Background:Cardiovascular complications remain the leading cause of mortality in patients undergoing maintenance hemodialysis (MHD), with heart failure (HF) representing a major clinical challenge. Beyond neurohormonal dysregulation, malnutrition and chronic microinflammation contribute significantly to disease progression. This study investigated whether angiotensin receptor-neprilysin inhibition combined with enteral nutritional support could provide additive benefits in this high-risk population. Methods:A randomized controlled clinical study was conducted involving 60 MHD patients with HF, allocated to standard therapy or combined intervention groups. The intervention consisted of sacubitril/valsartan administration together with structured enteral nutrition support. Cardiac structure and function, inflammatory markers, nutritional indices, immune parameters, and quality-of-life scores were evaluated over 6 months. In parallel, a rat model of post-infarction HF was established to validate mechanistic and physiological changes, including echocardiographic measurements and serum biomarker assessment. Results:Patients receiving the combined regimen demonstrated superior improvement in left ventricular systolic performance, with greater reductions in LV dimensions and circulating BNP levels compared with conventional treatment. Inflammatory mediators including IL-1β, IL-6, and CRP were significantly attenuated, while serum albumin, total protein, hemoglobin, and immunoglobulin levels increased more prominently. Quality-of-life scores improved without excess adverse events. Experimental findings mirrored clinical observations: treated rats exhibited improved LVEF, reduced ventricular remodeling indices, and decreased BNP and pro-inflammatory cytokines relative to untreated HF controls. Conclusion:The integration of sacubitril/valsartan therapy with enteral nutritional supplementation exerts synergistic effects on cardiac remodeling, inflammatory modulation, and metabolic recovery in MHD-associated HF. These findings support a multidimensional therapeutic strategy targeting both neurohormonal activation and nutritional-inflammatory imbalance.
Purpose:Type 5 diabetes mellitus (T5DM), recently proposed as a diabetes phenotype associated with chronic undernutrition, remains poorly characterized regarding pancreatic structural changes. This study aimed to describe pancreatic MRI morphological features in individuals with clinically suspected T5DM from a resource-limited African setting. Methods:This retrospective case series included four individuals with clinically suspected T5DM from Mzuzu Central Hospital, Malawi. Clinical characteristics, nutritional history, and routine abdominal MRI findings were reviewed. Pancreatic morphology was assessed using manual segmentation of axial T2-weighted PROPELLER images, with segmentation-derived pancreatic area and volume obtained. Results:Four individuals (two females and two males; age range, 10-35 years) were included. All patients had a lean body habitus (BMI range, 16.4-18.3 kg/m2), childhood nutritional deprivation history, and no documented diabetic ketoacidosis or recurrent ketosis. MRI demonstrated a consistent morphological pattern characterized by relative preservation of the pancreatic head and uncinate process with reduction of the distal pancreas. Three patients showed thinning of the pancreatic body and tail, while the youngest patient demonstrated a shortened pancreatic tail not reaching the splenic hilum. Pancreatic body diameter ranged from 7.6 to 11.6 mm, with segmentation-derived pancreatic volume ranging from 16.9 to 27.3 cm3. Conclusion:Individuals with clinically suspected T5DM demonstrated a recurrent pancreatic MRI pattern of preserved head morphology with reduced body and tail structures. These preliminary findings suggest that MRI-based pancreatic morphological assessment may provide additional structural information for malnutrition-associated diabetes phenotyping, particularly in settings with limited metabolic characterization.
Background:Painful diabetic peripheral neuropathy (PDPN) is a common complication of diabetes mellitus characterized by chronic neuropathic pain, sleep disturbance, and impaired quality of life. Although pharmacological therapies remain the cornerstone of treatment, many patients experience inadequate symptom control. Access to advanced interventional pain management techniques, including radiofrequency ablation and neuromodulation, remains limited in many healthcare settings. We report the first case of ultrasound-guided lumbar sympathetic block (LSB) performed for refractory PDPN at Mzuzu Central Hospital, Malawi. Case Presentation:A 19-year-old woman with a 9-year history of type 1 diabetes mellitus presented with bilateral lower-limb neuropathic pain that had persisted for 6 years and progressively worsened over the preceding 3 years. Symptoms were more severe in the right lower limb, with a baseline Numerical Rating Scale (NRS) score of 8/10. Clinical features included burning pain, stabbing pain, numbness, allodynia, sleep disturbance, and impaired mobility. The Douleur Neuropathique 4 (DN4) score was 8/10. Previous treatment with amitriptyline, gabapentin, vitamin B supplementation, diclofenac, and tramadol failed to provide satisfactory symptom relief.The patient underwent four ultrasound-guided right lumbar sympathetic blocks using 10 mL of 1% lidocaine between May 15 and May 25, 2026. Pain intensity decreased from an NRS score of 8 to 4 immediately after the first procedure and from 5 to 1 after the second procedure. Complete pain relief was achieved before the third procedure and was maintained throughout the two-week follow-up period. Skin temperature increased by approximately 0.9-1.0°C after each block. No procedure-related complications were observed. Conclusion:Repeated ultrasound-guided lumbar sympathetic block provided substantial and sustained pain relief in refractory PDPN. This minimally invasive, low-cost, and reproducible technique may represent a practical therapeutic option for selected patients with refractory neuropathic pain and may be particularly valuable in settings where access to advanced pain interventions is limited.
Introduction:While computer experience is often considered a key determinant of digital health adoption, psychological factors such as computer anxiety may play an equally important role. This study examined the relative contributions of computer experience and computer anxiety to digital health adoption intention among healthcare workers in Malawi. Methods:A cross-sectional survey was conducted among 615 healthcare workers in Malawi. The primary outcome variable was digital health adoption intention, while key explanatory variables included computer anxiety and Computer experience. Internal consistency was assessed using Cronbach's alpha. Bivariate associations were examined using Welch's t-tests and chi-square tests, while Pearson correlation analysis was used to assess relationships among key variables. Hierarchical linear regression models were estimated to evaluate the independent effects of computer experience and computer anxiety on digital health adoption intention. Results:Participants reported high digital health adoption intention (mean = 6.52, SD = 1.02) and relatively low computer anxiety (mean = 2.08, SD = 1.33). Compared with healthcare workers with low digital health system adoption intention, those with high adoption intention were more likely to have received DHS training (42.3% vs. 32.8%, p = 0.021), reported longer computer use experience (9.2 vs. 7.9 years, p = 0.010), and exhibited lower computer anxiety scores (1.77 vs. 2.49, p < 0.001). In hierarchical regression analyses, computer experience variables explained only 1.1% of the variation in adoption intention (R2 = 0.011), whereas computer anxiety alone explained 6.9% (R2 = 0.069). After adjusting for computer experience, age, gender, qualification, occupation, and experience, computer anxiety remained the only significant predictor of adoption intention (β = -0.212, 95% CI: -0.277 to -0.147, p < 0.001). Conclusions:The findings of the study suggest that interventions aimed at reducing computer anxiety play a critical role in improving the acceptance and sustainability of digital health systems in resource-constrained healthcare settings.
Aim:To quantify publication trends, map international collaboration networks, and identify dominant and emerging research themes in Pulmonary fibrosis(PF) imaging (2015-2024). Methods:A structured Web of Science search combining PF- and imaging-related terms yielded 1,159 English-language original research articles. Analyses employed CiteSpace, VOSviewer, and Scimago Graphica for trend assessment, keyword co-occurrence, citation burst detection, and collaboration network visualization. Results:Annual publication volume showed sustained linear growth (R2 = 0.867). Researchers from 64 countries contributed; the United States led in output (332 publications) and citation impact (9,821 citations), while China ranked second in volume (224 publications) with lower proportional citation impact. The Western Europe-North America axis showed the densest collaborative ties. Keyword co-occurrence revealed close thematic links among idiopathic pulmonary fibrosis, high-resolution computed tomography (HRCT), usual interstitial pneumonia (UIP), survival, and mortality. Citation burst analysis identified "deep learning" as the strongest and most sustained burst (2021-2024), by which point it had shifted from exploratory method to established domain. Three overlapping research phases emerged: diagnostic framework consolidation (2015-2018), computational computed tomography (CT)-based phenotyping (2016-2022), and therapeutic expansion toward antifibrotics and progressive fibrosing interstitial lung disease (2019-2024). Conclusion:PF imaging research has shifted from diagnostic consensus toward quantitative CT biomarkers and artificial intelligence(AI)-driven phenotyping, driven by the need to reduce interobserver variability and enable individualized risk stratification. Geographic fragmentation and limited multicenter validation remain key barriers to AI generalizability. Future priorities include standardized imaging protocols, prospective multicenter validation cohorts, and integration of AI-driven CT phenotyping with multi-omics and circulating biomarkers for prognostic precision.
Introduction:The Malawi Ministry of Health (MMoH) and partners developed a comprehensive Coronavirus Disease 2019 (COVID-19) Vaccine Related Events (VREs) response plan in 2022. A VRE is any anticipated threat that could erode the public's trust in vaccines or vaccination delivery. We explored the MMoH's readiness to implement the plan by assessing the availability of VRE-related documents describing the overall process of identifying, reporting, investigating, and coordinating a VRE response; and by assessing the strengths and weaknesses of the current system. Methods:We conducted a cross-sectional assessment among MMoH staff involved in VRE response at national, district, and health facility level using a survey and a semi-structured interview guide in ten districts in Malawi in 2023. Ten VRE-related documents were assessed and their availability visually confirmed. We assessed each of the survey findings by district and zone. Ten key themes pertaining to VRE identification, reporting, investigation, and response were explored in 109 Key Informant Interviews (KIIs) and six Focus Group Discussions (FGDs). Results:More than 60% of respondents reported having access to VRE-related documentation, but less than 10% reported access to non-Adverse Events Following Immunisation (non-AEFIs)-related guidance. Participants identified existing processes for AEFIs, but noted the lack of training, coordination, and budgetary support for both AEFI and non-AEFI activities. Health facilities with VRE response teams or committees had implemented aspects of the response plan, emphasizing the need to formulate teams or committees in all health facilities. Conclusion:Adequate implementation of Malawi's VRE response plan will require expanded training opportunities, sustained funding, and improved coordination across all levels of the health system.
Background:Cerebral palsy (CP) is the leading cause of childhood disability worldwide, with a significantly higher burden in low- and middle-income countries (LMIC). In Malawi, children with CP often face limited access to rehabilitation services, social exclusion, and poor health outcomes, all of which negatively affect their quality of life (QoL). Although the CP QoL-Child is a validated instrument for assessing QoL in children with CP, no culturally adapted or translated version existed for Malawi. Aim:This study aimed to translate, culturally adapt, and validate the CP QoL-Child primary caregiver version into Chichewa for use in Malawi. Methods:This cross-sectional study involved 62 caregivers of children with CP in Malawi. The CP QoL-Child for Primary Caregivers was translated into Chichewa following standard guidelines. Internal consistency was assessed with Cronbach's alpha and test-retest reliability with intraclass correlation (ICC). ANOVA was used to explore associations with GMFCS levels. Results:The Chichewa CP QoL-Child showed excellent internal consistency (α = 0.96 overall; domain α = 0.65-0.96). Test-retest reliability was strong, with ICCs ranging from 0.84 to 0.96. The Access to Services domain had the lowest internal consistency (α = 0.65), while the highest temporal stability was found in Feelings about Functioning and Emotional Well-being (ICC = 0.96). Conclusion:The Chichewa version of the CP QoL-Child for Primary Caregivers shows strong reliability and offers a valuable tool for understanding and improving the quality of life of children with CP in Malawi, with potential to inform interventions and policy.
BackgroundChronic alcohol exposure leads to progressive neurodegeneration, primarily driven by sustained neuroinflammation and microglialactivation. While microRNAs are key regulators of neuroimmune responses, the specific role of miR-146a-5p and its downstreamtargets in ethyl alcohol (EtOH)-induced neuroinflammatory injury remain poorly understood.MethodsA chronic EtOH exposure model was established in C57BL/6 mice and BV-2 microglial cells. Neuroinflammatory damage wasassessed using behavioral tests (Morris water maze), apoptosis assays, cytokine quantification, and immunostaining. Theregulatory relationship between miR-146a-5p and its target gene Btg2 was investigated using luciferase reporter and RNA pull-down assays, combined with gain-of-function approaches. ResultsEtOH exposure significantly downregulated miR-146a-5p expression in both mouse hippocampal tissue and BV-2 cells.Overexpression of miR-146a-5p in vivo improved spatial learning and memory, reduced neuronal apoptosis, and attenuatedmicroglial activation and pro-inflammatory cytokine (IL-1β, IL-6, TNF-α) production. Mechanistically, Btg2 was identified as adirect target of miR-146a-5p. EtOH-induced Btg2 upregulation was reversed by miR-146a-5p overexpression in vitro.Importantly, restoring Btg2 expression abolished the anti-inflammatory and anti-apoptotic effects of miR-146a-5p in EtOH-treated BV-2 cells.ConclusionThis study identifies the miR-146a-5p/Btg2 axis as a critical regulator of EtOH-induced microglial activation andneuroinflammation. Targeting this pathway may offer a promising therapeutic strategy for alcohol-related neurodegeneration.
Background: The anatomy of the zygomatic bone, maxilla, periorbital, and mental regions is important because important vessels and nerves pass through these regions. The zygomaticofacial nerve can be injured during facial surgeries, especially during zygomatic implant surgeries. Infraorbital and mental nerves are among the nerves blocked during local anesthesia in dentistry.Objective: To evaluate the topographic and morphometric characteristics of the zygomaticofacial, infraorbital, and mental foramina, and to determine their anatomical variations and clinical significance in order to provide guidance for maxillofacial surgical procedures andregional anesthesia applicationsMethods: 30 dry human skull bones (60 sides) were examined. The distance of the zygomaticofacial foramen to the edge of the orbit, thedistance to the lower end of the zygomaticomaxillary suture, the distance to the upper end of the zygomaticotemporal suture, andthe distance to the infraorbital foramen were measured. The distance of the infraorbital foramen to the edge of the orbit and thelower end of the suture zygomaticomaxillaris was measured. Morphometric measurements of the mental foramen variations wereexamined.Results: Distance between infraorbital foramen and zygomaticomaxillary suture found 24.42 mm on the right; 25.21 mm on the left. It was statistically significant (p = 0.030). The location of the zygomaticofacial foramen was evaluated in four regions (A, B, C, and D), andthe most frequent location was region A.Conclusion: Determining the area where the zygomaticofacial foramen is most commonly located will serve as a guide to help prevent nerve injury during facial surgery. It is important that there is no significant difference in the distances between the foramina on the rightand left sides to facilitate surgical interventions.
Introduction: Ovarian cancer is a leading gynecological malignancy mortality globally. Clinical outcomes in sub-Saharan Africa (SSA) are poor, largely due to late-stage presentation and limited accessing to effective treatment options. Referral pathways also delay diagnosis and compromise delivery of guideline-concordant care. A comprehensive mapping of evidence on ovarian cancer presentation andmanagement across SSA is needed to characterize what is known, where evidence is concentrated, and where critical gaps persist. Methods and analysis: This protocol describes a systematic scoping review of literature on ovarian cancer presentation and management in SSA. The review will be conducted in accordance with the Arksey and O’Malley methodological framework and reported using PRISMA-ScR guidance. The Population Concept Context (PCC) framework will guide eligibility and data charting (Population: individuals diagnosed with ovarian cancer, including epithelial ovarian cancer and, where specified, fallopian tube or primary peritoneal cancer;Concept: presentation from symptom onset to diagnosis and management across the care pathway; Context: SSA). We will search PubMed, Embase, Scopus, Web of Science, CINAHL, and the Cochrane Library, alongside relevant grey literature sources (organizational websites, conference proceedings, dissertations/theses). Searches will be limited to English-language evidence published between January 2000 and June 2026. Two reviewers will independently screen titles/abstracts and full texts, with disagreements resolved by consensus or a third reviewer. Data will be charted using a standardized extraction form capturing study characteristics, presentation indicators (symptoms, stage at diagnosis, delays), diagnostic/staging approaches, management modalities (surgery, systemic therapy, radiotherapy, supportive/palliative care), and barriers/facilitators. Results will be synthesized using descriptive mapping and narrative/ thematic synthesis. Ethics and dissemination: Ethics approval is not required as this review will use de-identified publicly available data. Findings will be disseminated through peer-reviewed publications, conference presentations, and stakeholder engagement to inform policy, service delivery, and research priorities for improving ovarian cancer outcomes in SSA. Strengths and limitations of this study: This review will provide a comprehensive evidence map across the ovarian cancer care pathway in sub-Saharan Africa, drawing on both published and grey literature to characterize the scope, distribution, and nature of available evidence. Rigor and transparency will be strengthened through dual independent screening of titles/abstracts and full texts. However, restricting inclusion to Englishlanguage evidence published between 2020 and June 2026 may result in the omission of relevant studies from earlier periods or those published in other languages. In addition, no critical appraisal of the quality of the studies will be undertaken, consistent with the objectives of a scoping review to map evidence rather than evaluate study quality.
Introduction: Although Malawi has expanded various digital health initiatives under its National Digital Health Strategy, there is still limited research on how prepared frontline healthcare workers really are to adopt and use Digital Health Systems (DHS). Most previous studies have focused on system level improvements in data reporting rather than on the experiences and preparedness of the users themselves. This is a major gap as healthcare workers’ level of preparedness directly influences system performance, and data quality. This study assessed healthcare workers’ preparedness to adopt DHS in Malawi.Methods: A cross-sectional study was conducted using a structured questionnaire administered to 615 healthcare workers in selected districts across the three regions of Malawi. Key TAM constructs were analysed using descriptive statistics and binary logistic regression.Results: Overall preparedness levels among healthcare workers for DHS adoption were high. Behavioural intention (94.3%), job relevance (94.1%), and subjective norms (92.1%) recorded the highest scores. Significant predictors of adoption were behavioural intention (OR = 2.67, p < 0.001), job relevance (OR = 2.12, p < 0.001), perceived usefulness (OR = 1.85, p = 0.002), and subjective norms (OR = 1.58, p = 0.014). Majority of respondents from the Southern region reported having attended DHS training compared tothose from the Northern region (OR = 2.337, 95% CI:1.549-3.097, p < 0.001), while no significant difference was observed for the Central region (p = 0.330). A higher proportion of male respondents reported having previously attended digital health training compared to female respondents (OR = 1.496, p = 0.019).Conclusion: Motivational and social factors are the main predictors of DHS adoption in Malawi, while technical capacity remains a challenge. To ensure successful implementation and scale-up of digital health initiatives in Malawi, policymakers and health managers should focus on strengthening and improving user training, improving access to computers and reliable internet within health facilities, and promoting a supportive organisational culture.
Objective:To evaluate whether adding a spleen- and kidney-invigorating Chinese herbal decoction to highly active antiretroviral therapy (HAART) improves immune recovery and nutritional status in people living with HIV. Methods:Forty adults living with HIV were randomly allocated to receive either standard HAART alone or HAART plus a Chinese herbal decoction composed of astragalus, Chinese yam, dangshen, poria cocos, white atractylodes rhizome, radix pseudostellariae, and rehmannia glutinosa. Immune indices (CD4+, CD8+ T cells, Th17 cells), inflammatory cytokines (interferon-γ [IFN-γ], tumor necrosis factor-α [TNF-α]), hematological and nutritional parameters (hemoglobin, serum albumin), adverse drug reactions, and Medical Outcomes Study HIV Health Survey (MOS-HIV) scores were compared between groups. Results:Compared with HAART alone, HAART plus Chinese herbal decoction produced more marked immune reconstitution. At 6-12 months, the combination group had higher CD4+ counts (37.58 ± 3.76 vs 30.25 ± 3.02 cells/µL, P < 0.0001), lower CD8+ counts (22.41 ± 2.25 vs 28.62 ± 2.65 cells/µL, P < 0.0001), and higher Th17 levels (2.26 ± 0.23 vs 1.89 ± 0.19 cells/µL, P < 0.0001). IFN-γ and TNF-α concentrations were significantly reduced, while hemoglobin (126.87 ± 12.68 vs 116.32 ± 11.65 g/L, P = 0.009), serum albumin (38.82 ± 3.84 vs 32.45 ± 3.26 g/L, P < 0.0001), and MOS-HIV scores (80.36 ± 8.07 vs 72.58 ± 7.25, P = 0.0026) were higher in the combination group. The incidence of adverse reactions was similar between the two groups. Conclusion:Adjunctive use of a spleen- and kidney-invigorating Chinese herbal decoction with HAART may help restore the balance of T-lymphocyte subsets, attenuate systemic inflammation, enhance immune function, and improve nutritional status in patients with acquired immune deficiency syndrome.
BackgroundDual practice—where health professionals simultaneously participate in public and private healthcare markets—is common in many health systems but presents complex governance challenges. In 2026, the Government of Malawi issued Presidential Executive Order No. 1 of 2026, prohibiting public health workers from soliciting informal payments in public facilities and restricting their ownership or financial interests in private healthcare establishments. The policy has generated significant national debate regarding its implications for health system governance and workforce incentives.ObjectiveThis commentary examines the policy rationale and potential implications of the Executive Order, focusing on the tension between addressing conflicts of interest and maintaining appropriate incentives for health workforce retention.DiscussionDrawing on international literature and comparative policy experiences, the commentary situates Malawi’s reform within the broader global discourse on dual practice regulation. Evidence from multiple health systems indicates that physician ownership of private facilities can introduce structural conflicts of interest that undermine public sector performance through patient diversion, reduced public sector effort, and erosion of public trust. However, outright restrictions on private sector engagement may also carry unintended consequences in settings where public sector remuneration is limited and specialist workforce shortages are acute. International experiences demonstrate that successful regulation of dual practice requires careful alignment of governance mechanisms, workforce incentives, and health system accountability.ConclusionMalawi’s Executive Order represents a decisive attempt to strengthen the integrity of public healthcare delivery by addressing ownership-based conflicts of interest. Its long-term effectiveness will depend on balanced implementation, transparent regulatory guidance, and complementary reforms that address workforce incentives and health system capacity. The current debate offers an opportunity to move beyond polarized narratives and instead focus on building a governance framework that simultaneously protects public trust and supports a sustainable health workforce.
BackgroundAchieving health-related Sustainable Development Goals (SDGs) in Africa is increasingly threatened by the rising burden of cardiovascular diseases (CVD), exacerbated by limited healthcare infrastructure and constrained resources. Mathematical modellingoffers a powerful tool for informing CVD prevention and control strategies; however, its application in Africa remains poorly understood. This scoping review aims to map existing modelling studies, identify methodological and contextual gaps in the literature,and inform future model development for effective decision-making.MethodsThis scoping review followed Levac et al.’s framework and PRISMA-ScR guidelines to explore how mathematical models have been used to study CVD in Africa. We included studies published since 2000 that used structured models to simulate how CVD progresses and responds to risk factors or interventions. Our search, conducted in PubMed and Google Scholar, focused on models relevant to local settings and policy. Data were extracted and analysed thematically. As the review used only publicly available data, no ethical approval was needed. The protocol was registered with the Open Science Foundation.ResultsCVD modelling studies in Africa span nearly two decades, with a geographic concentration in South Africa, Nigeria, and Kenya, while many low-resource and fragile settings remain underrepresented. A range of modelling approaches were used, including decision- analytic models, microsimulation, and WHO-CHOICE frameworks, with recent studies increasingly incorporating dynamic and stochastic elements. Interventions modelled included pharmacological treatments (e.g., statins, antihypertensives), lifestyle modifications (e.g., salt reduction, increased physical activity), and community-level prevention strategies. Many models assessed combinations of interventions and accounted for multiple risk factors. However, limitations in local data availability led to reliance on extrapolated estimates, assumptions about treatment effects, and expert-informed parameterization. Few studies calibrated models to local epidemiological data or disaggregated outcomes by equity dimensions such as gender, income, or geography.ConclusionWhile CVD modelling in Africa has progressed, its utility for informing real-world policy remains limited by insufficient incorporation of health system constraints and equity considerations. To maximize impact, future efforts should prioritize the development of context-specific microsimulation frameworks that integrate system dynamics, reflect local implementation realities, and use countryspecificdata for calibration.
Background Frotteurism has been regarded as just a nuisance crime but studies have shown that victims experience months of distress and feelings of violation and disgust. As nursing undergraduates navigate from their residence to their points of clinical placement, they may be exposed to frotteuristic treatments from members of the public and this might cause them distress. As no similar data exists in literature, this study ascertained the frequency, perceived effect, and coping strategies for frotteurism among undergraduates at the University of Nigeria, Enugu. Methods Across-sectional descriptive design was adopted among 229 Nursing undergraduates. Data was collected using a researcher-developed structured questionnaire for prevalence and perceived effects and the BRIEF coping inventory to ascertain coping mechanisms. Results Majority (73.4%) of respondents had experienced frotteuristic victimization at least once. Rubbing of the thigh by a stranger (58.5%) and touching that involves any sensitive areas (56.8%) were the commonest frotteuristic treatments experienced, though their frequencies were low, (1.42 +/- 1.13, and 1.35 +/- 1.11) respectively. The reported effects of frotteurism were anger/upset (4.36 +/- 0.98), and changes in behavior such as being more cautious while in public places (4.23 +/- 0.98). Coping strategies among victims included turning to work/ other activities to take their minds off (2.58 +/- 1.18) and accepting the reality that it had happened (2.53 +/- 1.10). Experience of frotteurism was not significantly associated with the demographic characteristics of age (p = .760), gender (p =.863), and academic level of study.. There was no significant association between the frequency of frotteurism treatment and perceived effects among victims (p =.457). Conclusion The majority of the respondents had experienced a frotteuristic victimization by strangers and the experience was perceived to be upsetting. Findings highlight the need for healthcare providers to recognize the need for providing supportive interventions to victims of this common but often overlooked sexual offense.
BackgroundMagnetic resonance imaging (MRI) in young infants requires effective immobilization to ensure diagnostic image quality. Although non-pharmacological approaches such as the feed-and-swaddle technique are widely recommended, they are not always successful. Sedation in neonates remains controversial, particularly in resource-limited settings. This study aimed to evaluate the feasibility and observed safety profile of intramuscular ketamine for MRI sedation in young infants at Mzuzu Central Hospital, Malawi.MethodsThis retrospective case series included five young infants (aged 3-90 days) who underwent abdominal MRI under ketamine sedation between August 2025 and March 2026. Diagnoses included three cases of congenital biliary atresia, one cloacal exstrophy, and one sacrococcygeal teratoma. All patients initially failed non-pharmacological sedation using the feed-and-swaddle technique alone. Sedation was performed by an experienced anesthesiologist using intramuscular atropine (0.01 mg/kg) followed by ketamine (4-5 mg/kg). MRI scans were performed using a 1.5 T system. Respiratory status was assessed via MRI respiratory gating waveforms. Clinical data were collected from medical records, including anesthesia records, and analyzed descriptively.ResultsAll MRI examinations were successfully completed, with a mean scan time of 23 minutes. No clinically significant adverse events were observed, including oxygen desaturation or airway-related complications. No overt clinical signs suggestive of hemodynamic instability were noted. All images were of diagnostic quality as assessed by the radiologist. The target sedation depth was achieved in all cases without the need for additional dosing. The mean time to emergence was 40 minutes, and the mean time to full recovery was 94 minutes, with no cases of delayed recovery or agitation.ConclusionIntramuscular ketamine, when used with appropriate precautions, appears to be a feasible option and may represent a safe alternative for MRI sedation in young infants in resource-limited settings.
Background Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease with poor prognosis. Its early diagnosis is challenging due to nonspecific clinical features and overlap with infectious pulmonary diseases. Bronchoalveolar lavage fluid (BALF) provides direct access to lower respiratory tract cellular components, offering potential adjunctive diagnostic value. This study aimed to evaluate the cytological characteristics of BALF in IPF and assess their utility in differentiating IPF from non-fibrotic pneumonia. Methods We retrospectively analyzed 64 IPF patients and 64 age-, sex-, and intensive care unit (ICU) admission-matched patients with community-acquired pneumonia (CAP) who underwent BAL at the First Affiliated Hospital of Xi'an Jiaotong University (January 2021-November 2025). BALF total cell counts and differential cell proportions were measured. Multivariable logistic regression identified independent discriminators, and receiver operating characteristic (ROC) curve analysis evaluated the diagnostic performance of individual and combined BALF parameters. Results IPF patients showed significantly higher proportions of macrophages (median 29.55% vs. 11.70%, P<0.001), lymphocytes (7.20% vs. 3.60%, P=0.031), and eosinophils (1.00% vs. 0.40%, P=0.008), and a significantly lower neutrophil proportion (58.50% vs. 80.90%, P<0.001) compared with pneumonia patients. Multivariable analysis confirmed eosinophil percentage (OR=1.871, 95%CI:1.123-2.836) and macrophage percentage (OR=1.139, 95%CI:1.082-1.199) as independent discriminators of IPF. The combined logistic regression model incorporating these two parameters yielded an area under the curve (AUC) of 0.832 (95%CI:0.761-0.903), with a sensitivity of 93.8% and a specificity of 65.6%, outperforming either parameter alone. Conclusions BALF cellular profiles differ significantly between IPF and non-fibrotic pneumonia. Macrophage and eosinophil percentages are independent discriminators of IPF, and their combination provides good discriminative performance. Although BALF cytology alone is insufficient for a definitive diagnosis, it serves as a valuable adjunctive tool, particularly when high-resolution computed tomography findings are atypical or when infection is suspected. These findings support the potential utility of BALF cellular analysis in the diagnostic workup of IPF and warrant further prospective validation, including integration with molecular biomarkers.
