Health Science Reports

Background: Deceased-donor kidney transplantation is a component of the Brazilian transplant system and takes place within a deceased-donation environment that in-cludes donor identification, notification, family approach and authorization, organ allocation, and logistics. This study described temporal, macroregional, and federative unit-level variation in deceased-donor kidney transplantation in Brazil from 2014 to 2024, together with hospitalization-based indicators and contextual indicators of the deceased-donation environment. Methods: This nationwide descriptive time-series study used publicly available secondary data from the Hospital Information System of the Unified Health System (SIH/SUS), the Brazilian Transplant Registry (RBT/ABTO), and the Brazilian National Transplant System (SNT). Indicators includ-ed the number of transplants, transplant rates per million population, kidney transplant waiting list stock, mean length of hospital stay, in-hospital mortality, potential donor notifications, and family interview and refusal proportions. The three databases were analyzed separately and in parallel, without linkage. Results: The annual number of deceased-donor kidney transplants increased over the study period. The kidney trans-plant waiting list stock also increased. Mean length of hospital stay decreased, and in-hospital mortality decreased over time. Marked macroregional and federative unit-level heterogeneity was observed in transplant activity, hospitalization-based indica-tors, and contextual indicators of the deceased-donation environment. Conclusions: Deceased-donor kidney transplantation increased in Brazil between 2014 and 2024, although regional disparities persisted. These findings support monitoring strategies that incorporate contextual indicators alongside measures of transplant activity. Be-cause this was a descriptive study based on secondary data from distinct sources, the findings should not be interpreted as evidence of causal relationships.

Background Anticoagulants are high-risk medications that require careful consideration of the risks and benefits. In the setting of advanced kidney disease decisions around prescribing anticoagulants is problematic. This relates to a lack of good-quality evidence and the altered renal clearance and protein binding in kidney disease. This leads to prescribing variation and results in patients experiencing different standards of care. The aim of this study was to explore the factors influencing anticoagulant prescribing decisions among nephrology and haematology healthcare professionals in commonly encountered scenarios, in order to better understand variation in prescribing practice. Methods Three case-vignettes were presented to 15 haematology and nephrology professionals as part of a semi-structured interview. Participants were purposively selected based on variable responses to a UK anticoagulant prescribing practice survey. An inductive thematic analysis was undertaken as described by Braun and Clark with an iterative review process to identify final themes. Results There were five main themes that arose from the analysis; evidence, patient factors, knowledge and experience, team influence and systems and they were present across all the three vignettes. The prescribing of anticoagulation in advanced kidney disease is strongly influenced by the knowledge and expertise gleaned by prescribers previous experiences and the incorporation of patient factors. Prescribers commonly seek opinion from senior staff and other members of the multiprofessional team to support their decision making. Decisions are also influenced by organisational factors that are beyond their individual control. Conclusion Development of guidelines, delivery of education and good-quality evidence is needed to improve prescribing variation and ultimately the quality of care provided to patients with advanced kidney disease.

Background: Uremic pruritus affects up to 90% of individuals and substantially impairs quality of life, in the group of patients undergoing chronic dialysis. Despite multiple therapeutic options, an optimal and well tolerated treatment remains elusive. Ketotifen, a mast cell stabilizer with antihistaminic properties prevent itch by inhibition of mast cell derived tryptase, which modulates protease-activated receptor-2 (PAR-2) in the cowhage itch pathway. Materials and Methods: In this prospective observational study, 230 chronic dialysis patients were screened, of whom 48 (20.9%) had clinically significant pruritus identified using a structured questionnaire. Twenty-four patients with moderate-to-severe symptoms who were prescribed ketotifen as part of routine clinical care consented to prospective follow-up. Ketotifen was initiated at 1 mg twice daily, with dose escalation to 2 mg twice daily in patients with persistent symptoms according to routine clinical practice. Pruritus severity was assessed using visual (VAS), verbal (VRS), and numerical (NRS) rating scales before and after treatment. Results: After two weeks of initial 1mg therapy, 19 showed significant clinical improvement. Mean scores reduced 77.5 [-&gt;] 27.1 (VAS), 87.5 [-&gt;] 20.8 (VRS), and 74.2 [-&gt;] 25 (NRS) (around 65% reduction with p < 0.001 across all scales). Clinical relief was achieved in 83.3% overall and mild tolerable drowsiness occurred only at the 2mg dose. Conclusion: Ketotifen is a safe, effective and well tolerated option for moderate to severe uremic pruritus in dialysis patients. Larger multicenter studies are warranted to confirm efficacy and optimize dosing.

Background Women living with Human Immunodeficiency Virus (WLHIV) are at high risk of cervical cancer. While Human Papilloma Virus Deoxyribonucleic acid (HPV DNA) testing is the standard of care, its cost limits widespread use in resource-limited settings, therefore visual inspection with acetic acid (VIA) remains the primary screening method. This study therefore evaluated the diagnostic accuracy of VIA compared to HPV DNA testing for cervical cancer screening among WLHIV in Nigeria. Methods This cross-sectional analytical study was conducted between November 2022 and November 2024 in Osogbo, Nigeria among 300 WLHIV on antiretroviral therapy aged 25-49 years underwent cervical cancer screening using VIA and HPV DNA testing (Ampfire HPV test kits, ATILA Biosystems(R) USA). All 309 participants underwent colposcopy and biopsy regardless of their screening results, with histological examination serving as the gold standard. Data were analyzed using Stata, with diagnostic performance measures calculated using histology as the gold standard. Results The mean age of participants was 42.6 {+/-} 6.4 years. Thirty-six of 309 women (11.7%) were VIA-positive, while 91 (29.4%) were HPV-positive. Histology confirmed CIN2+ in 22 participants (7.1%). HPV testing demonstrated significantly higher sensitivity than VIA for detecting CIN2+ (91.2%, 95% CI: 76.3-98.1 vs. 44.1%, 95% CI: 26.7-62.6; p<0.001) and higher negative predictive value (98.9%, 95% CI: 96.3-99.8 vs. 92.0%, 95% CI: 88.0-95.0; p<0.001). However, VIA showed higher specificity (91.7%, 95% CI: 87.8-94.7 vs. 83.3%, 95% CI: 78.4-87.6; p=0.003). The agreement between the two tests was fair (kappa = 0.20, p<0.001). Both HPV positivity (adjusted OR: 42.1, 95% CI: 9.5-186.2; p<0.001) and VIA positivity (adjusted OR: 6.9, 95% CI: 2.6-18.4; p<0.001) were independently associated with CIN2+. Conclusion HPV DNA testing demonstrated superior sensitivity and negative predictive value compared to VIA for detecting CIN2+ among WLHIV, while VIA showed higher specificity. Keywords: Cervical cancer screening, visual inspection with acetic acid, Human Papilloma Virus Women living with HIV, Nigeria

Abstract Background: Cervical cancer is the most common malignancy among Zambian women, and HIV coinfection accelerates disease progression. However, in the contemporary era of widespread antiretroviral therapy, the determinants of cervical cancer disease state among women living with HIV at Zambia's primary oncology referral centre are not fully understood. This study aimed to investigate these determinants at the Cancer Disease Hospital in Lusaka. Methods: An analytical cross-sectional study was conducted using medical records of 198 WLHIV with histologically confirmed invasive cervical cancer. Data on demographics, HIV status (CD4 count, viral load), and cancer characteristics (FIGO stage) were abstracted. Descriptive statistics, bivariate analyses, and multivariable logistic regression were performed. Results: The prevalence of advanced stage (Stage III/IV) cervical cancer was 34.4% (68/198), while 54.5% presented with Stage IIB disease. Metastatic disease was only 7.1% (14/198). The peak age of diagnosis was 40-49 years (51.5%). Median CD4 count was 484 cells/uL, and 89.4% had suppressed viral loads. No significant association was found between HIV disease status and advanced-stage cancer (CD4 <200: AOR 1.42, 95% CI 0.68-2.96; detectable viral load: AOR 1.38, 95% CI 0.71-2.68). Younger WLHIV aged 30 to 39 years had the highest proportion of advanced-stage disease (38.5%), as did peri-urban residents (40.0%) compared to Lusaka residents (30.0%). Conclusion: In the ART era, HIV disease status is no longer the dominant determinant of cervical cancer stage among WLHIV at CDH who develop invasive cancer, likely due to effective immune reconstitution. However, persistent Stage IIB presentation indicates inadequate screening coverage. Younger WLHIV and peri-urban residents are at highest risk of late-stage diagnosis. Keywords: Cervical Cancer; Uterine Cervical Neoplasms; Antiretroviral Therapy; HIV infections; FIGO Staging; Zambia

Background: Human papillomavirus (HPV) is the leading cause of cervical cancer and the vaccine is the key preventive measure. In 2023, Bangladesh launched a school-based HPV vaccination campaign for girls aged 10-14 years. However, vaccine uptake among this group in urban settings remains suboptimal. This study explored adolescent girls (aged 10-14 years) understanding attitude, and motivation towards the vaccine, as well as the practical challenges impacting on vaccine uptake. Methods: From April to June 2024, a qualitative study was undertaken in two urban slums in Dhaka, Bangladesh. Through a combination of convenience and snowball sampling, we conducted 15 in-depth interviews and one focus group discussion using the World Health Organizations Behavioral and Social Drivers (BeSD) tool. Interviews were conducted in the native Bengali language, audio recorded, and transcribed verbatim. Framework analysis was performed to emerge key themes and generate study findings. Results: A total of 26 girls with a mean age of 12.65 (SD: 1.23) participated in the study. While some participants believed that the HPV vaccine could reduce the infection during menstruation or prevent childbirth-related complications, there was uncertainty regarding the appropriate age for vaccination. Concerns were raised about menstrual irregularities, infertility, and the potential negative impact on marital prospects. Students spoke about being subjected to inappropriate jokes from their male peers. Male guardians were identified as the key decision makers and were perceived to be against the need for this vaccine. Operational barriers including inaccessible digital registration, limited information about the vaccine, and lack of systematic follow-up constrained the participation in the school-based HPV campaign. Conclusions: Adolescents in urban slums faced multi-layered barriers, including knowledge gaps, cultural barriers, and accessibility challenges to HPV vaccination. Strengthening adolescent-friendly communication, engaging parents, teachers and male students, simplifying registration, adequate vaccine supply and ensuring supportive school-based vaccination processes are critical to improving equitable coverage and acceptance.

Background: Pancreatic ductal adenocarcinoma (PDAC) has remained one of the most serious malignancies and is still a leading cause of cancer-related deaths worldwide. Great attention has been paid to the relationship between diabetes mellitus and PDAC. The aim of our study was to analyse the mutual association of PDAC and diabetes mellitus in the entire population of the Czech Republic within a 5-year period. Methods: The incidence of PDAC in 2018-2022 was estimated based on the individual population data from the Czech National Cancer Registry. Another data source, the National Registry of Reimbursed Health Services that collects data from health insurance companies, was used to identify individuals recently diagnosed with diabetes mellitus. For the purpose of this study, diagnosis of new-onset of diabetes mellitus was defined as the time of the first prescription of any antidiabetic drug or another related health care service. Subsequently, patients diagnosed with PDAC in 2022 were followed retrospectively to see if they had been diagnosed with diabetes mellitus in the last five years before diagnosis of pancreatic cancer. Results: In 2022, 2,189 patients aged 60 years or older were diagnosed with pancreatic cancer. New-onset diabetes was observed in 17.4% within five years prior to diagnosis, with the highest occurrence (12.4%) within the last three years. Among patients aged 60-74 years, the respective proportions were 14.4% within three years and 5.7% four to five years prior to pancreatic cancer diagnosis. Conclusion: The incidence of pancreatic cancer in the Czech Republic is among the highest in Europe. One-fifth of PDAC cases are diagnosed following new-onset diabetes mellitus in patients over sixty. Unintended significant weight loss combined with new-onset diabetes thus must not be overlooked, as these can be early signs of PDAC. An individualised diagnostic work-up should follow without any unnecessary delay.

HIV/AIDS remains a major global public health challenge, and disparities in HIV testing persist. In 2024, an estimated 87% of people living with HIV were aware of their status, with lower testing coverage among children aged 0-14 years (63%), and among men (84%) compared with women (92%). Romania initiated its national AIDS program in 1995 and quickly progressed in addressing the epidemic; however, HIV testing remains largely concentrated in specialized services, with late diagnosis, missed testing opportunities, and stigma continuing to limit timely identification and linkage to care. This study aimed to understand better HIV testing/screening practices among clinicians in eastern Romania and to identify gaps that could be addressed through medical education. We conducted an analytical cross-sectional study among healthcare providers in the eastern region of Romania to assess whether HIV testing is routinely offered to patients, explore gaps in clinical judgment and perceived responsibility, and identify factors that facilitate HIV testing. A 17-question anonymous survey was distributed via WhatsApp to clinician groups between August 1 and September 30, 2023. Respondents included physicians (71.9%), nurses (28.1%), and other healthcare professionals, working in infectious diseases (36.0%), internal medicine (22.3%), primary care (13.7%), and other specialties, such as obstetrics-gynecology and pediatrics (18.0%). Only 38.1% of respondents reported routinely screening all patients aged 18 years and older for HIV, while 61.9% did not offer regular HIV testing. The most cited reasons for not screening were the perception that HIV testing was not their responsibility and that their department did not require testing (18.1% each). Clinicians working in settings with established policies on HIV confidentiality, non-discrimination, testing, and post-exposure prophylaxis were more likely to offer routine testing. Universal HIV screening remains uncommon among clinicians in eastern Romania. Supportive institutional policies appear to facilitate routine testing and may reduce missed opportunities for early diagnosis. Normalizing HIV testing as part of routine clinical care, in line with the Romanian National Health Strategy 2022-2030, is crucial for enhancing early detection and strengthening prevention efforts through coordinated action among clinicians, public institutions, and civil society.

Objective -- To analyze the incidence dynamics of uveal melanoma (UM) in Irkutsk Oblast over the period 2023 -- 2025, assess the structure of newly diagnosed cases by territory and stage, and compare the outcomes of anticancer care with those of other constituent entities of the Russian Federation that lead in registered prevalence of malignant neoplasms (MN) of the eye and adnexa. Materials and Methods. Data from the cancer registry of the Irkutsk Regional Oncology Dispensary (IROD) for 2023 -- 2025 and information from the state reference book "The State of Cancer Care for the Population of Russia in 2025" (P.A. Herzen Moscow Oncology Research Institute) were used. The analysis included cases of MN of the eye and adnexa (ICD - 10 code C69) of uveal localization. Incidence rates per 100,000 population, stage distribution, proportion of morphological verification, mortality, and the cohort of patients under follow-up were calculated. Results. Over three years, 112 new cases of UM were registered in Irkutsk Oblast (37, 36, and 39, respectively), corresponding to a crude incidence rate of approximately 1.6 per 100,000 population per year. In 2025, the region ranked 3rd in the Russian Federation for the number of newly registered patients with MN of the eye (45 individuals) and 1st for the registered prevalence rate (15.6 per 100,000). The highest proportion of stage I disease (58.3 %) and one of the lowest mortality rates (1.9 %) were observed. Conclusions. Irkutsk Oblast is characterized by a consistently high incidence of UM, accompanied by a favorable stage distribution and low mortality, reflecting both the biological and geographic features of the region and an adequate level of organization of ophthalmic oncology care.

Background: The Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) remain a major public health concern in Ghana. Despite sustained progress in treatment and prevention, regional prevalence variations persist, driven by healthcare access, urbanization, and socio-economic factors. This study identifies trends and hotspots to guide effective HIV surveillance and control strategies in Ghana. Methods: A retrospective ecological study was conducted using secondary HIV data confirmed by laboratory testing, from the Ghana District Health Information Management System (DHIMS2) for the period 2020 to 2024. HIV prevalence was calculated as the number of confirmed cases per 100,000 population, using denominators from the Ghana Statistical Service 2021 Population and Housing Census. Spatiotemporal variation in prevalence was visualized using choropleth maps. Global Morans Index examined whether overall spatial dependency existed, followed by local indicators of spatial association (LISA), comprising local Morans I and the Getis-Ord Gi* statistic, to identify local clusters, outliers, and hotspots or coldspots. Results: National HIV prevalence per 100,000 population rose from 0.68 in 2020 to 0.84 in 2024. The highest burden was in the southern and middle belt regions: Western North (2.16), Bono East (1.71), Eastern (1.30), Volta (1.06), and Ahafo (1.01). Northern regions remained consistently low throughout the study period, with Northern (0.32), Upper East (0.26), and Savannah (0.30) recording averages below 0.50 per 100,000. Global Morans Index indicated a dispersed pattern in 2020 (I = -0.43), spatially random pattern between 2021 and 2023, and weak positive spatial association in 2024 (I = 0.22). Conclusions: Regional disparity in HIV prevalence in Ghana is widening, with greater burden concentrated in the more urbanized southern regions. Interventions guided by surveillance data and tailored to specific regions, including strengthened testing infrastructure and a more equitable distribution of health resources, are needed to curb transmission and support HIV in Ghana and the AIDS control programme. Keywords: HIV, AIDS, spatiotemporal analysis, Morans I, Getis-Ord Gi*, Ghana

Objective: In Japan, antiretroviral therapy (ART) for individuals living with human immunodeficiency virus (HIV) is financially supported through the Physical Disability Certification System for Immunological Impairment. However, certification requires multiple laboratory assessments after diagnosis, possibly delaying ART initiation. This study examined the impact of these eligibility requirements on ART initiation using real-world clinical data. Design: Single-center retrospective cohort study. Setting: Nagoya Medical Center, Japan. Subjects, participants: A total of 568 patients who attended their first consultation between 2015 and 2019 were included. Of these, 434 were ART-naive, and 134 had already initiated ART at the first visit. Main outcome measures: ART initiation rate, time to treatment initiation, factors associated with treatment delay, and utilization of the Physical Disability Certificate system. Results: Among the 434 untreated patients, the median time to ART initiation was 42 days. Seven patients (1.6%) did not meet the Grade 4 certification requirements and remained untreated. Overall, 13 of the 568 patients (2.3%) were affected by the certification system, including those importing ART from overseas or using alternative financial support mechanisms. Non-Japanese nationality, lack of health insurance, unstable employment, and low CD4 cell counts were significantly associated with failure to initiate treatment. Among the 134 previously treated patients, 108 (80.5%) had obtained a Physical Disability Certificate. Conclusions: Although relatively few patients were affected, certification requirements may delay ART initiation among socioeconomically vulnerable populations. Further multi-center and cost-effectiveness studies are needed to improve compatibility between long-term financial support systems and rapid ART initiation strategies after diagnosis.

Long-term data describing cancer patterns in Iraq remain generally limited. This retrospective observational study was conducted to evaluate the distribution and longitudinal patterns of malignant solid tumors diagnosed over a period of 12 years (2014-2025) at a major tertiary oncology center in the Kurdistan Region of Iraq. Demographic characteristics, cancer types, and temporal trend changes in cancer distribution were analyzed. Comparisons were made between the first (2014-2019) and second (2020-2025) halves of the study period. Descriptive statistics, Chi-square tests, and linear regression analyses were used to evaluate the temporal trends. After excluding records with incomplete data, 11,704 patients were included. Breast cancer was the most frequently diagnosed malignancy, accounting for over one-quarter of all cases, followed by lung, colorectal, prostate, and bladder cancers, in descending order. Women represented the majority of patients, and the mean age at diagnosis increased significantly over time. In general, the relative distribution of colorectal, genitourinary, pancreatic, uterine, and thyroid cancers increased during the study period, whereas breast and lung cancers showed a modest but significant proportional decline despite remaining the most common malignancies. A marked reduction in case numbers was observed in 2020, followed by progressive recovery in subsequent years. To conclude, cancer patterns in the Kurdistan Region of Iraq changed substantially during the 12-year study period, with increasing proportions of colorectal and several other malignancies alongside an older age at diagnosis. These findings likely reflect a combination of demographic changes, evolving lifestyle-related risk factors, and improvements in cancer detection and referral. The results provide contemporary evidence to support regional cancer control strategies, screening programs, resource allocation, and future epidemiological research.

Nutritional status and immune function have a significant impact on the prognosis of patients undergoing maintenance hemodialysis (MHD). Previous studies have shown that the Geriatric Nutritional Risk Index (GNRI) and the Prognostic Nutritional Index (PNI) at the initiation of dialysis can be used to assess the prognosis of MHD. However, as the physical status of patients are usually unstable in the early stage of dialysis, we hypothesized that the nutritional status and immune function after a certain period of stable dialysis might be more closely related to the prognosis. This study conducted a retrospective analysis of patients who started MHD between January 1, 2019 and December 31, 2021. A total of 200 patients were included, with 66 patients succumbing during follow-up. Both initial PNI and initial GNRI exhibited a negative correlation with all-cause mortality (p=0.019 and p=0.046, respectively). After three months of MHD, both PNI and GNRI increased in most patients; however, only the PNI measured after three months was significantly associated with prognosis and higher PNI was associated with a better prognosis (p<0.001). Multivariate Cox regression analyses indicated that only PNI after three months of MHD was linked to prognosis (p=0.004). Kaplan-Meier curves demonstrated patients experiencing a decrease in PNI following three months of MHD had poorer prognoses compared to those whose PNI increased (p=0.004). Furthermore, the predictive value of PNI after three months of MHD was evident in both younger (<60 years old; p=0.024) and older (>60 years old; p=0.022) patient groups. Both the PNI and GNRI showed a downward trend before death, but only PNI had a significant decline (p=0.03, compared with PNI after three months of MHD). In conclusion, for patients undergoing MHD, the correlation between PNI and prognosis is closer than that of GNRI, and the PNI after three months of MHD is a statistically significant but moderate predictor of long-term outcomes.

Background: Mortality and hospital admissions due to Severe Acute Respiratory Infection (SARI) peaked between January and August 2025 in Brazil. Methods: The Brazilian Ministry of Health data on hospital admissions and deaths caused by SARI were compiled by age group (<5, 5-14, 15-49, 50-64, 65+ years) and quarter between January 2023 and June 2025. SARI causes were aggregated into SARS-Cov-2, Influenza, Respiratory Syncytial Virus (RSV), and other viruses (parainfluenza, adenovirus, rhinovirus, bocavirus, metapneumovirus). Multinomial regression was used to impute likely causes of death when these were not laboratory confirmed. Results: In the second quarter of 2025 (2025/2), RSV mortality rate among children <5 years reached 60 per 100,000, which is a 43% increase compared with 2024/2. Mortality rate for the joint impact of parainfluenza, adenovirus, rhinovirus, bocavirus, and metapneumovirus in the same age group doubled from 20 to 40 on the same scale in 2025/2 compared to 2024/2. Over the same period, influenza mortality tripled among the aged, whereas mortality due to other respiratory viruses increased less dramatically, except for SARS-CoV-2, which decreased among the aged from 150 to 25 per 100,000 between 2023/1 and 2025/2. Other age groups remained relatively stable over the period. The variation in hospital admissions largely followed that of mortality. Conclusions: While deaths and hospital admissions caused by SARS-CoV-2 declined rapidly since 2023, mortality rates of other respiratory viruses, mainly influenza and RSV, increased significantly among children <5 years and the aged in 2025/2. Public health policies that facilitate vaccine uptake against these infections should be given high priority.

Abstract Aim: Low chemotherapy response is a major risk factor for early mortality in cancer patients; it is one of the biggest challenges in cancer treatment. Main aim of this study is to identify chemotherapy non-responder, prognostic significance of pre-chemotherapy baseline variables in survival, distinguish most effective anti-cancer drug classes and formulation. Methods: In this multi-center retrospective cohort (n=2459) patients deceased with NSCLC and received anti-cancer drugs were included for analyses. To identify chemotherapy non-responder, patient population was divided into three sub-groups based on chemotherapy prescription frequency [1-15] as group-A, [16-30] as group-B, and [[&ge;]31] as group-C. Multivariate analysis was performed to identify risk of 1-year mortality in these groups. To prognose chemotherapy response in resected and unresected NSCLC patients, 0-7 days pre-chemotherapy white blood cell (WBC) count total five-ranges were compared as per overall survival in abnormal Vs normal WBC counts. Results: Post-stratification in group-A there were (n=1289) patients, in group-B (n=648) patients, and in group-C (n=522) patients. In group-A (n=301) patients 23% were found to have no new metastasis post-diagnosis significantly less p-value (0.004) compared to Group-B (n=125) 19.3%, and group-C (n=110) 19.2% patients p-value (0.008). Metastasis during chemotherapy was found significantly less in 20% patients of group-A, compared to (33%) in group-B, and (43%) in group-C p-value (<0.001). Post-chemotherapy initiation OS in group-A patients were significantly less 9 months (95% CI 9.3 - 9.6) compared to group-B 19 months (95% CI 17.7 - 20.2) and group-C 36.6 months (95% CI 34.6 - 38.5) patients p-value (<0.0001). Despite of low new metastasis and post chemo metastasis, group-A patients survived significantly less based on these outcomes group-A patients were considered as chemotherapy non-responder. Males and NSCLC stage III/IV patients were at higher risk; clinical benefits are corelated to surgery and radiotherapy for chemotherapy non-responder. Leukocytosis in both resected/unresected NSCLC group-A (13%) patients were found to be bad prognostic factor of survival in unresected group-B (5%) patients. Oral formulation of receptor tyrosine kinase inhibitors (RTKI) was effective in non-responders. Conclusion: Stratification of patient population based on chemotherapy prescriptions could be a useful method to find chemotherapy response in retrospective analysis. Patients with pre-chemotherapy leukocytosis should be closely monitored prior to selection of chemotherapy dose and formulation.

Background: Though progress has been made towards universal access to diagnosis and treatment, inequalities in HIV testing are a major obstacle to HIV care in the world, as not everyone has enough access to HIV testing services. Progress is being made towards universal HIV testing and treatment, but inequalities in HIV testing are also an important hurdle to HIV care. Design: Cross-sectional secondary analysis Setting: Nationally representative survey across all 16 administrative regions of Ghana. Participants: 22,058 respondents (15,014 women aged 15-49 and 7,044 men aged 15-59) from the 2022 Ghana Demographic and Health Survey. Primary outcome measure: HIV testing uptake, defined as ever having been tested for HIV and received results (binary: yes/no). Aim: The aim of this study was to examine socioeconomic inequalities and spatial clustering in uptake of HIV testing in Ghana in the 2022 Ghana Demographic and Health Survey (GDHS). Specifically, it considered the level of inequality in wealth, the factors related to these inequalities, and the spatial distribution of HIV testing and factors associated with uptake of HIV testing. Methods: The secondary analysis of cross sectional data was done on 22,058 respondents from all 16 administrative regions of Ghana by using descriptive statistics, Erreygers concentration index, Wagstaff decomposition, spatial autocorrelation techniques, and multilevel logistic regression. Results: The findings showed that there was significant pro-rich inequality in HIV testing, with the majority of inequalities observable not being accounted for by the difference in wealth, but in education level. There was a significant geographic clustering with hotspots in the south, and coldspots in the north. HIV testing uptake was significantly predicted by wealth, education, and the age, sex, marital status and being covered by health insurance Conclusion: The study revealed that socioeconomic and geographical inequalities still exist and have significant impacts on uptake of HIV testing in Ghana. It suggests specific programs such as those aimed at disadvantaged communities, geographic areas, greater access to health insurance, and improved community-based HIV testing services to help ensure equitable access.

Background. The clinical course of coronavirus disease 2019 (COVID-19), and the ability to anticipate which patients will require intensive care, were poorly characterized in Central Asia during the first pandemic wave. We aimed to describe the clinical features of hospitalized COVID-19 patients at the Tashkent State Medical University, Uzbekistan, and to identify risk factors for intensive care unit (ICU) admission. Methods. In this single-centre cross-sectional study, we reviewed the records of 2500 consecutive patients hospitalized between 11 April and 8 August 2020. Patients were grouped as asymptomatic or symptomatic, and symptomatic patients were compared by ICU versus non-ICU status. Groups were compared with chi-square or Fisher's exact and Mann-Whitney U tests. Univariable and multivariable logistic regression identified risk factors for ICU admission. Results. Of 2500 patients (median age 36 years; 60.9% male), 989 (39.6%) were asymptomatic and 1511 (60.4%) symptomatic. In total, 129 (5.2%) were admitted to the ICU and 38 (1.5%) died. ICU patients were older (median 56 vs 40.5 years) and more often had bilateral pneumonia, oxygen desaturation and cardiometabolic comorbidity. In the multivariable model (AUC 0.82), the independent predictors of ICU admission were ischemic heart disease (aOR 4.20), shortness of breath (aOR 3.22), hypertensive heart disease (aOR 2.93) and male sex (aOR 2.00). Conclusions. Older age, cardiometabolic comorbidity and respiratory compromise identified patients at high ICU risk. As one of the first clinical COVID-19 descriptions from Uzbekistan, these data provide a baseline for preparedness in Central Asia.

Background: ALECT2 is the third most common cause of renal amyloidosis in the United States, with a strong predilection for Hispanic patients in the Southwest. (PMID:24522497) Despite its regional prevalence, the data on the trajectory of kidney function decline and post-transplant outcomes remain poorly characterized. Methods: This is a retrospective study of patients diagnosed with ALECT2 by kidney biopsy at UNM from January 2014 to April 2024. Pre- and post-biopsy eGFR trajectories and post-transplant allograft function were analyzed. Results: 12 patients had pre-biopsy data available, with the mean age at diagnosis 64 SD 12.0 years, 8(67%) were females, and 8 identified as Hispanic. Mean eGFR at diagnosis was 31 (SD 29) indicating advanced kidney disease with 67% diagnosed as CKD stage 4 or 5. Concomitant kidney pathology was identified in 50% with diabetic nephropathy being present in 2/3 of those. A significant change in the eGFR trajectory identified at the time of biopsy through change point analysis [Figures A,C,D] Among four patients who underwent kidney transplantation, allograft eGFR remained stable over more than 60 months of follow-up [Figure D] Conclusion: In this cohort of predominantly Hispanic patients, ALECT2 amyloidosis presented with advanced CKD and accelerated loss of kidney function, which prompted a biopsy that detected the disease. Post- transplant allograft function was well maintained, supporting kidney transplantation as a viable treatment strategy for ALECT2-associated kidney disease.

Introduction Globally and in Africa, HIV mortality is reported to have decreased over the years. Cameroon's national mortality rate was 1.7% in 2023, and there exist regional disparities and underreporting. We assessed the mortality and associated factors among People Living with HIV(PLHIV) initiated into HIV care from January 2021 to December 2023 at the Bamenda regional hospital (BRH) Methods A retrospective cohort study was conducted from June 2024 to December 2024 at the BRH. Using a non-probabilistic consecutive sampling technique, 331 newly initiated participants on ART were included. Data was collected from medical records using a questionnaire and analyzed using R software version 4.3.1. A multivariable Cox regression model included variables that showed statistical significance and assessed their relationship with mortality while adjusting for potential confounders. Significant predictors of mortality were identified. Results The mean age of participants was 41.6 {+/-} 11.7 years, and females constituted 57.7%. Opportunistic diseases were present in 19.0% of cases, with tuberculosis (8.2%) being the most common. Key comorbidities included hypertension (8.8%), diabetes (3.9%), and hepatitis B (3.0%). Blood tests showed elevated liver enzymes (ALAT/ASAT: 41.7{+/-}23.6 U/L) and high blood sugar (144.4{+/-}7.4 mg/dL). In contrast, kidney function (Creatinine: 0.9{+/-}0.2 mg/dL) and immune cell counts (Lymphocytes: 1.8{+/-}0.7 x103/L) appeared normal overall. A cumulative mortality rate of 7.6% over three years (approximately 2.5% per year) was observed. Male sex (AHR=7.83, 95% CI:1.44-42.5, p=0.017), opportunistic diseases (AHR=5.66, 95% CI:1.71-18.7, p=0.004), comorbidities (AHR=6.04, 95% CI:2.02-18.1, p=0.001), Abnormal ALAT/ASAT (p=0.005), and WHO clinical stage III (AHR: 1.1, 95%CI: 1.01 -1.5, p < 0.001), were identified as predictors of mortality. Whereas, BMI and ART adherence showed no significance. Conclusion Mortality among PLHIV in this study was associated with advanced disease, opportunistic diseases, commorbidities and abnormal laboratory findings. Strengthening early diagnosis, management of opportunistic infections, and monitoring of clinical and laboratory indicators may help reduce mortality in this population.

Abstract Objective: To synthesize the available evidence on the association between SARS-CoV-2-related microvascular thrombosis and acute kidney injury (AKI), with emphasis on renal outcomes, mortality, and renal replacement therapy requirements. Methods: This systematic review followed the PRISMA 2020 statement and was prospectively registered in PROSPERO (CRD420251132701). PubMed/MEDLINE, Scopus, and Embase were searched for systematic reviews, including meta-analyses, and umbrella reviews investigating the association between SARS-CoV-2-related microvascular thrombosis and acute kidney injury. Two reviewers independently performed study selection, data extraction, and methodological quality assessment using AMSTAR-2 and ROBIS. Evidence was synthesized through a structured narrative synthesis supported by quantitative data extracted from the included reviews. Results: Six evidence syntheses evaluating kidney involvement, thrombotic events, and microvascular mechanisms in COVID-19 were included. AKI incidence was 9.2% (95%CI 4.6-13.9) among hospitalized patients and 32.6% (95%CI 8.5-56.6) among critically ill patients. In children with multisystem inflammatory syndrome associated with SARS-CoV-2, AKI incidence was 20% (95%CI 14-28). Microvascular or thrombotic events were associated with adverse renal outcomes (OR 2.14; 95%CI 1.32-3.48). AKI was associated with increased mortality (OR 4.68; 95%CI 1.06-20.70) and greater likelihood of renal replacement therapy requirement (OR 2.87; 95%CI 1.45-5.68). The certainty of evidence ranged from moderate to high for the principal outcomes. Conclusion: Current evidence supports an important association between microvascular thrombotic injury and COVID-19-associated AKI. These findings reinforce the relevance of endothelial dysfunction and thromboinflammatory pathways in kidney involvement during COVID-19 and highlight the need for early renal monitoring, risk stratification, and kidney-protective strategies in high-risk patients. Keywords: COVID-19; Acute Kidney Injury; Microvascular Thrombosis; SARS-CoV-2; Renal Replacement Therapy; Systematic Review