The Research of Medical Science Review

Background: Preoperative psychological distress may alter pain perception and recovery after surgery. This study evaluated the relationship of anxiety and depressive symptoms before surgery with postoperative pain among patients treated at Bacha Khan Medical Complex. Methods: An analytical cross-sectional study was conducted among 120 adults aged 18-65 years who underwent elective procedures under general or regional anesthesia. Anxiety and depression were assessed preoperatively with DASS-based subscales, and pain was recorded after surgery on a 0-10 Visual Analogue Scale. Data were summarized as frequencies, percentages and cumulative percentages. Results: Extremely severe anxiety was the most frequent anxiety category (46/120; 38.3%), whereas moderate depression was the most frequent depression category in the source table (54 participants; 45.0%). A VAS score of 10 was recorded in 31 patients (25.8%), and the pain-severity table classified 40 patients (33.3%) as having worst pain. The descriptive pattern indicated greater postoperative pain among patients with higher preoperative anxiety. Moderate-to-severe depressive symptoms also occurred in patients reporting higher pain, although the relationship was less consistent. Conclusion: Preoperative anxiety appeared to be more consistently related to postoperative pain than depression. Screening and targeted psychological support before surgery may strengthen perioperative pain management. Because the available analysis was descriptive and cross-sectional, confirmatory studies with inferential testing are required.

Zinc oxide nanoparticles (ZnONPs) are widely used in various industrial and biomedical applications; however, their potential health risks remain a growing concern. This study investigated the nephrotoxic effects of both acute and chronic ZnONPs exposure in male adult albino mice. Mice were intraperitoneally administered ZnONPs at a dose of 5 mg/kg body weight weekly for acute exposure (1 week) and twice weekly for chronic exposure (10 weeks). A glucose tolerance test (GTT) was performed to assess metabolic disruption. The results revealed that chronic ZnONPs administration impaired glucose tolerance, suggesting a diabetogenic effect. Moreover, ZnONPs significantly increased the expression of pro-inflammatory (NF-κB, TNF-α) and apoptotic (caspase-3) markers in renal tissues, with more pronounced effects observed under chronic exposure. Notably, a marked downregulation of the antioxidant protein Sirtuin-1 (SIRT1) was observed, particularly in chronically treated mice, indicating impaired redox homeostasis. Collectively, these findings demonstrate that ZnONPs induce renal toxicity through mechanisms involving inflammation, oxidative stress, and apoptosis, with severity increasing over time.

Background: Malaria remains one of Zambia's most persistent public health problems despite long-standing investments in case management, vector control, health education and surveillance. Local heterogeneity means that national averages can hide community-level drivers of transmission. This paper examined demographic, preventive and social factors associated with malaria infection in Kawama East Compound, Mufulira District, Copperbelt Province. Methods: The study used an analytical cross-sectional design. A multistage sampling approach was used to select households from Kawama East Compound, and 355 participants were included. Data were collected using semi-structured questionnaires and analysed using descriptive statistics, chi-square tests and logistic regression. Adjusted odds ratios were used to identify factors independently associated with malaria infection. Results: Most respondents were female (77.7%), while 22.3% were male. Although 70% of respondents reported participation in environmental sanitation and 72% recognised malaria as a serious problem, uptake of personal preventive measures was weak: 71.8% did not sleep under insecticide-treated nets and 72% did not apply mosquito repellents. Higher adjusted odds of malaria infection were observed among respondents aged 30-35 years (AOR = 4.05, 95% CI: 1.95-8.42), males (AOR = 3.24, 95% CI: 1.75-5.97), married participants (AOR = 4.97, 95% CI: 2.67-9.28), participants from households with five or more members (AOR = 2.20, 95% CI: 1.20-4.06), respondents not using ITNs (AOR = 2.60, 95% CI: 1.21-5.60), respondents not using repellents (AOR = 3.91, 95% CI: 1.87-8.18), and those living near mosquito breeding sites (AOR = 2.10, 95% CI: 1.13-3.61). Conclusion: Malaria risk in Kawama East Compound is shaped by household conditions, limited use of preventive measures and environmental exposure. Control efforts should move beyond generalised messaging and focus on targeted ITN coverage, repellent promotion, household-level environmental management, and risk communication tailored to men, married households and larger families

Background: Social media has become an important part of daily life, particularly among university students. Platforms such as Facebook, Instagram, TikTok, Snapchat, and WhatsApp are widely used for communication, information sharing, and social interaction. Although social media provides several benefits, excessive or uncontrolled use may negatively affect mental health. Previous studies have shown that prolonged exposure to social media may contribute to psychological problems such as anxiety, depression, stress, loneliness, and sleep disturbances. University students, especially those in health sciences programs, may be more vulnerable due to academic workload and psychological stress. Despite increasing global attention, limited data are available from remote regions such as Kurram District. Objective: To assess the association between social media use and mental health among students of KMU Institute of Health Sciences (IHS) Kurram. Materials and Methods: A cross-sectional descriptive study was conducted among undergraduate students of KMU Institute of Health Sciences Kurram. A total of 272 participants were selected from a population of 929 students using a simple random sampling technique. Data were collected using a structured questionnaire consisting of two sections: demographic information and social media usage patterns, and mental health assessment based on questions related to depression, anxiety, and stress. Participation was voluntary and informed consent was obtained from all participants. Data were analyzed using SPSS version 24, and descriptive statistics including frequencies and percentages were used to summarize the data. Results: The findings showed that the majority of participants were aged 20–22 years (53.3%), and 58.1% were male. Most students reported using social media for 1–2 hours daily (43.4%). A large proportion of participants reported checking social media during study hours and experiencing difficulty limiting their social media use. Many students also reported sleep disturbance, feelings of sadness or depression, anxiety due to negative online content, and reduced concentration associated with social media use. However, some participants also indicated that social media provides emotional support and increases social connection. Conclusion: The study concludes that social media plays an important role in students‟ daily lives and has both positive and negative effects on their mental health. Excessive or uncontrolled use of social media may contribute to psychological distress and reduced academic concentration among students. Promoting responsible and balanced social media use is essential to improve students‟ mental well-being and academic performance

Background: Child malnutrition remains a preventable contributor to under-five morbidity and mortality in rural South Africa. Although updated global and South African guidance emphasises prevention, early identification, breastfeeding support, safe complementary feeding and timely referral, caregiver knowledge and care-seeking pathways remain uneven in resource-constrained settings [1]. Aim: To explore caregivers’ feeding practices, understanding of malnutrition, home responses to childhood illness and pathways to formal care among under-five children admitted for nutritional rehabilitation. Setting: A rural district hospital serving low-income communities in King Cetshwayo District, KwaZulu-Natal, South Africa. Methods: A qualitative descriptive study was conducted with purposively selected mothers and primary caregivers of under-five children admitted with malnutrition. Ten unstructured face-to-face interviews were conducted in isiZulu, audio-recorded, transcribed, translated into English and analysed using qualitative content analysis. Rigour was strengthened through an audit trail, reflexive notes, de-identification of transcripts and language verification. Results: Four interrelated themes were identified: feeding practices; caregiver knowledge of malnutrition; interventions undertaken after recognising illness; and access to health care services. Caregivers described early introduction of thin cereal-based feeds, formula dilution, low dietary diversity, limited recognition of danger signs, reliance on home or traditional remedies, and delayed care seeking shaped by poverty, cultural explanations of illness and fear of negative staff attitudes. Conclusion: In this rural setting, inadequate nutrition knowledge was not a stand-alone problem; it operated with poverty, sociocultural illness interpretations and perceived health-system barriers. Routine primary health care should therefore combine practical feeding counselling, safe formula-preparation support, ORS demonstration, culturally respectful harm-reduction messages and respectful provider-caregiver communication

Background: Unsafe abortion remains a major cause of maternal morbidity and mortality in Pakistan. Nurses play a critical role in post-abortion care (PAC), yet their attitudes and practices toward safe abortion services remain understudied. This study evaluated nurses' attitudes and practices regarding safe abortion care in a tertiary care hospital in Lahore. Methods: A descriptive cross-sectional study was conducted among 300 female nurses working in obstetrics, gynaecology, emergency, and medical/surgical wards of Mayo Hospital, Lahore. Data were collected using a structured 30-item questionnaire assessing attitudes (15 items) and practices (15 items) on a 5-point Likert scale. Descriptive statistics were computed using SPSS version 25. Results: Regarding attitudes, 40% of nurses agreed that safe abortion is necessary for women's healthcare, while 39.6% disagreed. Nearly half (45.3%) supported regular ethical training on abortion. Regarding practices, 45.7% had received formal training on safe abortion, but only 37% provided non-judgmental counselling. Resource inadequacy was reported by 43.7% of nurses. A significant attitude-practice gap was identified across multiple domains. Conclusion: Nurses demonstrated polarized attitudes and suboptimal practices regarding safe abortion care. Targeted training, ethical guidance, and institutional support are urgently needed to improve reproductive health services.

Background: Improper disposal of unused and expired medications poses significant risks to public health and the environment. In Pakistan, safe disposal practices are poorly understood and rarely implemented due to limited awareness and lack of structured take-back programs. Objective: This study aimed to assess the knowledge, attitude, and practice (KAP) regarding safe disposal of unused medications among the general public in Bahawalpur, Punjab, and to identify associated demographic factors. Methods: A cross-sectional study was conducted from January to March 2025 among 417 adults aged 18 years and above in Bahawalpur. Data were collected using a validated, self-administered questionnaire covering demographics, knowledge, attitude, and practice related to medication disposal. Descriptive statistics, Chi-square tests, and logistic regression were used for analysis using SPSS v26. Results: Of 417 participants, 58.5% had poor knowledge, 62.1% had a negative attitude, and 71.2% reported unsafe disposal practices. The most common disposal method was discarding medications in household trash (54.7%). Higher education level, employment in healthcare-related fields, and female gender were significantly associated with better knowledge and safer practices (p < 0.05). Lack of awareness about disposal guidelines and absence of disposal facilities were the main barriers reported. Conclusion: The study reveals substantial gaps in knowledge, attitude, and practice regarding safe medication disposal in Bahawalpur. Targeted public education campaigns, pharmacist-led counseling, and establishment of medicine take-back programs are recommended to reduce environmental contamination and public health risks.

Advanced Practice Nurses (APNs) play a crucial role in addressing the growing demands of modern healthcare through advanced clinical expertise, leadership, and evidence-based practice. As healthcare systems face challenges such as chronic diseases, aging populations, and workforce shortages, APNs have expanded their roles in primary, acute, and community care by providing comprehensive assessment, diagnosis, treatment, health promotion, and care coordination. Their contributions have been linked with improved patient outcomes, increased access to quality healthcare, enhanced patient satisfaction, and cost-effective service delivery. Beyond direct patient care, APNs contribute to education, research, quality improvement, and health policy, strengthening healthcare systems and promoting innovation. The integration of telehealth and digital technologies has further expanded their ability to deliver accessible care, particularly in underserved communities. Continued investment in education, supportive legislation, and collaborative practice models is essential to fully utilize the potential of APNs in improving healthcare quality and advancing patient-centered care.

Background: Diabetic chronic kidney disease (CKD) is a major complication of diabetes mellitus, associated with increased morbidity, mortality, and reduced quality of life (QoL). Poor glycemic control, reflected by elevated glycated hemoglobin (HbA1c), may further worsen disease burden and patient well-being, particularly in late-stage CKD. Objective: To examine the relationship between HbA1c levels and quality of life in patients with stage 4 and stage 5 diabetic CKD. Methods: A hospital-based cross-sectional study was conducted among adult patients with type 2 diabetes and advanced CKD attending nephrology and dialysis units. HbA1c levels were obtained from laboratory records, and QoL was assessed using the validated Kidney Disease Quality of Life Short Form (KDQOL-SF) questionnaire. Glycemic control was categorized as good (<7%), moderate (7–8%), and poor (>8%). Data were analyzed using descriptive statistics, correlation tests, and regression analysis. Results: Higher HbA1c levels were significantly associated with lower overall QoL scores. Patients with poor glycemic control demonstrated greater impairment in physical functioning, psychological well-being, and social participation compared to those with better glycemic control. A negative correlation was observed between HbA1c levels and QoL domains, indicating that worsening glycemic status is linked to diminished patient well-being. Conclusion: Poor glycemic control is significantly associated with reduced quality of life in late-stage diabetic CKD patients. Optimizing HbA1c levels may improve both clinical outcomes and patient-centered well-being. These findings highlight the importance of integrated management strategies focusing on glycemic control and quality of life in this high-risk population.

Tinea imbricata (ringworm), a tropical fungal infection due to Trichophyton concentricum, is a neglected tropical disease prevalent in indigenous populations of Southeast Asia, Oceania, and Central and South America. Despite more than 50 years of reported endemicity, the reasons underlying its distinct geographical and ethnic distribution remain obscure. We bring together available evidence on host genetics and skin microbiota in tinea imbricata disease, highlighting two key yet underexplored factors. We discuss emerging information about antifungal drug resistance, including the recent identification of terbinafine resistant T. concentricum strains among indigenous Malaysian populations, as well as the latest treatment approaches, including new drugs in the pipeline. Literature was searched via PubMed, ScienceDirect and clinical trial registries up to June 2025. There is evidence for both autosomal dominant and recessive modes of inheritance with candidate genes such as DEFB4 (β-defensin 2) and CLEC7A (dectin-1) associated with susceptibility. Studies focusing on skin microbiome demonstrate decreased commensal bacteria (Cutibacterium acnes, Staphylococcus epidermidis) in populations, implicating microbiome dysbiosis in the development of this condition. Therapeutic outcomes are poor and relapse rates are more than 50% at six months. The growing reports of terbinafine resistance justify revisit to current antifungal algorithms. We advocate for a paradigm incorporating host genetic screening, microbiome and antifungal resistance for clinically cured tinea imbricata. Knowledge gaps include lack of genome-wide association studies, microbiome longitudinal studies and randomized trials in endemic countries

Background: Preoperative psychological distress may alter pain perception and recovery after surgery. This study evaluated the relationship of anxiety and depressive symptoms before surgery with postoperative pain among patients treated at Bacha Khan Medical Complex. Methods: An analytical cross-sectional study was conducted among 120 adults aged 18-65 years who underwent elective procedures under general or regional anesthesia. Anxiety and depression were assessed preoperatively with DASS-based subscales, and pain was recorded after surgery on a 0-10 Visual Analogue Scale. Data were summarized as frequencies, percentages and cumulative percentages. Results: Extremely severe anxiety was the most frequent anxiety category (46/120; 38.3%), whereas moderate depression was the most frequent depression category in the source table (54 participants; 45.0%). A VAS score of 10 was recorded in 31 patients (25.8%), and the pain-severity table classified 40 patients (33.3%) as having worst pain. The descriptive pattern indicated greater postoperative pain among patients with higher preoperative anxiety. Moderate-to-severe depressive symptoms also occurred in patients reporting higher pain, although the relationship was less consistent. Conclusion: Preoperative anxiety appeared to be more consistently related to postoperative pain than depression. Screening and targeted psychological support before surgery may strengthen perioperative pain management. Because the available analysis was descriptive and cross-sectional, confirmatory studies with inferential testing are required.

Zinc oxide nanoparticles (ZnONPs) are widely used in various industrial and biomedical applications; however, their potential health risks remain a growing concern. This study investigated the nephrotoxic effects of both acute and chronic ZnONPs exposure in male adult albino mice. Mice were intraperitoneally administered ZnONPs at a dose of 5 mg/kg body weight weekly for acute exposure (1 week) and twice weekly for chronic exposure (10 weeks). A glucose tolerance test (GTT) was performed to assess metabolic disruption. The results revealed that chronic ZnONPs administration impaired glucose tolerance, suggesting a diabetogenic effect. Moreover, ZnONPs significantly increased the expression of pro-inflammatory (NF-κB, TNF-α) and apoptotic (caspase-3) markers in renal tissues, with more pronounced effects observed under chronic exposure. Notably, a marked downregulation of the antioxidant protein Sirtuin-1 (SIRT1) was observed, particularly in chronically treated mice, indicating impaired redox homeostasis. Collectively, these findings demonstrate that ZnONPs induce renal toxicity through mechanisms involving inflammation, oxidative stress, and apoptosis, with severity increasing over time.

Background: Malaria remains one of Zambia's most persistent public health problems despite long-standing investments in case management, vector control, health education and surveillance. Local heterogeneity means that national averages can hide community-level drivers of transmission. This paper examined demographic, preventive and social factors associated with malaria infection in Kawama East Compound, Mufulira District, Copperbelt Province. Methods: The study used an analytical cross-sectional design. A multistage sampling approach was used to select households from Kawama East Compound, and 355 participants were included. Data were collected using semi-structured questionnaires and analysed using descriptive statistics, chi-square tests and logistic regression. Adjusted odds ratios were used to identify factors independently associated with malaria infection. Results: Most respondents were female (77.7%), while 22.3% were male. Although 70% of respondents reported participation in environmental sanitation and 72% recognised malaria as a serious problem, uptake of personal preventive measures was weak: 71.8% did not sleep under insecticide-treated nets and 72% did not apply mosquito repellents. Higher adjusted odds of malaria infection were observed among respondents aged 30-35 years (AOR = 4.05, 95% CI: 1.95-8.42), males (AOR = 3.24, 95% CI: 1.75-5.97), married participants (AOR = 4.97, 95% CI: 2.67-9.28), participants from households with five or more members (AOR = 2.20, 95% CI: 1.20-4.06), respondents not using ITNs (AOR = 2.60, 95% CI: 1.21-5.60), respondents not using repellents (AOR = 3.91, 95% CI: 1.87-8.18), and those living near mosquito breeding sites (AOR = 2.10, 95% CI: 1.13-3.61). Conclusion: Malaria risk in Kawama East Compound is shaped by household conditions, limited use of preventive measures and environmental exposure. Control efforts should move beyond generalised messaging and focus on targeted ITN coverage, repellent promotion, household-level environmental management, and risk communication tailored to men, married households and larger families

Background: Social media has become an important part of daily life, particularly among university students. Platforms such as Facebook, Instagram, TikTok, Snapchat, and WhatsApp are widely used for communication, information sharing, and social interaction. Although social media provides several benefits, excessive or uncontrolled use may negatively affect mental health. Previous studies have shown that prolonged exposure to social media may contribute to psychological problems such as anxiety, depression, stress, loneliness, and sleep disturbances. University students, especially those in health sciences programs, may be more vulnerable due to academic workload and psychological stress. Despite increasing global attention, limited data are available from remote regions such as Kurram District. Objective: To assess the association between social media use and mental health among students of KMU Institute of Health Sciences (IHS) Kurram. Materials and Methods: A cross-sectional descriptive study was conducted among undergraduate students of KMU Institute of Health Sciences Kurram. A total of 272 participants were selected from a population of 929 students using a simple random sampling technique. Data were collected using a structured questionnaire consisting of two sections: demographic information and social media usage patterns, and mental health assessment based on questions related to depression, anxiety, and stress. Participation was voluntary and informed consent was obtained from all participants. Data were analyzed using SPSS version 24, and descriptive statistics including frequencies and percentages were used to summarize the data. Results: The findings showed that the majority of participants were aged 20–22 years (53.3%), and 58.1% were male. Most students reported using social media for 1–2 hours daily (43.4%). A large proportion of participants reported checking social media during study hours and experiencing difficulty limiting their social media use. Many students also reported sleep disturbance, feelings of sadness or depression, anxiety due to negative online content, and reduced concentration associated with social media use. However, some participants also indicated that social media provides emotional support and increases social connection. Conclusion: The study concludes that social media plays an important role in students‟ daily lives and has both positive and negative effects on their mental health. Excessive or uncontrolled use of social media may contribute to psychological distress and reduced academic concentration among students. Promoting responsible and balanced social media use is essential to improve students‟ mental well-being and academic performance

Background: Child malnutrition remains a preventable contributor to under-five morbidity and mortality in rural South Africa. Although updated global and South African guidance emphasises prevention, early identification, breastfeeding support, safe complementary feeding and timely referral, caregiver knowledge and care-seeking pathways remain uneven in resource-constrained settings [1]. Aim: To explore caregivers’ feeding practices, understanding of malnutrition, home responses to childhood illness and pathways to formal care among under-five children admitted for nutritional rehabilitation. Setting: A rural district hospital serving low-income communities in King Cetshwayo District, KwaZulu-Natal, South Africa. Methods: A qualitative descriptive study was conducted with purposively selected mothers and primary caregivers of under-five children admitted with malnutrition. Ten unstructured face-to-face interviews were conducted in isiZulu, audio-recorded, transcribed, translated into English and analysed using qualitative content analysis. Rigour was strengthened through an audit trail, reflexive notes, de-identification of transcripts and language verification. Results: Four interrelated themes were identified: feeding practices; caregiver knowledge of malnutrition; interventions undertaken after recognising illness; and access to health care services. Caregivers described early introduction of thin cereal-based feeds, formula dilution, low dietary diversity, limited recognition of danger signs, reliance on home or traditional remedies, and delayed care seeking shaped by poverty, cultural explanations of illness and fear of negative staff attitudes. Conclusion: In this rural setting, inadequate nutrition knowledge was not a stand-alone problem; it operated with poverty, sociocultural illness interpretations and perceived health-system barriers. Routine primary health care should therefore combine practical feeding counselling, safe formula-preparation support, ORS demonstration, culturally respectful harm-reduction messages and respectful provider-caregiver communication

Background: Unsafe abortion remains a major cause of maternal morbidity and mortality in Pakistan. Nurses play a critical role in post-abortion care (PAC), yet their attitudes and practices toward safe abortion services remain understudied. This study evaluated nurses' attitudes and practices regarding safe abortion care in a tertiary care hospital in Lahore. Methods: A descriptive cross-sectional study was conducted among 300 female nurses working in obstetrics, gynaecology, emergency, and medical/surgical wards of Mayo Hospital, Lahore. Data were collected using a structured 30-item questionnaire assessing attitudes (15 items) and practices (15 items) on a 5-point Likert scale. Descriptive statistics were computed using SPSS version 25. Results: Regarding attitudes, 40% of nurses agreed that safe abortion is necessary for women's healthcare, while 39.6% disagreed. Nearly half (45.3%) supported regular ethical training on abortion. Regarding practices, 45.7% had received formal training on safe abortion, but only 37% provided non-judgmental counselling. Resource inadequacy was reported by 43.7% of nurses. A significant attitude-practice gap was identified across multiple domains. Conclusion: Nurses demonstrated polarized attitudes and suboptimal practices regarding safe abortion care. Targeted training, ethical guidance, and institutional support are urgently needed to improve reproductive health services.

Background: Improper disposal of unused and expired medications poses significant risks to public health and the environment. In Pakistan, safe disposal practices are poorly understood and rarely implemented due to limited awareness and lack of structured take-back programs. Objective: This study aimed to assess the knowledge, attitude, and practice (KAP) regarding safe disposal of unused medications among the general public in Bahawalpur, Punjab, and to identify associated demographic factors. Methods: A cross-sectional study was conducted from January to March 2025 among 417 adults aged 18 years and above in Bahawalpur. Data were collected using a validated, self-administered questionnaire covering demographics, knowledge, attitude, and practice related to medication disposal. Descriptive statistics, Chi-square tests, and logistic regression were used for analysis using SPSS v26. Results: Of 417 participants, 58.5% had poor knowledge, 62.1% had a negative attitude, and 71.2% reported unsafe disposal practices. The most common disposal method was discarding medications in household trash (54.7%). Higher education level, employment in healthcare-related fields, and female gender were significantly associated with better knowledge and safer practices (p < 0.05). Lack of awareness about disposal guidelines and absence of disposal facilities were the main barriers reported. Conclusion: The study reveals substantial gaps in knowledge, attitude, and practice regarding safe medication disposal in Bahawalpur. Targeted public education campaigns, pharmacist-led counseling, and establishment of medicine take-back programs are recommended to reduce environmental contamination and public health risks.

Advanced Practice Nurses (APNs) play a crucial role in addressing the growing demands of modern healthcare through advanced clinical expertise, leadership, and evidence-based practice. As healthcare systems face challenges such as chronic diseases, aging populations, and workforce shortages, APNs have expanded their roles in primary, acute, and community care by providing comprehensive assessment, diagnosis, treatment, health promotion, and care coordination. Their contributions have been linked with improved patient outcomes, increased access to quality healthcare, enhanced patient satisfaction, and cost-effective service delivery. Beyond direct patient care, APNs contribute to education, research, quality improvement, and health policy, strengthening healthcare systems and promoting innovation. The integration of telehealth and digital technologies has further expanded their ability to deliver accessible care, particularly in underserved communities. Continued investment in education, supportive legislation, and collaborative practice models is essential to fully utilize the potential of APNs in improving healthcare quality and advancing patient-centered care.

Background: Diabetic chronic kidney disease (CKD) is a major complication of diabetes mellitus, associated with increased morbidity, mortality, and reduced quality of life (QoL). Poor glycemic control, reflected by elevated glycated hemoglobin (HbA1c), may further worsen disease burden and patient well-being, particularly in late-stage CKD. Objective: To examine the relationship between HbA1c levels and quality of life in patients with stage 4 and stage 5 diabetic CKD. Methods: A hospital-based cross-sectional study was conducted among adult patients with type 2 diabetes and advanced CKD attending nephrology and dialysis units. HbA1c levels were obtained from laboratory records, and QoL was assessed using the validated Kidney Disease Quality of Life Short Form (KDQOL-SF) questionnaire. Glycemic control was categorized as good (<7%), moderate (7–8%), and poor (>8%). Data were analyzed using descriptive statistics, correlation tests, and regression analysis. Results: Higher HbA1c levels were significantly associated with lower overall QoL scores. Patients with poor glycemic control demonstrated greater impairment in physical functioning, psychological well-being, and social participation compared to those with better glycemic control. A negative correlation was observed between HbA1c levels and QoL domains, indicating that worsening glycemic status is linked to diminished patient well-being. Conclusion: Poor glycemic control is significantly associated with reduced quality of life in late-stage diabetic CKD patients. Optimizing HbA1c levels may improve both clinical outcomes and patient-centered well-being. These findings highlight the importance of integrated management strategies focusing on glycemic control and quality of life in this high-risk population.

Tinea imbricata (ringworm), a tropical fungal infection due to Trichophyton concentricum, is a neglected tropical disease prevalent in indigenous populations of Southeast Asia, Oceania, and Central and South America. Despite more than 50 years of reported endemicity, the reasons underlying its distinct geographical and ethnic distribution remain obscure. We bring together available evidence on host genetics and skin microbiota in tinea imbricata disease, highlighting two key yet underexplored factors. We discuss emerging information about antifungal drug resistance, including the recent identification of terbinafine resistant T. concentricum strains among indigenous Malaysian populations, as well as the latest treatment approaches, including new drugs in the pipeline. Literature was searched via PubMed, ScienceDirect and clinical trial registries up to June 2025. There is evidence for both autosomal dominant and recessive modes of inheritance with candidate genes such as DEFB4 (β-defensin 2) and CLEC7A (dectin-1) associated with susceptibility. Studies focusing on skin microbiome demonstrate decreased commensal bacteria (Cutibacterium acnes, Staphylococcus epidermidis) in populations, implicating microbiome dysbiosis in the development of this condition. Therapeutic outcomes are poor and relapse rates are more than 50% at six months. The growing reports of terbinafine resistance justify revisit to current antifungal algorithms. We advocate for a paradigm incorporating host genetic screening, microbiome and antifungal resistance for clinically cured tinea imbricata. Knowledge gaps include lack of genome-wide association studies, microbiome longitudinal studies and randomized trials in endemic countries