosis (94% more likely to progress), marital status (widowed women were 36% more likely to progress), partner’s education (secondary education increased the likelihood by 23%), partner’s employment status (unemployed partners increased the likelihood by 40%), desire for more children, partner’s HIV-negative status. Progression to fourth and subsequent births showed a continued decline, with the likelihood of a fourth birth being 82% lower and a fifth or sixth birth 85% lower. Women with secondary education were significantly less likely to progress to fifth births.

CONCLUSION: Overall, the corrected total fertility rate is 3.54, it’s below the national estimates and Southwest region which implies fertility is declining among women living with HIV in Ibadan. The findings revealed the relevance of socio-economic and demographic factors in childbearing progression among women living with HIV. Focused interventions should aim to provide better family planning support and integrate reproductive health counseling into HIV care programs.

PMID:40170188 | DOI:10.1186/s13104-025-07193-4

Parasit Vectors. 2025 Apr 1;18(1):124. doi: 10.1186/s13071-025-06772-5.

ABSTRACT

BACKGROUND: Thioester-containing proteins (TEPs) serve as crucial effectors and regulatory components within the innate immune system of mosquitoes. Despite their significance, the mechanisms by which TEPs exert negative regulation on the immune response in mosquitoes remain inadequately understood. This study aims to elucidate the role of TEPs in the negative regulation of melanization, thereby advancing our comprehension of their regulatory function in the immune response.

METHODS: We infected female Anopheles stephensi mosquitoes with Plasmodium yoelii by allowing them to feed on pre-infected female Kunming mice. Western blot, quantitative polymerase chain reaction, differential gene expression analyses, and gene silencing were then conducted. Student’s t-test was used to analyze continuous variables, with statistical significance defined as p < 0.05.

RESULTS: A. stephensi TEP15 (AsTEP15) negatively regulated mosquitos’ innate immunity and promoted Plasmodium development. AsTEP15 knockdown induced mosquito resistance to malaria parasite melanization during the oocyst stage and significantly reduced sporozoite numbers. Further analysis showed that AsTEP15 mainly negatively affects the TEP1 and immune deficiency (IMD) pathway, thereby inhibiting melanization.

CONCLUSIONS: We describe a mosquito TEP that negatively regulates immunity, further enriching the functional diversity of TEP family members. In addition, our results suggest that oocysts may exploit TEPs to escape or inhibit mosquito immunity, highlighting potential targets for blocking malaria transmission.

PMID:40170182 | DOI:10.1186/s13071-025-06772-5