Abstract Background: Stroke is the most common life-threatening neurological disease worldwide which affects about 15 million people yearly. The current study intended to evaluate the possible role of the phosphorylated neurofilament-H (PNF-H) level in predicting the functional outcome in patients with acute ischaemic cerebrovascular disease. Materials and Methods: The study was carried out on 50 adult patients with acute ischaemic cerebrovascular disease. A group of 20 healthy volunteers were used as a control. All patients underwent, on admission, a computed tomography (CT) scan of the brain, routine laboratory investigations, and magnetic resonance imaging (MRI) if indicated. The patients were then followed for three months and assessed by the PNF-H levels, the Glasgow Coma Scale (GCS), and the National Institute of Health Stroke Scale (NIHSS) on day one and day seven. The outcome was assessed by the Glasgow Outcome Score and Modified Rankin Score (MRS) after three months. Patients were classified according to MRS into two groups: group I with a good outcome (MRS = 1, 2, 3) and group II with a poor outcome (MRS = 4, 5, 6). Results: On day seven, the mean PNF-H concentrations were significantly elevated in group I and group II as compared to day one or controls (P < 0.001). In addition, group II showed significantly lower PNF-H levels on day seven as compared to group I. The results obtained from the receiver operating characteristic curve performed for the outcome of ischaemic stroke show that PNF-H at a cutoff of 8.1 ng/mL could predict the outcome after acute ischaemic stroke. Conclusion: Our results demonstrate the advantage of using PNF-H as an early prognostic marker for the outcome in patients with acute ischaemic stroke.

Abstract Introduction: The ongoing conflict in Sudan has resulted in a massive displacement crisis, with millions internally displaced and fleeing to neighbouring countries. This study aims to investigate the prevalence and associated factors of depression and anxiety among Sudanese refugees in the Kiryandongo Refugee Settlement, Uganda. The findings will improve our understanding and guide targeted interventions in mental health. Materials and Methods: A cross-sectional study was conducted from December 14 to 21, 2024, involving 106 Sudanese refugees. Depression and anxiety were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires, respectively. Socio-demographic data were collected and analyzed. A Pearson Chi-Square test was used to compare between the different depression status based on characteristics like gender, employment, and living on campus. Results: The study revealed a 43% prevalence of moderate to severe depression and a 24% prevalence of moderate to severe anxiety. Significant gender differences were observed, with males reporting higher rates of severe depression and females exhibiting higher rates of moderate to severe anxiety. On-campus residents showed a higher prevalence of depression, while off-campus residents reported slightly higher anxiety rates. Self-harm thoughts were significantly associated with severe depression. No significant associations were found between mental health outcomes and marital status, employment, or living with families. Discussion: Sudanese refugees in Kiryandongo face significant mental health challenges, highlighting the need for culturally sensitive and gender-responsive services. Future efforts should prioritize standardized screenings and address pre- and post-migration trauma. Urgent actions, such as crisis teams and mobile clinics, are essential for their well-being.

Abstract Background: Traumatic pancreatic injury, though infrequent, poses diagnostic challenges with delayed recognition contributing to increased morbidity and mortality. Serum lipase and amylase are standard pancreatic injury markers, yet hyperlipasaemia can arise from non-pancreatic aetiologies in polytrauma. This study aimed to characterize non-pancreatic causes of hyperlipasaemia in polytrauma patients. Materials and Methods: A descriptive cohort study was conducted on adult polytrauma patients admitted between January 2016 and December 2022, with measured lipase levels. Patients with confirmed pancreatic injuries were excluded. Group I comprised patients with normal lipase levels, while Group II exhibited hyperlipasaemia. Statistical analysis assessed associations between hyperlipasaemia and clinical variables. Results: Of 130 patients, 86.2% were male, with a mean age of 28.05 ± 9.82 years. Blunt trauma (87.7%) and motor vehicle accidents (65.4%) were predominant. Hyperlipasaemia was observed in 58.5% of patients. Significant associations were found between hyperlipasaemia and elevated alanine aminotransferase, aspartate aminotransferase levels, abdominal and pelvic injuries (P < 0.05), and prolonged hospital stays. Multivariate logistic regression identified negative focused assessment with sonography for trauma (FAST) and abdominal/pelvic involvement as independent predictors of hyperlipasaemia. Conclusion: Hyperlipasaemia in polytrauma patients frequently occurs in the absence of pancreatic injury. Associated risk factors include concomitant abdominal and pelvic trauma, negative FAST results, and elevated hepatic transaminases. These findings underscore the necessity of interpreting hyperlipasaemia within the broader clinical context of polytrauma, rather than solely as a marker of pancreatic injury.

Abstract The article explores the training methodologies for chest tube insertion, emphasizing the importance of practical experience for enhancing the competence of healthcare professionals. It discusses various training modalities, including cadaver models and simulation-based techniques, which help medical trainees develop both technical proficiency and ethical responsibility in patient care. The article also highlights the disparities in current training practices and advocates for a standardized, competency-driven frameworks to optimize patient safety and improve clinical outcomes. By incorporating innovative training strategies, as virtual reality and app-based simulations, this article provides insights into bridging the existing performance gaps in emergency practice of chest tube insertion.

Abstract Globally, the increase in type 2 diabetes mellitus (T2DM) prevalence and related complications underscores the critical need for effective management strategies. Although various medications are available, the challenge of medication adherence remains prominent among patients. This review investigates the effects of pharmacist-led interventions on medication adherence, health-related quality of life (HRQoL), and the prevention of acute events in T2DM patients. A comprehensive literature search was conducted using Google Scholar and the PubMed database, focusing on studies published in the last decade that examined pharmacist-led interventions specifically targeting adherence, HRQoL, and acute events. The findings reveal that pharmacist-led interventions have a beneficial impact on enhancing medication adherence, improving HRQoL, and decreasing the incidence of acute events for individuals with T2DM. These interventions contribute to better medication knowledge, address patient inquiries and concerns, and offer personalized support tailored to individual patient needs. Consequently, pharmacist-led initiatives play a vital role in the effective management of T2DM, helping to minimize acute events and improve overall patient outcomes. Future research should delve into identifying specific barriers to medication adherence, and to the development of tailored interventions that can address these challenges. Additionally, it is essential to evaluate clinical, humanistic, and economic outcomes associated with these interventions. Moreover, innovations in medication design, particularly those that decrease dosing frequency, could further enhance adherence rates and optimize glycemic control in patients living with T2DM.

Summary O trauma é responsável por 5,8 milhões de mortes anuais no mundo, sendo 90% em países de baixa e média renda. Centros de trauma especializados são essenciais para melhorar a sobrevivência de pacientes gravemente feridos, mas muitos países em desenvolvimento enfrentam desafios para estabelecer esses serviços. O Hospital de Base do Distrito Federal (HBDF), desde sua fundação em 1960, sempre foi referência em casos complexos, mas também enfrentava superlotação, falta de recursos e equipes sem treinamento específico para trauma. Em 2011, após adquirir experiência em Tel-Aviv, Israel, e outras experiências internacionais, iniciamos um projeto para transformar o HBDF em um centro especializado em trauma, com apoio irrestrito da alta gestão do hospital e apoios e parcerias com outros serviços. A equipe do hospital começou a treinar e implementar protocolos de atendimento ao trauma, o que resultou na criação do Serviço de Cirurgia de Trauma e, em 2013, no lançamento de um programa de residência nessa área. Entre 2018 e 2021, o serviço de trauma do HBDF conseguiu reduzir a mortalidade na sala de admissão de trauma em 49%. A experiência do HBDF mostra que a criação de Centros de Trauma em países em desenvolvimento pode depender mais de organização e mudanças culturais do que de grandes investimentos financeiros. A padronização de procedimentos e o treinamento contínuo fazem uma diferença significativa, melhorando os resultados para os pacientes e a qualidade do atendimento hospitalar.

Abstract Background: Chronic inflammation is increasingly recognized as a key factor in many age-related diseases that can lead to acute hospitalizations. Recent research studies have explored the potential of inflammatory biomarkers, such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), as predictors of physical and cognitive decline in older adults. This study investigates the association between these inflammatory markers and frailty status in the elderly population. Materials and Methods: This study included 90 patients, aged 65 years and above. This study compared three groups based on their frailty status: frail, pre-frail, and nonfrail. They are compared with an age-matched control group. TNF-α, CRP, and IL-6 were measured in all groups and other routine investigations. Using the regression analysis method, the correlation between each marker and frailty components was calculated. Results: While there were no significant differences in age, blood tests, and certain hormones, the frail group had significantly lower testosterone levels and higher levels of inflammatory markers (CRP, TNF-α, and IL-6). Additionally, the frail group exhibited significant impairments in hand grip (HG) strength, physical activity, and weight loss compared with the other groups. Conclusion: Significant differences were found between CRP, TNF-α, and IL-6 in the three studied groups and a significant correlation to all the studied frailty components such as HG, slowness, weight loss, and exhaustion.

Abstract Background: Diastolic dysfunction is common in patients undergoing coronary artery bypass grafting (CABG). This study investigates the effects of ivabradine, a selective inhibitor of the cardiac pacemaker current (If), on diastolic function following CABG. Materials and Methods: This prospective cohort study included sixty adult patients with coronary artery disease and preserved systolic left ventricular function but with diastolic dysfunction (DD). Patients were randomly assigned into two groups: Group I received standard postoperative medical therapy with ivabradine (5.0–7.5 mg BID), initiated early after surgery, whereas Group II received standard postoperative medical therapy alone. Exclusion criteria included those having concomitant valvular or pericardial disease, atrial fibrillation, and contraindications to ivabradine. Echocardiographic parameters, including left atrial dimensions, filling velocities, tissue Doppler imaging, and deceleration time, were assessed preoperatively, at 7 days postoperatively and at 90 days. Results: Group I exhibited significant reductions in blood pressure and hematocrit levels and elevated levels of creatine kinase-MB and LDH, along with reductions in left atrial volume, aortic diameter, and right ventricular diameter, whereas Group II showed decreased platelet counts, ejection fraction, and isovolumic relaxation time; an improvement in diastolic function, and lack of tendency toward normalization of DD. Conclusion: The addition of ivabradine to standard postoperative therapy may enhance diastolic function in patients post-CABG surgery. Further prospective studies with larger cohorts are warranted to confirm these findings.