INTRODUCTION: The integrity of the Achilles tendon (AT) plays a significant role in foot biomechanical efficiency. Diabetes mellitus contributes to the development of AT tears which impairs movement and productivity. The objective of this study was to sonographically assess the prevalence and associated factors of Achilles tendon tears in Type-2 diabetes mellitus, with and without peripheral neuropathy (PN), and compare with a control population. METHODS: A prospective cross-sectional study was conducted on 71 Type-2 diabetics subjects and 80 controls. AT tears and calcifications were detected in the subjects using high resolution B-mode ultrasound. RESULTS: AT calcification was significantly associated with dominant and non-dominant foot AT tear, while HbA1c and PN were significantly associated with dominant foot AT tear (P < 0.05, respectively). There were significantly more AT calcifications and tears on the dominant foot AT of diabetics with PN (P < 0.001). The prevalence of AT tears in Type-2 diabetics was 7.75%. HbA1c ≥ 6.95% was shown to have a high sensitivity (75%), specificity (74.60%) and accuracy (75.35%) to correctly predict the development of a non-traumatic AT tear in diabetics with PN. CONCLUSION: The prevalence of AT tear in Type-2 diabetics, based on sonographic diagnosis, is low. The likelihood of AT tears increases in the dominant foot when HbA1c level equals or exceeds 6.95% in diabetics with peripheral neuropathy. This preliminary study showcases the need to incorporate Achilles tendon sonographic evaluation to rule out tears in the management of diabetics.
INTRODUCTION: Women of reproductive age often face hormonal fluctuations, dual‐role pressures, and a tendency to use the internet as a coping mechanism, all of which may lead to persistent distress and impair memory and concentration. This study aimed to identify the associations between anxiety persistence and severity, premenstrual dysphoric disorder (PMDD), and problematic internet use (PIU) and cognitive function in women of reproductive age. METHODS: In this cross‑sectional analytic observational study at Baiturrahman Primary Health Care Centers in Banda Aceh, Indonesia (March 2025), 86 women aged 19–45 were recruited via accidental sampling. Initial anxiety screening used the GAD‑7, excluding scores 0–4 and including only respondents with scores ≥ 5. We then assessed PMDD with the Premenstrual Symptoms Screening Tool (PSST), PIU via a standardized questionnaire, and cognitive dysfunction using Montreal Cognitive Assessment-Indonesian Version (MoCA‑INA), where dysfunction was defined as a score < 26. RESULTS: The majority of respondents experienced cognitive dysfunction (74.42%, n=64). This occurred within a sample where 61.63% (n= 53) exhibited severe anxiety and 53.49% (n=46) had anxiety lasting ≥ 5 years. Additionally, 39.53% (n=34) screened positive for PMDD and 77.91% were classified as having problematic internet use. Significant associations were found between cognitive dysfunction and anxiety severity (Odds Ratio, OR = 4.7; 95% Confidence Interval, CI: 1.23–17.9; p-value, p = 0.023), anxiety duration ≥ 5 years (OR = 4.9; 95% CI: 1.27–18.9; p = 0.021), PMDD positivity (OR = 7.3; 95% CI: 1.48–36.6; p = 0.015), and problematic internet use (OR = 5.7; 95% CI: 1.33–24.7; p = 0.019). CONCLUSION: Anxiety severity and duration, PMDD, and problematic internet use are associated with cognitive dysfunction among reproductive-aged women.
INTRODUCTION: Tuberculosis (TB) is a major health burden in the world, and particularly in individuals living with HIV. This study evaluated the comparative performance of GeneXpert MTB/ RIF and Lipoarabinomannan tests against TB culture, in HIV-positive and HIV-negative patients in the University Teaching Hospital of Kigali. METHODS: A total of 124 participants (37 HIV-positive and 87 HIV-negative) were enrolled. Sputum, urine, and other specimens were tested using GeneXpert MTB/RIF and urinary LF-LAM, with results compared against TB culture on Lowenstein–Jensen media as the diagnostic gold standard. RESULTS: In HIV-positive patients, LF-LAM had a sensitivity of 75% (95% CI: 47%-91%) and a specificity of 84% (95% CI: 65%-94%), whereas GeneXpert had a sensitivity of 67% (95% CI: 39%-86%) and a higher specificity of 96% (95% CI: 80%-99%). All tests performed better in HIV-positive patients (p-value = 0.0008 for LAM; p-value = 0.0001 for GeneXpert). In the HIV-negative group, GeneXpert's sensitivity was 65% (95% CI: 41%- 83%), significantly outperforming LF-LAM's sensitivity of 35% (95% CI: 17%- 59%). These findings underscore the importance of tailored diagnostic approaches based on patient immune status to optimize TB detection accuracy. The study elucidated the disparities between the LAM test and GeneXpert in diagnosing tuberculosis among patients with or without HIV, paving the way for more targeted and effective diagnostic interventions. CONCLUSION: The study findings showed a complementary role of both GeneXpert and LF-LAM. LF-LAM is strongly effective as a quick screening test in TB detection and an early intervention tool in HIV-positive patients because it has a much greater diagnostic sensitivity in this population. Integration of the LAM test into TB diagnostic algorithms for immunocompromised populations could improve early detection and treatment initiation, thus reducing TB morbidity and mortality.
INTRODUCTION: Epilepsy stands out as one of the prevalent neurological conditions, especially in children, caused by impaired brain function with the typical symptom of recurrent seizures due to the release of electrical charges from proximal brain neurons without provocation. The aim of this study is to identify the risk factors that contribute to the development of drug-resistant epilepsy (DRE) in pediatric patients with a prior history of epilepsy. METHODS: A cross-sectional observational analytic study was carried out on pediatric patients with epilepsy at Dr. Kariadi Hospital Semarang, Indonesia by analyzing the patient’s medical records. The data were analyzed with univariate and bivariate tests and presented in tabular form. RESULTS: Based on the findings from 73 medical records collected for this study, the incidence of drug-resistant epilepsy (DRE) was identified in 58 subjects (79.5%). Bivariate analysis revealed significant risk factors associated with DRE, namely the type of anti-epileptic drugs (AEDs) used and their dosage (p < 0.001). Another factor shown to increase the risk of DRE was seizure frequency (p = 0.016). CONCLUSION: The risk factors for the occurrence of DRE in children identified in this study include the type and dosage of anti-epileptic drugs (AEDs), as well as seizure frequency. Inadequate or inappropriate administration of AEDs may increase the likelihood of recurrent epileptic seizures and elevate the risk of developing DRE. Frequent seizures, which are commonly associated with DRE in pediatric patients, may further damage the developing brain.
INTRODUCTION: TLower limb amputation (LLA) is the complete loss of any part of the lower extremity along the transverse anatomical plane. It is one of the oldest surgical procedures, with origins tracing back to Hippocrates and evidence of amputation dating 31,000 years ago. LLA is a common disability globally, affecting an estimated 65 million individuals, with 1.5 million amputations performed annually, 60% involving lower limbs. This study aimed to investigate the prevalence, risk factors, outcomes, and management of LLA at Hoima Regional Referral Hospital, Uganda. METHODS: A retrospective cross-sectional study was conducted using data from operating room registries, medical files, and physiotherapy records. After verification for completeness and clarity, data were analysed using SPSS, with results presented in tables and graphs. RESULTS: A total of 60 patient files were reviewed. Most patients were male (68.3%), aged ≥50 years (65.0%), from rural areas (61.7%), with secondary education (41.7%), and Catholic (35.0%). The prevalence of LLA was 6.7%. Significant risk factors included age, sex, diabetes mellitus, BMI, and gangrene. Of the four amputees, 25% required re-amputation, 25% experienced in-hospital mortality, and 50% utilized physiotherapy. Psychological scores ranged from 3 to 10 (mean: 6.0), with 75% showing good psychological status and 25% fair status. CONCLUSION: LLA remains a significant public health concern, impacting quality of life. Key factors associated with LLA include age, sex, diabetes mellitus, BMI, and gangrene.
INTRODUCTION: Abdominal pregnancy is a rare type of ectopic pregnancy, and it is associated with high morbidity and mortality. Its diagnosis is very challenging to establish, most often in an acute setting, leading to a high percentage of fetal and maternal morbidity and mortality. CASE PRESENTATION: We present the case of a 27-year-old G2P1001 with abdominal pregnancy at 35 weeks 3 days who presented with painful fetal movements. She consulted the district hospital initially, where she was misdiagnosed and reassured as having a normal, evolving pregnancy. Later, with worsening of symptoms, she was referred to the tertiary hospital, where she was assessed, and ultrasonography findings revealed an empty uterus, a live fetus outside the uterine cavity, the placenta attaching to the fundus (ill-defined fundus), consistent with advanced abdominal pregnancy with a live fetus. Laparotomy was planned and performed, and a healthy newborn was born. The mother successfully recovered and was discharged uneventfully with her baby. CONCLUSION: Abdominal pregnancy poses a challenge in establishing a diagnosis, with a greater chance in cases of increased awareness. It requires a high index of suspicion for diagnosis and skills, as timely diagnosis leads to the correct treatment immediately and reduces morbidity and mortality. The Ministry of Health, in collaboration with the teaching universities, should prepare timely refresher courses for junior doctors to increase their awareness and enhance early ultrasonography to confirm the location of pregnancy for pregnant mothers.
INTRODUCTION: Scrub typhus is a zoonotic infection caused by Orientia tsutsugamushi, transmitted through the bite of infected chiggers. It is an emerging public health concern in many tropical regions, including South and Southeast Asia, and is often underdiagnosed due to its nonspecific clinical presentation. The disease spectrum ranges from mild febrile illness to severe multi-organ dysfunction, contributing significantly to morbidity and mortality if untreated. CASE PRESENTATION: We describe seven cases of scrub typhus presenting with varied clinical manifestations and outcomes. One patient developed neurological involvement, another progressed to acute respiratory distress syndrome (ARDS), and one experienced acute kidney injury (AKI). Two patients had concurrent co-infections that modified their disease progression, while the remaining two presented with mild, self-limiting illness and responded rapidly to doxycycline therapy. The diversity in presentation underscores the diagnostic challenges associated with this infection. CONCLUSION: Scrub typhus should be considered in the differential diagnosis of acute undifferentiated febrile illness, particularly in endemic areas. Early recognition, appropriate serological testing, and timely initiation of specific antimicrobial therapy are essential to prevent complications. Increased clinical awareness and improved diagnostic capacity are key to reducing the burden of this potentially life-threatening but treatable disease.
INTRODUCTION: The new preservative-free treatment for dry eye patients, perfluorohexyloctane, has been considered in recent studies. This study aimed to assess the feasibility of perfluorohexyloctane for dry eye treatment. METHODS: This review was conducted following the PRISMA guidelines. We performed a comprehensive literature search across five online databases: PubMed, Cochrane, ProQuest, ScienceDirect, and Google Scholar. Human studies using perfluorohexyloctane as dry eye or dry eye disease (DED) therapy published in English, and full-text journals available were inclusion criteria in this review. We identified corneal fluorescein staining (CFS) as the main outcome measurement. RESULTS: Five RCTs and two cohort studies were analyzed. Most studies were conducted in Western countries, except one RCT in China. One hundred percent perfluorohexyloctane was used in all studies. All studies showed improvement in CFS to the control group, with a significance level of p ≤ 0.001, except for one study where p = 0.2786. CONCLUSION: Perfluorohexyloctane shows promising potential as a new therapeutic approach for patients with dry eye disease, but additional research is needed, especially in Eastern countries. Keywords: Dry eye disease, meibomian gland dysfunction, dry eye treatment, perfluorohexyloctane, eye drops, systematic review.
INTRODUCTION: The present study was conducted to evaluate the association between periodontitis and sperm quality. METHODS: A systematic review and meta-analysis of any observational studies published from inception to August 2024 in Scopus, PubMed, ScienceDirect, EBSCO, and Google Scholar was performed. A JBI checklist was used to assess the risk of bias. Statistical analysis was performed using Stata version 17. Fixed- or random-effects model meta-analyses were used and reported as pooled odds ratio (OR) and 95% confidence interval (CI). RESULTS: Six studies involving 987 men aged ≥21 years were included in the systematic review, and four of them were included in the meta-analysis. Periodontitis was significantly associated with any sperm abnormalities (OR = 1.86; 95% CI = 1.32-2.60; p = 0.0003). In subgroup analysis, significant associations were found between periodontitis and sperm quality in Asian populations (OR = 2.13; 95% CI = 1.48-3.07; p = 0.0001) and subnormal sperm count (OR = 2.08; 95% CI = 1.03- 4.23; p = 0.04). When stratified by the severity, moderate-to-severe periodontitis was associated with sperm quality (OR = 2.76; 95% CI = 1.78-4.26; p <0.0001). CONCLUSION: This study shows that periodontitis is associated with any sperm abnormalities.
INTRODUCTION: Wound dressing is one of the most frequent procedures in surgical wards, ranging from simple to complex dressings. The aim of this study was to describe wound care practices and assess variability in wound dressing among surgical care providers in Rwanda. METHODS: A mixed-method study was conducted in three Rwandan hospitals among surgical health professionals (surgeons, GPs, and nurses). A questionnaire assessing knowledge, attitudes, and practices regarding wound dressing was administered, followed by a focused group discussion. Data analysis was done using Stata software and thematic analysis for qualitative responses. The study aimed to explore the professionals' perspectives on wound dressing principles. Findings were analyzed through frequency tables and thematic interpretation to assess knowledge and practice. RESULTS: A total of 98 health professionals participated in the study, including 69 nurses, 17 GPs, and 12 surgeons, with a median age of 32.5 years. The median knowledge score on wound dressing was 6.7, with 47.96% scoring low (≤50%). Knowledge disparities were found between healthcare providers: significant differences in knowledge were found between surgeons and nurses (p<0.001) but not between GPs and nurses (p=0.11). Regarding attitudes, 83.67% believed locally made gauze could prevent surgical site infections, and 23.47% were uncomfortable leaving closed wounds undressed. Most (78.57%) always used locally made gauze, with 54% choosing dressings based on availability. CONCLUSION: There is considerable variability in the knowledge, attitudes, and practices related to wound dressing among healthcare professionals in Rwanda. To improve and standardize wound care, the implementation of standardized guidelines, multi-disciplinary training, and ongoing professional development is needed for improved health care outcomes.
INTRODUCTION: Although cervical cancer is preventable, it remains a major public health burden in low- and middle-income countries (LMIC). Evidence abounds to show that its prevalence can be reduced by screening for premalignant cervical lesions. However, poor uptake of cervical cancer screening in LMIC has been linked to numerous barriers operational at the individual and health-system levels. The study adopted an analytical framework to explore the barriers to the uptake of cervical cancer screening reported by women who were aware of its benefits (screen-aware). METHODS: Reproductive age women who were aware of cervical cancer screening were recruited from outpatient clinics in health facilities across the three tiers of service delivery using simple random sampling technique. RESULTS: Most of the barriers to accessing cervical cancer screening from this study were related to acceptability of the procedure, and these were largely demand-side factors such as negative expectations, preferences, poor risk perception, low self-esteem and religious stigma. Availability-related barriers were the second commonest group, including supply-side determinants like non-availability of personnel for the screening, non-recommendation of the procedure by health workers, long waiting times at the clinics, and discouraging attitude of the healthcare providers. Less than one-tenth of the women reported access to the location of the screening facilities as a barrier to its utilization. CONCLUSION: Employing the analytical framework made it easier to identify the dimensions of barriers to accessing cervical cancer screening, design strategies to mitigate these barriers, and evaluate the effectiveness of the various interventions.
INTRODUCTION: Tuberculosis (TB) mainly affects the respiratory tract, with one-third of cases occurring as extra-pulmonary TB involving distant organs like the brain, bones, and abdomen. About one-quarter of the global population is estimated to have been infected with TB. This study was done to review TB care and control activities over five years by analyzing the screening methods, means of diagnosis, and treatment outcomes in a tertiary health facility in Nigeria. METHODS: A cross-sectional study was conducted at the Federal Teaching Hospital, Ido-Ekiti, Southwestern Nigeria, from 2018 to 2022. A retrospective review of hospital records of all patients registered and managed at the DOTS clinic from 2018 to 2022 was done. Tuberculosis treatment outcomes were assessed according to World Health Organization (WHO) guidelines. SPSS version 20.0 was used to analyze the data. RESULTS: Records of a total of 193 patients were reviewed. About three-fifth of the patients, 115 (59.6%) were males. About two-fifths 74 (38.3%) of the patients were within the age group of 40-59 years. About three-fourths, 143 (74%) of the patients recorded successful treatment. Also, there is a statistically significant association (p=0.036) between treatment success and the age group of patients. CONCLUSION: The prevalence of TB in our study demonstrated an increasing trend over the years from 2018 to 2020 and then decreased from 2021 to 2022. The productive age groups (40-59 years) and males were at the greater prevalence of TB, highlighting the importance of strengthening sustainable TB care and control activities in our facility.
INTRODUCTION: Septic emboli migration originating from a prosthetic valve can cause embolic injury in various organs. Pulmonary embolism is one of the uncommon presentations. CASE PRESENTATION: A 35-year-old male with a history of recurrent infective endocarditis and prosthetic tricuspid valve replacement ten years prior presented to the hospital with complaints of fever, chills, and fatigue. The patient suddenly developed dyspnea, hemoptysis, and chest pain during hospitalization. A thorax CT scan revealed multiple solid and cavitary nodules in both lungs, subpleural wedge-shaped opacities, pleural effusion, and contrast-enhanced pericardium, which were indicative of pulmonary septic embolism with pericarditis. Blood cultures were positive for Staphylococcus aureus. The patient was given oxygen supplementation, anticoagulants, and antibiotics. His symptoms improved, and he was discharged with continued antibiotics for thirty days. CONCLUSION: Septic pulmonary embolism should be considered in patients with pulmonary embolism symptoms and a history of prosthetic valve replacement. Early recognition and appropriate management are vital for improving outcomes and reducing mortality.
INTRODUCTION: Strongyloidiasis, caused by Strongyloides stercoralis, is a significant health threat, especially in tropical regions. Ivermectin is the standard treatment, but concerns about resistance have spurred interest in alternatives like moxidectin, known for its favorable pharmacokinetics and potential efficacy. METHODS: This systematic review and meta-analysis, registered with PROSPERO (CRD42024576472), evaluated randomized controlled trials on the efficacy and safety of moxidectin for Strongyloides stercoralis infections. PubMed, EBSCOHost, ProQuest, and Google Scholar were searched for relevant studies. Cure rates, mean larval reduction rates, and adverse events were analyzed, and study quality was assessed using the Cochrane Risk of Bias tool. Three trials with 1,062 participants were included in the analysis. RESULTS: Moxidectin showed efficacy comparable to ivermectin (RR 0.98 [95% CI 0.95-1.01], I²=0%) and placebo, with cure rates meeting non-inferiority thresholds. Mean larvae reduction rates were high across studies, and adverse events were mild and infrequent, with headache as the most common. No serious AEs were reported, although the trials were underpowered to detect rare events. CONCLUSION: Moxidectin provides a safe and effective alternative to ivermectin for treating strongyloidiasis, with advantages like a longer half-life and fixed dosing, particularly in limited-resource settings. However, further multicenter studies are necessary to validate these findings across broader populations.
INTRODUCTION: Sulphadoxine-pyrimethamine (SP) is the recommended drug for malaria chemoprophylaxis in pregnancy. However, there are growing reports of resistance to its use. This study compared the efficacy of Sulphadoxine-pyrimethamine with azithromycin (SPAZ) versus Sulphadoxine-pyrimethamine as chemoprophylactic agents against malaria in pregnancy. METHODS: A triple-blind randomized trial was conducted among women presenting for antenatal services between February and November 2023. One hundred women were randomized into two groups: those who received SP and a placebo (Group I) and those who received SPAZ (Group II). The collected data were coded and analyzed using Statistical Product and Service Solutions (SPSS) version 26, and p<0.05 was considered significant. RESULTS: There was no statistically significant difference between the two groups regarding the clearance of maternal parasites, maternal packed cell volume (PCV), cord blood parasites, fetal PCV, fetal birth weight, and placental parasitaemia despite having reduced incidences of anaemia and malaria parasitaemia in the SPAZ group. CONCLUSION: The results of this study suggest that SPAZ is as efficacious as SP for malaria chemoprophylaxis in pregnancy and can be used in place of SP in areas with established resistance to SP.
INTRODUCTION: Febrile neutropenia (FN) is an oncological emergency and requires prompt intervention. Recommended management of febrile neutropenia is based on local epidemiology of microorganisms. Rwanda lacks data on local epidemiology for febrile neutropenia. This study aims to highlight the epidemiology of bacteremia causing febrile neutropenia in pediatric populations in Rwanda. METHODS: A retrospective cross-sectional study was conducted over a period of 5 years at three referral hospitals in Rwanda. This study included patients with febrile neutropenia aged less than 15 years. A structured questionnaire was used for data collection, and Stata version 13 was used for analysis. RESULTS: This is the 1st study describing the epidemiology of microorganisms in neutropenic cancer patients in Rwanda. A total of 138 children were included in this study; 92 patients (67%) had hemato-oncology diseases, with acute lymphoblastic leukemia (ALL) represented at 50%, while 46 patients (33%) were non-cancer patients. Prevalence of FN in hemato-oncology was 36%. The rate of bacteremia was 37.6% (52/138). Gram-negative pathogens predominated at 65.4% of all isolates, with Escherichia coli being more common. Concerning antibiotic susceptibility, Gram negatives were largely resistant to 3rd generation cephalosporins, but most of them showed sensitivity to carbapenems. Unfortunately, 67% of S. aureus was mainly MRSA. The 30-day all-cause mortality rate in cancer patients with FN was 19%. CONCLUSION: This study showed that E. coli was the most common organism causing bacteremia in febrile neutropenic pediatric patients, with high resistance to 3rd generation cephalosporins and gentamicin. The use of carbapenems as empiric treatment of febrile neutropenia is highly recommended.
INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is a prevalent cause of chronic liver impairment and is significantly correlated with type 2 diabetes mellitus (T2DM). A liver biopsy is the definitive method for diagnosing NAFLD, but it has substantial restrictions. Pentraxin 3 (PTX3) is an acute phase reactant, and elevated plasma PTX3 levels are considered a sign of NAFLD. Furthermore, T2DM patients exhibited higher Pentraxin 3 serum levels than healthy people. Given that T2DM is a major health concern in Egypt, we intended to investigate the utility of serum Pentraxin 3 as a non-invasive diagnostic of NAFLD in T2DM patients. METHODS: Ninety-six subjects were divided into three equal groups: T2DM with NAFLD, T2DM without NAFLD, and healthy controls. Evaluations included medical history, clinical exams, lab tests (CBC, blood sugar, ALT, AST, creatinine, lipid profile, and Pentraxin), and imaging (ultrasound and Fibroscan). NAFLD diagnosis uses clinical and imaging criteria, with biopsies for unclear cases. RESULTS: When comparing diabetic patients with NAFLD to people with diabetes without NAFLD, at a cut-off value of more than 2.3 ng/mL, Pentraxin 3 has a sensitivity of 87.5%, specificity of 93.75%, positive predictive value of 93.3%, and negative predictive value of 88.2%, with an accuracy of 87.8%. CONCLUSION: This study revealed increased PTX3 levels in diabetic patients with NAFLD compared to people with diabetes without NAFLD and controls. Thus, we showed that Pentraxin 3 is a biomarker for NAFLD with high sensitivity and specificity when suspected in T2DM patients.
INTRODUCTION: Adult-Onset Still's Disease (AOSD) is a rare, multi-systemic autoinflammatory disorder with a global incidence of 0.62 cases per 100,000 people annually. While it exhibits a bimodal age distribution affecting individuals between 15-25 years and 36-46 years, specific prevalence data in Rwanda remains limited. The disease's complex clinical presentation and unclear etiology often result in delayed diagnosis. This case study analysed and documented the clinical presentation, therapeutic management, and the diagnostic challenges of Adult-Onset Still's Disease. CASE PRESENTATION: A 27-year-old female presented with a two-week history of escalating fever, multiple joint pains, and swelling. The patient met multiple Yamaguchi criteria, leading to an AOSD diagnosis. Treatment with high-dose Prednisolone and Methotrexate, supplemented with Folic acid and Omeprazole, resulted in clinical improvement. Diagnosis was challenging due to the need for extensive exclusion of infectious, malignant, and autoimmune conditions, highlighting the complexity of identifying rare rheumatological diseases in resource-limited settings. CONCLUSION: This case study highlights the importance of recognizing AOSD's clinical patterns for timely diagnosis and appropriate therapeutic intervention. The successful treatment outcome demonstrates the effectiveness of standard therapeutic protocols in managing AOSD, even in resource-limited settings.
INTRODUCTION: Nurses are essential in multidisciplinary healthcare teams, especially in their constant contact with patients. Understanding patients' rights, which govern the interaction between healthcare recipients and providers, is crucial. This study assessed nurses' knowledge of psychiatric patients' rights at Ndera Neuropsychiatric Teaching Hospital. METHODS: A cross-sectional study was conducted from March 1 to 30, 2024, using an adapted questionnaire to evaluate nurses' knowledge of patients' rights. Data were collected via Google Forms, extracted as CSV files, and analyzed with Stata version 13. The Chi-square test examined the relationship between participants' characteristics and their knowledge level. RESULTS: The study included 140 nurses with a mean age of 34.15 years (SD = 8.5); 55% were male. Formal training on psychiatric patients' rights was reported by 67.9% of participants during their education and 86.4% at work. The majority demonstrated knowledge of rights such as dignity and respect (100%), treatment consent (97.9%), communication (97.9%), and complaints and grievances (97.1%). However, knowledge of the right to refuse treatment was lower at 67.9%. Self-rated knowledge showed 90% of nurses considered their knowledge excellent or good, while 7.9% rated it as fair. No significant association was found between socio-demographic characteristics and knowledge levels. CONCLUSION: Nurses at Ndera Neuropsychiatric Teaching Hospital generally know psychiatric patients' rights well, particularly regarding dignity, informed consent, and communication. However, gaps exist in understanding the right to refuse treatment. Demographic factors do not significantly affect knowledge. Challenges include high workload, communication barriers, lack of formal training, staff burnout, and resource shortages.
Dear Editor, Vibrio cholerae is a Gram-negative bacterium that causes an acute infectious disease called cholera, characterized by severe vomiting and diarrhoea. Numerous cholera outbreaks have been recorded throughout mankind's history [1]. Although significant improvements have been made in public health and preventive medicine, cholera is still a major threat to the health of humans globally [2]. Regions with sub-standard infrastructure of water, sanitation, and hygiene (WASH) suffer the most from the adverse effects of cholera pandemics [3]. V. cholerae can navigate through the aquatic surroundings due to its single polar flagellum, contributing to its persistence in cholera-prone zones. It is also a rod-shaped and curved facultative anaerobe bacterium that thrives in freshwater and saltwater ecosystems, where it attaches itself to shellfish containing chitin [4]. V. cholerae leads a two-way mode of life; it can flourish within human hosts as well as in water bodies. The bacterium forms biofilms on plankton surfaces while in water. This increases its persistence in the environment [5]. It primarily spreads to humans through eating contaminated food or drinking inadequately treated water, especially in overcrowded living conditions and places with limited sanitation. Besides, environmental features, including nutrient availability, temperature, and salinity, can influence the proliferation of V. cholerae in aquatic sources [6]. Nonetheless, regions like Sub-Saharan Africa and South Asia are correlated with seasonally variable cholera outbreaks [7], recording high number of cases after monsoon rains when there is a prevalence of water contamination. The human gut microbiome plays a significant role in both susceptibility to and defense against cholera [8]. This complex microbial ecosystem in the gut influences how the body responds to pathogens, and variations in the composition of the gut microbiome can impact the severity and outcomes of cholera infections [9]. Key areas of interest in understanding this role include the microbiome’s protective functions, its influence on immune responses, and its interactions with V. cholerae. A healthy and diverse gut microbiome can act as a natural barrier to V. cholerae colonization. Beneficial microbes like Lactobacillus and Bifidobacterium produce antimicrobial compounds and create a competitive environment that makes it more challenging for V. cholerae to establish itself [10]. Additionally, these microbes help maintain the gut’s mucosal barrier, which further protects against pathogen invasion. The gut microbiome has a strong influence on the host’s immune response, which is crucial in cholera infection. A balanced microbiome can regulate immune pathways and promote the production of protective antibodies like Immunoglobulin A (IgA) in the gut [11]. These antibodies can neutralize cholera toxins and prevent the bacteria from adhering to the intestinal wall. Dysbiosis, or an imbalance in the microbiome, may weaken this immune defense, making individuals more susceptible to severe cholera symptoms. Recent research suggests that a healthy gut microbiome may also enhance the effectiveness of cholera vaccines by supporting a more robust immune response [12]. Conversely, individuals with microbiome imbalances might have a reduced response to the vaccine, highlighting the microbiome’s role in immunization outcomes. Overall, understanding the human gut microbiome's role in cholera provides valuable insights into preventive and therapeutic strategies, including the potential for microbiome-targeted interventions to reduce susceptibility to cholera and improve treatment outcomes [13]. New approaches and therapies, as well as ongoing efforts, focus on sustainable solutions, leveraging technology, community-driven programs, and innovative treatment options. Key strategies include climate-resilient infrastructure, microbiome-based therapies, digital tools for monitoring, and novel sanitation technologies. Additionally, probiotic supplements and microbiome-targeted treatments are being explored as protective measures against waterborne pathogens [14]. Specific probiotic strains may help improve gut health and reduce the severity of diarrheal diseases, offering an accessible therapy that supports immune defense in vulnerable communities [15]. Furthermore, research into edible vaccines that use genetically modified plants to express antigens for diseases like cholera is underway [16]. These vaccines could offer an accessible, cost-effective alternative for populations with limited access to traditional immunization services [17].
