Search Results (8,531)

Background: People with chronic neurological disorders may be vulnerable to severe outcomes from vaccine-preventable infections. However, immunization recommendations for these patients may be difficult to identify and apply. This systematic review aimed to identify and describe official guidelines on preventive active immunization for individuals with chronic neurological disorders. Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and registered in the PROSPERO International prospective register of systematic reviews (CRD420251005848). Bibliographic databases (PubMed, Embase, Scopus) and grey literature sources were searched to identify official national or international clinical practice guidelines or comparable structured guidance documents providing recommendations relevant to chronic neurological disorders. The search was restricted to countries with a Human Development Index greater than 0.8, to allow comparison across broadly comparable healthcare and socioeconomic contexts. Data were extracted on document characteristics, neurological conditions addressed, vaccines covered, and vaccination-related recommendations. Results: Overall, 12 unique documents were included. Four were vaccination-focused documents including recommendations for neurological disorders, four were disease-management guidelines including vaccination-related recommendations, and four specifically addressed vaccination in selected neurological diseases. Guidance was unevenly distributed across countries, neurological conditions, and document types. Influenza and COVID-19 vaccination were the most consistently addressed vaccines. Multiple sclerosis was the condition with the most detailed guidance, especially regarding vaccination before disease-modifying therapies, live attenuated vaccines, vaccine timing in relation to immunosuppression or relapse, and protection of close contacts. Conclusions: Official immunization guidance for people with chronic neurological disorders remains limited and heterogeneous. Future guidelines should provide clearer and regularly updated recommendations to support vaccination assessment, treatment-sensitive planning, and multidisciplinary coordination. Full article

Background: Quality assurance (QA) is a cornerstone of safe and effective postgraduate training in gynecological laparoscopic surgery, where clinical outcomes depend on procedural complexity, equipment sophistication, and the coordinated competence of an entire surgical team. This article is a narrative review of the conceptual, professional, and regulatory foundations of QA in healthcare education, complemented by a structured synthesis of the collective teaching and clinical experience of the author group. It is not an empirical study, and the sections that follow present a conceptual mapping supported by expert perspective rather than original outcome data. Methods: Sources were identified through targeted searches of PubMed/MEDLINE and Google Scholar, supplemented by hand-searching of policy and curriculum documents issued by professional bodies and by backward citation tracking, without date restriction. Approximately 480 records were screened at title and abstract level, 112 were assessed as full text, and 41 sources were retained against predefined inclusion and exclusion criteria, with five further sources added during peer review. In a second and separate step, the ten co-authors, who hold teaching and supervisory roles in gynecological laparoscopy across academic centers in Romania and Germany, each completed the same six-item written prompt on training provision, trainer development, trainee assessment, and institutional QA practice; responses were coded thematically by two authors independently and consolidated into explicit points of convergence and divergence. Results: We describe how QA principles, originally articulated in general quality-management and health-promotion literature, have been adapted by professional and regulatory bodies, including the European Board and College of Obstetrics and Gynecology (EBCOG), European Society for Gynecological Endoscopy (ESGE), American Society for Gastrointestinal Endoscopy (ASGE), and the UK General Medical Council, into concrete standards for training providers, trainers, and trainees. We outline the structures used to monitor and audit training quality, including Kirkpatrick’s four-level evaluation model and periodic institutional review cycles, alongside documentation and certification pathways such as the Gynecological Endoscopic Surgical Education and Assessment (GESEA) program, with governance and financing as cross-cutting determinants of sustainability. The author synthesis converged on a consistent gap between documented standards and their routine enforcement and diverged on whether external review and formal certification should become mandatory. Conclusions: The conceptual architecture of QA in gynecological laparoscopy is coherent and broadly fit for purpose, but we identified no study linking the implementation of a specific QA standard to measurable gains in trainee competency or patient outcomes in this field. Proposals for harmonized, outcome-oriented, and where appropriate, mandatory external review should therefore be read as reasoned positions awaiting prospective evaluation rather than as evidence-based recommendations; generating that evidence, with the trainee’s own perspective collected rather than inferred, is the principal task for future research. Full article

Background: Women with chronic medical conditions are at increased risk of adverse pregnancy outcomes, making contraceptive counselling an essential component of comprehensive chronic disease management. However, evidence regarding the knowledge and clinical practices of non-obstetric physicians remains limited. This study evaluated physicians’ knowledge, attitudes, and practices regarding contraceptive counselling for women with chronic medical conditions in a tertiary referral hospital in Türkiye. Methods: A cross-sectional Knowledge–Attitude–Practice survey was conducted among 264 non-obstetric physicians at İzmir City Hospital between July and October 2025. The questionnaire assessed contraceptive counselling practices, awareness of the World Health Organization Medical Eligibility Criteria for Contraceptive Use (WHO MEC), postgraduate contraception training, perceived barriers, and educational needs. Categorical associations were examined using chi-square or exact procedures as appropriate, and multivariable binary logistic regression was performed to evaluate factors associated with self-reported routine contraceptive counselling while accounting for potential confounding. Results: Among the 260 physicians who responded to the relevant item, 89.2% agreed that contraceptive method selection may influence the course of chronic disease, whereas 37.9% of the total sample reported routinely providing contraceptive counselling. Awareness of the WHO MEC was limited, with 75.8% reporting no prior awareness, and 18.2% had received postgraduate contraception training. In the adjusted analysis, WHO MEC awareness (aOR = 2.76, 95% CI: 1.39–5.46; p = 0.004), postgraduate contraception training (aOR = 2.38, 95% CI: 1.12–5.07; p = 0.024), seeing ≥30 women of reproductive age per week (aOR = 2.07, 95% CI: 1.15–3.73; p = 0.016), female sex (aOR = 3.81, 95% CI: 1.90–7.65; p < 0.001), and >10 years of clinical practice (aOR = 2.38, 95% CI: 1.23–4.62; p = 0.010) were associated with higher odds of self-reported routine counselling. Specialty was not significantly associated after adjustment. Conclusions: Self-reported routine contraceptive counselling remained limited despite broad recognition of the relevance of contraception in chronic disease care. Guideline awareness, postgraduate training, clinical exposure, sex, and clinical experience were associated with routine counselling after adjustment, although causal relationships cannot be inferred from this cross-sectional study. These findings support further evaluation of educational and organizational strategies for integrating reproductive healthcare into chronic disease management. Full article

Background/Objectives: Sustainable Human Resource Management in healthcare requires the identification of factors that support motivation, well-being, and employment sustainability in nursing staff. The aim of this study was to assess motivating and demotivating factors related to nurses’ work motivation in a Polish university clinical hospital and to examine their associations with selected sociodemographic and occupational characteristics in order to identify Sustainable HRM practices that may be relevant to staff retention, professional resilience, and long-term workforce sustainability. Methods: The study was conducted among 300 nurses using a diagnostic survey method between October 2023 and March 2024. Associations between variables were examined using the χ² test of independence and Cramér’s V. Results: Salary level was the most important financial motivating factor in the nurses’ opinions. With regard to non-wage factors, the opportunity to improve qualifications at the employer’s expense was predominant. Friendly team relationships were identified as the key non-material motivating factor. The most frequently indicated demotivators were low salary, low occupational status, poor relationships with supervisors or team members, and limited autonomy. Significant associations were observed between financial motivating factors and age, professional experience, employment type, and salary level. Associations for indirect material, non-material, and demotivating factors were less consistent and generally weak. Conclusions: Effective nursing workforce management should combine fair remuneration with opportunities for professional development and measures that support positive workplace relationships and organizational culture. Interpreted within the Sustainable HRM framework, these findings may inform practices intended to support staff retention, professional resilience, and long-term workforce sustainability. Full article

Background: Pharmacists, as healthcare professionals of public trust, operate within a complex legal environment involving multiple forms of professional liability, particularly civil and criminal liability. Although these forms of responsibility are formally regulated by statutory law, the practical distinction between them remains largely dependent on judicial interpretation and case-specific circumstances. Objective: The aim of this study was to assess the scale and nature of judicial proceedings involving pharmacists and to identify the most common factors leading to civil and criminal liability. Additionally, the study sought to highlight the largely under-recognized phenomenon of legal actions involving pharmacists and to determine which areas of pharmacy practice generate the greatest legal risk. Methods: The study employed a mixed-methods design combining qualitative case law analysis with descriptive quantitative assessment. A total of 146 judicial decisions involving pharmacists were reviewed, including 43 civil and 19 criminal cases constituting the principal subject of the analysis. The examined judgments were assessed with regard to factual background, legal qualification, judicial reasoning, applied legal provisions, and type of liability imposed. Cases were additionally categorized according to the nature of the violation and the protected legal interest affected. Results: A total of 146 judicial decisions involving pharmacists were identified and analyzed, including 43 civil cases and 19 criminal cases. The findings demonstrate that legal proceedings involving pharmacists are not isolated events but represent a recurring phenomenon within professional practice. Civil cases were dominated by disputes related to reimbursement claims, prescription processing, and regulatory compliance, accounting for over half of all analyzed civil proceedings. In contrast, criminal cases were less frequent but displayed substantial heterogeneity, including unlawful medicine distribution, reimbursement fraud, breaches of professional duties, and other criminal offences. Importantly, only a minority of cases involved direct patient harm, while the majority arose from administrative, organizational, and regulatory obligations associated with pharmacy practice. The analysis identified prescription reimbursement procedures, medicine dispensing regulations, and pharmacy management responsibilities as the principal sources of legal risk for pharmacists. Conclusions: Published case law demonstrates the recurrent presence and considerable diversity of legal proceedings involving pharmacists. Most cases do not arise from direct patient harm but rather from regulatory, administrative, and organizational obligations associated with pharmacy practice. Civil proceedings are predominantly linked to reimbursement and prescription-related disputes, whereas criminal cases are less common but more diverse in nature. The results highlight the need for greater legal awareness among pharmacists, enhanced risk-management education, and stronger integration of legal competencies into undergraduate and postgraduate pharmacy training. Increased recognition of legal risks may contribute to both professional protection and improved patient safety. Full article

Background: The global healthcare landscape is being increasingly shaped by two pivotal trends: the adoption of international quality frameworks, such as Joint Commission International (JCI) accreditation, and the strategic shift towards resource-efficient models like outpatient surgery. While both areas have been extensively addressed in the healthcare literature, empirical evidence concerning their intersection remains limited. This scoping review aimed to systematically map the available literature, identify critical evidence gaps at the intersection of JCI accreditation and outpatient surgery, and examine implications for healthcare risk management and policy development. Methods: The scoping review was performed in accordance with the PRISMA-ScR guidelines. A dual-track evidence-mapping strategy was implemented across seven electronic databases and platforms (PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, eLIBRARY.ru, CyberLeninka, and Google Scholar) to search for publications published between January 2000 and May 2026. The final database searches were conducted on 15 May 2026. Data extraction was centered on study design, interventions, and key findings related to quality and risk management. Results: A total of 80 publications were included. The evidence comprised two complementary streams: literature concerning JCI accreditation and healthcare quality and safety, predominantly in hospital and general healthcare settings, and literature concerning outpatient, ambulatory, and day-surgery quality, safety, and hospital-substituting technologies. No empirical study directly evaluating the implementation or impact of JCI accreditation within outpatient surgery centers was identified. Conclusions: This scoping review identified a critical empirical evidence gap concerning the integration of accreditation and quality and risk-management frameworks in outpatient surgical settings. A hypothesis-generating conceptual framework is proposed to guide future empirical research evaluating whether and how JCI accreditation influences quality, safety, organizational, and economic outcomes in outpatient surgical settings. Full article

Background/Objectives: Cognitive behavioural therapy (CBT) is an effective intervention for promoting personal recovery among individuals diagnosed with schizophrenia; however, Saudi Arabia has a shortage of healthcare professionals trained to deliver it. Mental health nurses are well positioned to help address this gap. This study explored mental health nurses’ perspectives on a proposed culturally adapted CBT intervention for individuals diagnosed with schizophrenia and identified perceived barriers and facilitators to its implementation. Methods: Situated within the development phase of the Medical Research Council framework for complex interventions, the study examined perceived acceptability and anticipated feasibility rather than efficacy. Three face-to-face focus groups involving 19 mental health nurses were conducted between December 2020 and February 2021 at a tertiary mental health hospital in Riyadh, Saudi Arabia, during the COVID-19 pandemic. The focus group questions were informed by a systematic review of culturally adapted CBT components, and data were analysed using framework analysis. Results: Three themes emerged: acceptability, with nurses recognising the value of CBT in promoting recovery; barriers, including lack of role clarity within mental health nursing policy, dominance of the medical model, and engagement difficulties among individuals diagnosed with schizophrenia; and facilitators, including supportive nursing management, training opportunities, and family involvement. Conclusions: Mental health nurses expressed support for delivering CBT but identified organisational and training-related barriers. Successful implementation will require clear policy frameworks, structured culturally adapted CBT training, ongoing clinical supervision, supportive nursing management, and collaborative approaches that appropriately involve families. Full article

Background: Rare diseases collectively affect millions of children worldwide and are a major cause of pediatric morbidity, mortality, and lifelong disability. Although most have a genetic basis, obtaining a timely molecular diagnosis remains challenging because of substantial clinical and genetic heterogeneity. Advances in genomic medicine are transforming rare disease diagnosis and establishing genomics as the center of precision medicine. Methods: This review summarizes current evidence on genomic approaches for pediatric rare diseases, including established and emerging sequencing technologies, their clinical applications, implementation challenges, and future directions. Results: Whole-genome sequencing is increasingly being adopted as a first-line genomic test for suspected rare genetic disorders, particularly when the phenotype is heterogeneous or does not point to a specific diagnosis. Conventional cytogenetic and targeted molecular techniques remain important complementary approaches for selected phenotypes, variant classes, and orthogonal confirmation. Gene panels are effective for well-defined phenotypes, whereas whole-exome sequencing remains a high-yield approach for genetically heterogeneous disorders, particularly when whole-genome sequencing is not available or is not clinically indicated. Long-read whole-genome sequencing expands diagnostic capacity by detecting structural variants, repeat expansions, complex rearrangements, and non-coding pathogenic variants that frequently escape short-read technologies. Emerging multi-omics approaches further improve variant interpretation and help resolve previously unsolved cases. Beyond diagnosis, molecular findings guide personalized clinical management, genetic counselling, reproductive planning, and access to targeted therapies and genotype-driven clinical trials. However, broad implementation is constrained by challenges in variant interpretation, ethical and legal considerations, data governance, workforce capacity, cost, and inequitable access to genomic services. Artificial intelligence, international data-sharing initiatives, and coordinated healthcare networks are helping overcome these barriers and improve diagnostic equity. Conclusions: Whole-genome sequencing is increasingly emerging as a first-line genomic strategy for pediatric rare diseases, while complementary technologies, expert phenotyping, and iterative data interpretation remain essential for comprehensive and accurate diagnosis and equitable access to genomic medicine. Full article

Background/Objectives: Person-centered care (PCC) and the Technological Competency as Caring in Nursing (TCCN) theory are increasingly emphasized in nursing leadership, but no published study has evaluated a PCC/TCCN training program among Mongolian nurse managers. This uncontrolled, single-group pilot pre–post study examined immediate changes in nurse managers’ self-reported PCC and TCCN perceptions following a one-day collective training program. Methods: The program was delivered on 30 October 2025 during the 2nd International Nursing Symposium in Mongolia. Using convenience sampling, hospitals were invited to send nurse managers who were currently in post or senior nurses who had been formally nominated for such a role. Of 50 attendees, 30 met a pre-specified role-eligibility criterion and formed the matched pre–post analytic sample. Participants completed Mongolian versions of the Person-Centered Care Instrument (PCCI) and the Perceived Technological Competency as Caring in Healthcare Providers Instrument (TCCHI) immediately before and after the program. Pre–post differences were assessed with Wilcoxon signed-rank tests, effect sizes for the Wilcoxon signed-rank test (r = z/√N), and Holm–Bonferroni correction across 16 comparisons. Results: Total and all concept-level PCCI and TCCHI scores were higher after the program than before it, all 16 comparisons remained significant after correction, and the effect sizes were moderate to large (r = 0.41–0.61). The median within-person change was +22.0 points (95% CI 7.0 to 35.5) for the total PCCI score and +24.0 points (95% CI 10.5 to 38.0) for the total TCCHI score (Hodges–Lehmann estimates). Conclusions: In this small convenience sample of Mongolian nurse managers and senior nurses formally nominated for managerial roles, self-reported PCCI and TCCHI scores increased immediately after a one-day training program. Because the study used a single-group design without a control group, employed instruments not yet fully validated in Mongolian, and included no follow-up, these findings are preliminary evidence of an association rather than proof of program effectiveness. Larger, controlled studies with follow-up are needed. Trial Registration: TCTR20260513001, registered retrospectively on 13 May 2026, after data collection had been completed. Full article

Adolescence is a critical developmental period in which epilepsy can affect both health behaviors and psychological well-being. However, clinical indicators alone do not fully capture adolescents’ lived experience. Grounded in Self-Determination Theory, this study examined the cross-sectional associations among autonomy-supportive healthcare (ASH) environments, medication adherence, and life satisfaction in adolescents with epilepsy. A cross-sectional design was used with 1219 Italian adolescents with epilepsy (M age = 15.58, SD = 1.72), recruited through pediatric neurology clinics and national patient support organizations. Participants completed validated self-report measures: the Health Care Climate Questionnaire (HCCQ) for ASH, the Medication Adherence Report Scale (MARS) for medication adherence, and the Satisfaction With Life Scale (SWLS) for life satisfaction. A mediation model was tested to evaluate the indirectly associated paths among the variables. The mediation model showed a good fit to the data (χ²/df = 2.45, CFI = 0.994, RMSEA = 0.034, SRMR = 0.029). ASH was positively associated with both medication adherence (β = 0.40, p < 0.001) and life satisfaction (β = 0.23, p < 0.001), while medication adherence was positively associated with life satisfaction (β = 0.35, p < 0.001). The indirect statistical path from ASH to life satisfaction through medication adherence was also significant (β = 0.08, p < 0.001), indicating partial mediation. Overall, these findings highlight positive cross-sectional links between ASH environments, medication adherence, and psychological well-being in adolescents with epilepsy, underscoring the potential relevance of relational aspects of care in chronic disease management. Full article

Occupational exposure to blood and body fluids (OEBBF) continues to represent an important public health problem due to the associated medical, social and economic consequences. Young healthcare workers are at high risk of OEBBF because of their lack of experience, hesitation before performing a task and the nature of the task performed. This study aims to comparatively evaluate the knowledge, attitudes and perceptions on OEBBF among students from the Faculty of Medicine and the Faculty of Dental Medicine at Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, during the 2021–2022 academic year in order to facilitate the adaptation of educational materials used in training programs. Out of the 911 students who completed the questionnaire, 55% (502) correctly identified hepatitis B virus (HBV) as having the highest risk of transmission after an OEBBF, with statistically significantly higher percentages among Dental Medicine students (152; 60% vs. 350; 53%; p = 0.003). However, lower percentages of Dental Medicine students recognized the protective concentration of antibodies against HBV (173; 68% vs. 536; 82%; p < 0.001) or reported knowing to be vaccinated against hepatitis B (110; 43% vs. 459; 70%; p < 0.001). Additionally, higher percentages of Dental Medicine students reported not having an antibodies concentration measurement since they started their clinical practice (206; 81% vs. 439; 67%; p < 0.001). If an OEBBF were to occur, 43% (391) reported that they would induce bleeding, either instinctively (210; 23%) or because they considered it necessary (181; 20%). Ninety-three students (10%) reported at least one past OEBBF; 59 (63%) reported it to their supervisors. Statistically significantly higher percentages of Dental Medicine students reported a high perceived risk of exposure compared to Medicine students (117; 46% vs. 202; 31%; p < 0.001), with the finding supported by univariable and multivariable analyses. In conclusion, the reporting frequency of past OEBBF in our study population was low. However, enhanced efforts are required to improve knowledge and awareness regarding OEBBF risk and preventive measures. Additionally, efforts should focus on assessing the level of protection against hepatitis B among Dental Medicine students and on promoting timely reporting to ensure appropriate post-exposure management. Full article

Agentic artificial intelligence (AI) systems—software that plans, acts, and decides without step-by-step human approval—are already deployed in finance, healthcare, recruitment, and public services. They differ from earlier AI in one critical way. They do not produce outputs for a human to accept or reject. They take actions. Those actions may be irreversible. They may affect people who never used the system. Existing governance frameworks were not designed for this. Current alignment approaches—including reinforcement learning from human feedback, constitutional AI, and preference aggregation—assume that a well-aligned system satisfies what users ask for. This paper argues that the assumption fails in agentic contexts. What people ask for is not what they value. Preferences are volatile and user-centric. Values are stable, culturally grounded, and other-regarding. This paper proposes the Human Values Alignment Framework for Agentic AI (HVAF-A), grounded in Schwartz’s cross-culturally validated Basic Human Values theory. The framework connects value inputs, three alignment mechanisms (elicitation, arbitration, and propagation), and governance outcomes at individual, organizational, and societal levels. The paper positions the HVAF-A against the main international policy instruments—the EU AI Act, the NIST AI Risk Management Framework, ISO/IEC 42001, and the OECD and UNESCO principles—and specifies an empirical program of constructs, measures, validity tests, and study designs. An illustrative case study of an agentic hiring system shows how the framework would operate. This is a purely conceptual study. No study was conducted and no instrument was administered to validate the model. A dedicated section states the framework’s boundary conditions. Empirical validation is set out as future research. Full article

During the COVID-19 pandemic, healthcare-associated infections (HAIs) showed a significant increase, exacerbated by the prevalence of multidrug-resistant (MDR) organisms. Antibiotic overuse and infection control practices influenced HAI incidence rates, alongside the rising prevalence of resistant pathogens such as methicillin-resistant Staphylococcus aureus. Antibiotic-resistant pathogens causing healthcare-associated infections in COVID-19 patients include—in addition to methicillin-resistant Staphylococcus aureus—metallo-β-lactamase-producing carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Acinetobacter baumannii, extended-spectrum β-lactamase-producing Klebsiella pneumoniae, and vancomycin-resistant enterococci. COVID-19 impacted bacterial healthcare-associated infections in various ways, with an increase in the incidence of metallo-β-lactamase-producing, carbapenem-resistant organisms—a trend already noted prior to the pandemic. Furthermore, the pandemic laid the groundwork for future challenges in HAI management, highlighting the need for rigorous infection prevention and control protocols. Poorer outcomes were observed in hospitalized COVID-19 patients with antibiotic-resistant infections. Although increased infection prevention and control (IPC) measures led to a reduction in certain site-specific hospital-acquired infections, in other contexts, COVID-19 was associated with an increased incidence of bacterial hospital-acquired infections. Further research is needed to determine the cost–benefit ratio of maintaining COVID-19-related infection prevention and control protocols beyond the pandemic in order to reduce the impact of hospital-acquired infections. Furthermore, it is necessary to assess the long-term impact of the high usage of certain broad-spectrum antibiotics during the COVID-19 pandemic. Full article

Diabetes-related hypoglycemia contributes substantially to increased morbidity, mortality, health-care utilization, and reduced quality of life. Older adults with diabetes represent a heterogeneous group of patients who need individualized blood glucose targets to avoid hypoglycemia. Since the elderly present with varying degrees of functional and cognitive status and individualized health needs, their management varies among individuals. Complicating this, the hypoglycemia risk in older adults treated with insulin also varies due to aging, renal dysfunction, cognitive impairment, and other comorbidities. The challenge for healthcare providers is in considering all aspects of care in order to avoid hypoglycemia in elderly individuals. In this review, we introduce a Patient and Function Centric Approach to the assessment and management of hypoglycemia in older adults. This holistic framework extends beyond blood glucose values to systematically evaluate the other domains of patients’ health that influence hypoglycemia risk, including biochemical, medication, timing, autonomic, cognitive, mood, renal, pancreatic, hepatic, social, and physical function. The management of hypoglycemia in older adults should also include strategies to address both fear of hypoglycemia and hypoglycemia unawareness. In addition to physical limitations, the psychosocial barriers to self-care in older individuals with hypoglycemia are also of paramount importance. Using tools that measure diabetes burden, diabetes distress, and fear of hypoglycemia provides valuable insights into patient wellbeing. The use of newer anti-hyperglycemic medications, sensor-augmented insulin pump therapy, intranasal glucagon, and continuous glucose monitoring (CGM) has significantly contributed to reduced hypoglycemia incidence in individuals with diabetes. Overall, successful management requires a collaborative approach that empowers patients, respects their individual needs and preferences and helps them face the challenges associated with diabetes management with confidence rather than fear or anxiety. Adopting a patient- and function-centric approach to hypoglycemia management allows clinicians to move beyond a one-size-fits-all model and adopt individualized glycemic targets that improve overall diabetes control and mental well-being. Full article

Tuberculous meningitis (TBM) is a critically severe form of extrapulmonary tuberculosis in pediatric patients, presenting a significant diagnostic challenge during the early stages of clinical manifestation. Delayed recognition of meningeal tuberculous inflammation leads to the involvement of the brain parenchyma (encephalitis) and may result in irreversible neurological sequelae. Objective: To evaluate the clinical features, the spectrum of complications, and the acute outcomes of tuberculous meningitis in pediatric patients managed at a tertiary reference center. Materials and Methods: A retrospective observational study of 21 medical records was conducted for pediatric patients aged 3 months to 17 years (mean age: 6.7 ± 5.8 years) with a confirmed TBM diagnosis. The study included pediatric patients treated in the inpatient pediatric department (n = 6) or evaluated through the national telemedicine consultation system (n = 15) between 2017 and 2025. Results: A history of contact with a tuberculosis patient was established in 62% (13/21) of cases. At initial presentation, fever was recorded in 67% (14/21) of patients, nausea and/or vomiting in 52% (11/21), headache in 33% (7/21), and meningeal signs in 38% (8/21). The majority of patients (52%, 11/21) had not received BCG vaccination. Mycobacterium tuberculosis (MTB) was microbiologically confirmed in 19 patients (90.5%). MTB DNA was detected in the cerebrospinal fluid (CSF) in 71.4% of all patients (15/21; 78.9% of confirmed cases). Drug resistance (DR) was confirmed in 47.4% of confirmed patients (9/19; 42.9% of the total cohort), comprising MDR (15.8%, 3/19), pre-XDR (15.8%, 3/19), and XDR (15.8%, 3/19) strains. Neurological complications included hydrocephalus in 47.6% (10/21), motor deficits in 38.1% (8/21), and epileptic syndrome in 19.0% (4/21). In-hospital mortality was 0%, while four patients (19.0%) with critically severe irreversible brain damage were transitioned to palliative care. Conclusion: In this tertiary pediatric cohort, TBM presented predominantly as a severe form of meningoencephalitis with extensive brain parenchymal involvement and high rates of systemic dissemination, frequently complicated by hydrocephalus, motor deficits, and seizures. Epileptic seizures showed an exploratory statistical trend toward an association with unfavorable neurological outcomes (p = 0.052). These findings underscore the urgent need to optimize early diagnostic strategies within general healthcare networks. Full article