Due to the paucity of quantifiable data regarding the stroke burden, a prospective, population-based investigation into stroke incidence and outcomes was conducted in Ulaanbaatar, Mongolia, between 2019 and 2021.
In Ulaanbaatar, Mongolia's six urban districts, from January 1, 2019, to December 31, 2020 (population person-years, N=1,896,965), all stroke cases in adult residents (aged 16 years) were determined using standardized diagnostic criteria from multiple overlapping data sources on hospitalized, ambulatory, and deceased individuals. Undetectable genetic causes Sociodemographic data, medical history, and management strategies were collected. Incidence rates for first-ever stroke and its major pathological subtypes, both crude and standardized, were assessed, accompanied by 95% confidence intervals in the reported data. Outcomes were defined as 28-day case fatality ratios and functional recovery assessed on the modified Rankin scale at 90 and 12 months post-occurrence.
In a study of 3738 patients, stroke incidents were identified in 3803 instances. From this total, 2962 were first-time occurrences, presenting a mean age of 59 years (standard deviation 13), and 1161 (392%) were female. Crude incidence of a first stroke was 1561 per 100,000 people (95% confidence interval 1505-1618). After adjusting for the age structure of the Mongolian population, the rate increased to 1716 (1575-1856). Conversely, adjusting for the global population's age structure resulted in a lower rate of 1403 (1367-1439). Taking into account global factors, the incidence of pathological stroke subtypes for ischaemic stroke was 666 (95% CI 648-683), 545 (530-561) for intracerebral haemorrhage, and 187 (183-191) for subarachnoid haemorrhage. Ischaemic stroke and intracerebral haemorrhage were observed more frequently in men than in women, yet the risk of subarachnoid haemorrhage exhibited symmetry across the genders; this pattern of disparity was consistent across all age groups. Key risk factors were hypertension, found in 1363 (631% of 2161) cases; smoking, affecting 596 (268% of 2220) cases; regular alcohol use, observed in 533 (240% of 2220) cases; obesity, affecting 342 (161% of 2125) cases; and diabetes, affecting 282 (127% of 2220) cases. Only 9% of acute ischemic stroke cases received thrombolysis. Delayed presentation after symptom onset (median 160 hours, interquartile range 30-480 hours) played a significant part in this low utilization rate. A 28-day period showed an overall case fatality rate of 361% (95% CI 343-379). Ischemic stroke showed a case fatality rate of 148% (128-167), while intracerebral haemorrhage had a rate of 529% (499-558), and subarachnoid haemorrhage had a rate of 543% (494-591). Respectively, corresponding figures for poor functional outcome at one year, determined by mRS scores of 3-6 (signifying death or dependence), were 616% (95% CI 598-634), 475% (447-503), 770% (745-795), and 618% (570-665).
Intracerebral and subarachnoid hemorrhages, forms of stroke, are prevalent amongst Ulaanbaatar's urban population in Mongolia. Tragically, half of patients die within the first month, and more than two-thirds are either deceased or permanently reliant on others for care within three months. The overall occurrence of stroke, mirroring that in other countries, shows a mean age of 60 years, a notable ten years younger than the average age of stroke in high-income nations. These epidemiological data play a key role in formulating future stroke prevention programs that address primary and secondary prevention measures, and in enhancing the organization of care systems.
The George Institute for Global Health and the Science and Technology Foundation of Mongolia's Ministry of Education, Culture, and Science.
The Science and Technology Foundation of the Mongolian Ministry of Education, Culture, and Science and The George Institute for Global Health.

Childhood-onset chronic kidney disease, a progressively worsening condition, significantly impacts life expectancy and overall well-being. Urinary Dickkopf-related protein 3 (DKK3), a marker of kidney tubular cell stress, was analyzed to determine its predictive value for the short-term risk of chronic kidney disease progression in children and to identify those needing targeted nephroprotective strategies.
The present observational cohort study assessed the connection between urinary DKK3 and a composite kidney outcome (50% reduction in estimated glomerular filtration rate [eGFR] or progression to end-stage kidney disease) or the risk of kidney replacement therapy (dialysis or transplantation), focusing on the interaction with intensified blood pressure reduction strategies in the randomized controlled trial, ESCAPE. The ESCAPE (NCT00221845, derivation cohort) and 4C (NCT01046448, validation cohort) studies, which were prospective and multicenter, evaluated urinary DKK3 and eGFR in children (aged 3-18 years) with chronic kidney disease and available urine samples at both the baseline and subsequent 6-monthly follow-up appointments. Analyses were modified to account for age, sex, hypertension, systolic blood pressure SD score (SDS), BMI SDS, albuminuria, and eGFR.
Within the dataset, 659 children participated in the analysis, with 231 children from ESCAPE and 428 from 4C. The ESCAPE group utilized 1173 half-year blocks, and 2762 half-year blocks were employed in the 4C group. Across both study cohorts, a urinary DKK3 concentration above the median (greater than 1689 pg/mg creatinine) was associated with a considerably more pronounced 6-month eGFR decline when compared to levels at or below the median (-56% [95% CI -86 to -27] vs 10% [-19 to 39], p<0.00001, in ESCAPE; -62% [-73 to -50] vs -15% [-29 to -01], p<0.00001, in 4C). This association remained independent of factors such as the participants' diagnosis, pre-existing eGFR, and albuminuria levels. In the ESCAPE study, a favorable effect of intensified blood pressure management was observed selectively in children with urine DKK3 levels exceeding 1689 pg/mg creatinine, as highlighted by the combined kidney endpoint (HR 0.27 [95% CI 0.14 to 0.55], p=0.00003, number needed to treat 40 [95% CI 37 to 44] vs 2500 [669 to .]) and the necessity for renal replacement therapy (HR 0.33 [0.13 to 0.85], p=0.0021, number needed to treat 67 [61 to 72] vs 310 [274 to 359]). Within the 4C study, blocking the renin-angiotensin-aldosterone system resulted in significantly lower urinary DKK3 concentrations. Patients not on ACE inhibitors or ARBs showed a mean of 12235 pg/mg creatinine (95% confidence interval 10036-14433), while those receiving these inhibitors or blockers had a significantly lower mean of 6861 pg/mg creatinine (5616-8106), signifying statistical significance (p<0.00001).
Children with chronic kidney disease whose urine contains DKK3 could experience a short-term decline in kidney function, and this biomarker may allow for a personalized treatment approach targeting those who might benefit from heightened pharmacological nephroprotection, including increased blood pressure control efforts.
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Transgender women in sub-Saharan Africa, despite facing a substantial HIV burden, are not adequately represented in studies tracking their movement through the HIV care cascade in the region, to the best of our understanding. To evaluate HIV prevalence and establish HIV care continuum indicators for transgender women, this study analyzed data from three South African metropolitan municipalities.
Transgender women in the metropolitan municipalities of Johannesburg, Buffalo City, and Cape Town, South Africa, who are sexually active, were the target population for a biobehavioral survey data collection effort. In the study, respondent-driven sampling (RDS) was used to recruit participants who identified as transgender women, aged 18 years, and who reported consensual sexual activity with a male partner within the previous six months. Support medium To determine HIV status awareness, an interviewer-administered questionnaire served as a tool; blood specimens on dried blood spots were used to detect the presence of HIV antibodies, assess exposure to antiretroviral treatment (ART), and measure viral load suppression. HIV's 95-95-95 cascade indicators were estimated using population-based data derived through the application of RDS Analyst software with individualized RDS weights. Multivariate stepwise backward logistic regression was performed to identify the factors that correlate with each cascade indicator. In the final analysis, all eligible participants were considered.
From July 26, 2018, to March 15, 2019, a total of 887 sexually active transgender women were enrolled in Johannesburg, with 323 participants, 305 in Buffalo City, and 259 in Cape Town. read more In Johannesburg, the highest HIV prevalence was observed, with 229 (741%) of 309 tests returning positive results (a weighted prevalence of 633%, 95% CI 555-705). Subsequently, Buffalo City demonstrated a prevalence of 121 (437%) positives out of 277 tests (461%, 387-536), and Cape Town followed with 122 (484%) positives out of 252 tests (456%, 367-547). In Johannesburg, roughly 542% (95% confidence interval: 458-624) of transgender women with HIV reported knowing their HIV status; in Cape Town, the figure was 242% (154-358), and 395% (271-534) in Buffalo City. A substantial percentage of those in Johannesburg (821%, 733-885), Cape Town (782%, 579-903), and Buffalo City (647%, 452-802) who knew their HIV status were receiving ART. Viral suppression rates for those receiving ART were impressive, reaching 344% (272-424) in Johannesburg, 412% (307-526) in Cape Town, and 550% (407-684) in Buffalo City.
To achieve viral load suppression in transgender women living with HIV, it is necessary to employ innovative strategies for both diagnosis and treatment. To facilitate improvement in the HIV cascade for South African transgender women, specifically those from racial groups other than Black South African, those with low educational attainment, and those lacking consistent outreach exposure, innovative testing and adherence strategies, alongside differentiated HIV services are necessary.
The collaborative efforts of the US President's Emergency Plan for AIDS Relief and the US Centers for Disease Control and Prevention are essential in the fight against AIDS.