The emergence of the COVID-19 pandemic, caused by the SARS-CoV-2 virus, has significantly impacted cancer patients, particularly those with lung cancer. This review delves into the intersection of COVID-19 and lung cancer, addressing concerns regarding diagnosis, treatment, and outcomes.. Research demonstrates that patient co-factors, including age, sex, blood type, and knowledge levels, are strongly associated with the severity and mortality of COVID-19 in lung cancer patients. Older age, male gender, and specific blood types correlate with worse results. Cancer patients, already immunocompromised, face heightened risks from COVID-19, with increased morbidity and mortality rates. The pandemic has necessitated rapid adjustments in oncological care, including telemedicine and altered treatment protocols. Vaccination tactics are essential, with effectiveness differing based on whether patients have gotten the initial dosage, second dose, or booster doses. Various vaccination forms, including mRNA vaccines, viral vector vaccines, and inactivated virus vaccines, have differing effectiveness profiles, particularly in immunocompromised persons. Booster dosages have shown improved immunity against developing variations such as Delta and Omicron. Lung cancer, the second most diagnosed cancer globally, presents diverse challenges due to its association with smoking and exposure to environmental carcinogens. Diagnosis relies on histological confirmation, with treatment decisions guided by disease staging and molecular profiling. Innovative diagnostic tools, such as molecular markers and genetic sequencing, enhance personalized treatment approaches. The pandemic's impact on cancer diagnosis and treatment pathways underscores the need for vigilant surveillance and adaptive strategies to ensure optimal patient care. This abstract encapsulates the critical considerations and evolving landscape of managing COVID-19 and lung cancer, emphasizing the importance of tailored approaches in navigating these intertwined health crises. The abstract summarizes the diagnostic and management approaches for lung cancer and COVID-19, highlighting key methods such as radiographic screening, liquid biopsy, sputum examination, and nucleic acid amplification tests for diagnosis. Treatment strategies for both conditions are discussed, emphasizing the challenges faced by lung cancer patients, particularly in the context of COVID-19 infections. The abstract also addresses the importance of early detection through biomarker discovery and the development of new therapies tailored to individual patients. Furthermore, prognostic and predictive biomarkers for lung cancer are identified, such as EGFR mutations and ALK rearrangements, which inform treatment decisions. The abstract underscores the need for comprehensive care strategies that consider the intersection of lung cancer and COVID-19, ensuring optimal outcomes for affected patients. Ultimately, care strategies must take consideration of patient co-factors like age, sex, blood group, and knowledge levels, as well as vaccine administration schedules like first doses, second doses, and booster shots and vaccine type reflections. The overall strategy aims to improve treatment and immunization efficacy, improving lung cancer outcomes during the COVID-19 pandemic.

Nurses' knowledge, attitudes, and practices in oral care for mechanically ventilated patients: A scoping review.

Living donor liver transplantation (LDLT) is a life-saving procedure for patients with end-stage liver disease. As its use expands worldwide, ensuring the safety and well-being of live liver donors (LLD) is of paramount importance. Published evidence on early postoperative complications after living donor hepatectomy-those occurring within 90 days of surgery-is limited, and standardized postoperative care protocols are lacking. The International Liver Transplantation Society (ILTS) and the International Living Donor Liver Transplantation Group (iLDLT Group) convened a consensus conference in Toronto in March 2025 to develop guidelines for the safe care of the LLDs. This manuscript details the recommendations on early postoperative considerations for the safety of LLDs developed by Working Group III (WGIII) of the Consensus Scientific Committee, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for assessment of recommendations, and the Danish model of consensus. WGIII addressed four key areas: (1) standardized postoperative care, (2) early biliary complications, (3) early postoperative liver dysfunction, and (4) early postdischarge follow-up. This report emphasizes the need for vigilant postoperative monitoring in specialized units, with access to experienced providers and defined clinical pathways. Structured clinical and psychosocial follow-up protocols, perioperative prophylaxis for surgical site infections and venous thromboembolism, and management of early biliary and vascular complications are discussed. These may help standardize care, reduce complications and improve short-term outcomes in LLDs.

In vivo biocompatibility of poly-N-isopropylacrylamide (PNIPAM) hydrogels in Wistar rats: Hematological, biochemical, and histopathological assessments.

Pulmonary arterial hypertension (PAH) in India is a substantial yet under-recognized contributor to cardiovascular morbidity and mortality. Its progressive course, nonspecific early manifestations, and heterogeneous aetiologies often lead to delayed diagnosis and fragmented care. The unique epidemiological profile of India, characterized by a higher prevalence of PAH due to factors such as uncorrected congenital heart disease, environmental exposure, and chronic infections, underscores the need for a management approach tailored to Indian settings. These realities intersect with systemic challenges, including late presentation, resource constraints, a lack of local guidelines, and the costs of diagnostic workups and therapies, which hinder the delivery of standardized care. Variabilty in clinical practice in PAH management underscores the need for guidelines that account for local context and resources. Despite robust international recommendations, including those from the European Society of Cardiology and the European Respiratory Society, implementation of standardized risk stratification and treatment algorithms remains inconsistent across Indian centers. This variability reflects disparities in infrastructure, expertise, and affordability rather than differences in disease biology. This consensus document reviews current guidelines and advances in the management of PAH, consolidating evidence with potential for adoption in India and other low- and middle-income countries (LMICs). This document also highlights the need to establish centers of excellence, develop specialized care protocols, and increase awareness to improve patient outcomes.

External ventricular drainage (EVD) care bundle approaches are associated with reduced infection rates after EVD insertion. However, awareness and standardization of such protocols remain limited, and the current literature is sparse and has a high variability in analysis. We conducted a systematic review and meta-analysis of appropriate studies to identify the key components of an effective EVD care bundle for reducing EVD-related infections (ERIs). A systematic review of the literature was conducted to identify any studies presenting patient cohorts undergoing EVD placement and reporting the introduction of bundle care protocols including postoperative infection rates. Major scientific databases (PubMed/MEDLINE, EMBASE, and Scopus) were systematically searched for studies published up to December 31, 2024. Studies were screened, and data were extracted independently by 2 authors. Twenty-eight studies were included for analysis. ERI rates before and after the implementation of care bundle protocols were observed. Different care bundles were identified and categorized as follows: insertion bundles, manipulation bundles, dressing bundles, and others. Although the literature concerning the implementation of care bundles for ERI is deemed poor, our results show a significant reduction in the postoperative ERI rates; a meta-analysis of the studies comparing cohorts before and after the implementation of care bundle protocols reveals significant differences in the postoperative infection rate after EVD placement (odds ratio 3.70, 95% CI 2.89-4.74, P < .0001 for the overall effect, heterogeneity I2 = 46%). Implementation of care bundle approaches for EVD insertion is associated with a significant reduction in ERIs. The implementation of care bundle approaches and the strict knowledge, training, and adherence to these protocols permit a standardization of the procedure and a better postoperative management diminishing complication rates. The available evidence supports the broader adoption of care bundle protocols as a new standard of care in clinical practice.

Cystinosis is a rare lysosomal storage disorder that affects approximately 1 in 100,000 to 200,000 live births worldwide. Long-term graft success in cystinosis depends on cysteamine adherence and structured multidisciplinary transition, supported by protocols developed by both pediatric nephrologists and hospital organizations. This review explores institutional and regional care models, structured programs such as the RISE protocol and Got Transition's Six Core Elements, and major barriers including adult nephrology expertise, psychosocial stressors, and insurance coverage gaps. Additionally, we explore the impact of digital health tools for their role in supporting cysteamine adherence and maintaining continuity of care. Emerging technologies such as machine learning also provide future opportunities to improve patient care during the transition period. Transition plans must also integrate digital tools and mental health-informed strategies tailored to Gen Z and Alpha cystinosis patients. Due to the lifelong nature of cystinosis and the complexity of adolescent development, transition models are essential to promoting long-term autonomy in patients. We conducted a comprehensive search of the PubMed databases for studies published between 2000 and 2025 that addressed structured transition protocols and long-term outcomes in pediatric patients with cystinosis. A critical analysis of existing cystinosis transition protocols is essential to evaluate their strengths and limitations and to identify approaches better tailored to the needs of pediatric cystinosis patient populations. This review aims to evaluate elements of existing protocols, highlight components of a successful transition, and propose future strategies to improve care in patients with cystinosis.

Critical pertussis is a life-threatening illness that predominantly affects young infants, with substantial morbidity and mortality. In this study, we aimed to describe the epidemiology, clinical features, and variability in management of pediatric critical pertussis in the Gulf Cooperation Council (GCC) region. Multinational retrospective cohort study conducted between July 2022 and December 2024. Thirty-five PICUs in the six GCC countries. Children 16 years old or younger with laboratory-confirmed pertussis (by polymerase chain reaction or culture) admitted to a PICU. None. A total of 204 cases of critical pertussis were identified. Median (interquartile range [IQR]) age was 53 days (IQR, 36.5-89 d). Most patients (91.2%) were healthy before PICU admission. Comorbidities included acyanotic congenital heart disease (3.9%) or respiratory disease (2.9%). Only 17.3% had received infant pertussis vaccination and 4.1% had mothers vaccinated during pregnancy. The median duration of hospital stay was 9 days (IQR, 6-16 d), and PICU stay was 5 days (IQR, 3-10 d). Hyperleukocytosis (> 30 × 109/L) occurred in 49.5%. Respiratory distress (47.6%) and apnea (28.4%) were the main reasons for PICU admission. Management varied widely: leukoreduction was performed in 27.4%, with significant variation in practice across countries. Use of high-flow nasal cannula and mechanical also varied across the region. Extracorporeal membrane oxygenation was rarely used (1.5%). Echocardiography was obtained in nearly half of the cohort, and revealed pulmonary hypertension in 24 patients. Overall mortality was 15.2%, most commonly attributed to septic shock and respiratory failure. Critical pertussis predominantly affects young infants, with substantial morbidity, mortality, and wide variation in management practices. Our cohort from 2022 to 2024 highlights our GCC regional need for standardized care protocols and strengthened prevention.

The recent escalation of conflict in Gaza has resulted in a substantial burden of trauma-related injuries, particularly orthopedic trauma, with a total of 362 patients included in this study. This study presents a retrospective descriptive analysis of epidemiology, injury patterns, and clinical management of encountered orthopedic trauma cases during the conflict. This study aimed to characterize the mechanisms, patterns, and outcomes of orthopedic injuries sustained during the ongoing war in Gaza, with the goal of informing surgical response, resource allocation, and emergency preparedness in conflict settings. Data were retrospectively collected from the paper medical records of 362 patients with both direct conflict-related trauma and indirect conflict-affected orthopedic conditions, treated at the Jordanian Military Field Hospital – Southern Gaza (Khan Younis), between June 22 and October 2, 2024. Variables included demographic data, injury mechanisms, anatomical and injury types, surgical interventions, anesthesia modalities, perioperative care, and outcomes. Descriptive statistics were used to report frequencies, percentages, and means. The study included predominantly male patients (78.5%) with a mean age of 29.6 years. Blast injuries (48.3%) and gunshot wounds (31.2%) were the leading causes of trauma. The most common injuries were femur fractures (36.5%) and acute open fractures (36.2%). Frequent procedures included open reduction and internal fixation (34.8%) and fixation device removal (29.0%). General anesthesia (32.3%) and spinal anesthesia (29.8%) were commonly used, and all patients received antibiotics (100.0%). Anticoagulants were administered to 47.5% of patients, and 92.3% received physiotherapy. Surgical complications were low (4.4%), with no recorded venous thromboembolism events or deaths within 9 months. Orthopedic trauma during the Gaza conflict was primarily characterized by blast and gunshot injuries, with femur fractures being most prevalent. These findings underscore the importance of targeted trauma care protocols and resource planning in conflict zones. Despite relatively low short-term complications, only 30.1% of patients regained independent ambulation at 3 months, underscoring a substantial early disability burden. The high incidence of complex injuries, incomplete follow-up, and cohort heterogeneity limit definitive conclusions, but the findings point to an urgent need for sustained international support for trauma care and rehabilitation systems in Gaza.

ABSTRACTObjective(s)Peristomal skin complications occur in up to 29% of pediatric tracheostomy patients. While foam dressings have demonstrated superiority over traditional gauze, comparative evidence regarding silver‐impregnated versus standard foam dressings remains limited. This study aimed to compare the effectiveness of standard foam versus silver‐impregnated foam dressing in preventing peristomal complications following pediatric tracheostomy.MethodsThis prospective randomized controlled trial enrolled 50 pediatric patients (aged 0–18 years) undergoing elective tracheostomy between March 2022 and July 2024. Patients were randomly assigned to receive either standard foam dressing (Group A, n = 25) or silver‐impregnated foam dressing (Group B, n = 25). All patients followed a standardized postoperative care protocol. The primary outcome was incidence of peristomal complications during the first postoperative month. Secondary outcomes included pressure ulcer risk assessment using the Braden Q Scale and wound staging according to the National Pressure Injury Advisory Panel (NPIAP) classification.ResultsThe complication rate was 12% (n = 3) in the foam dressing group and 8% (n = 2) in the silver‐impregnated foam dressing group, and no statistically significant difference was detected (risk difference: 4%, 95% CI: −0.114 to 0.194, p = 1.000). No significant differences were observed in Braden Q scores on postoperative days 1, 7, 14, and 21 (p > 0.05). NPIAP staging revealed comparable pressure ulcer severity between groups (p = 1.000).ConclusionNo statistically significant difference was detected between standard foam and silver‐impregnated foam dressing when combined with standardized care protocols. However, the small sample size limits statistical power to detect clinically meaningful differences, and as this study was not designed as a non‐inferiority trial, equivalence cannot be concluded. Larger trials are needed to confirm these findings. Standard foam dressing may be a lower‐cost option for routine postoperative wound management in pediatric tracheostomy patients.Level of Evidence2.Trial Registration: NCT07392294.

There is growing interest in improving recovery after cesarean section and optimizing the childbirth experience due to the declining fertility rate. However, studies on Enhanced Recovery After Cesarean Section (ERAC) implementation and the parturient's experience remain scarce. This study aims to compare the effects of the ERAC and standard of care (SOC) protocol on hospital length of stay (LOS) and Obstetric Quality-of-Recovery score (ObsQoR-11). A randomized clinical trial enrolling pregnant women was conducted at a single center. Participants were randomized in a ratio of 1:1 to the ERAC group or the SOC group. ERAC protocol involved multiple evidence-based interventions: reduced fasting intervals, early mobilization and function training, early urinary catheter removal, and multimodal analgesia. The primary outcome was LOS and ObsQoR-11 score. The secondary outcomes were the global health numeric rating scale (NRS), the time to first flatulence, the time to first off-bed activity, and the postoperative visual analog scale (VAS) scores. Fetal Apgar scores and postoperative complications were recorded. A total of 140 participants were finally analyzed. There was no significant difference in the LOS between the ERAC and SOC groups (55.0 ± 11.6h vs. 55.5 ± 12.2h, P = 0.804). The ObsQoR-11 score was significantly higher in the ERAC group compared with the SOC group (77 [IQR, 59-89.25] vs. 60 [IQR, 50-70], median difference 16, 95% CI 10-22, P < 0.001). The global health NRS score was significantly higher in the ERAC group. The time to first off-bed activity and the time to first flatulence were significantly shorter in the ERAC group. The VAS scores at the postoperative 24h and 36h were significantly lower in the ERAC group than in the SOC group. Fetal Apgar scores were similar in both groups. There was no difference in the incidence of postoperative nausea and vomiting, urinary retention, wound infection, puerperal sepsis, and readmission between the two groups. Compared with the SOC protocol, the ERAC protocol had no significant effect on the LOS while significantly reducing the ObsQoR-11 score and the global health NRS score. Use of an ERAS protocol is feasible and improves recovery quality in parturients. The improvement in recovery experience, without increasing LOS or costs, underscores the intrinsic value of ERAC in promoting patient-centered care. Registered in the Chinese Clinical Trial Registry (ChiCTR2100046887) on May 29, 2021. URL: https://www.chictr.org.cn/showproj.html?proj=126128.

Cardiogenic shock (CS) is a syndrome of low cardiac output associated with high inpatient morbidity and mortality. Studies have supported the early transfer of patients with CS from spoke sites to the nearest regional hub center, forming the basis for the "hub-and-spoke" model. Contemporary CS algorithms revolve around invasive hemodynamic monitoring and temporary mechanical circulatory support guided by a multidisciplinary CS team. However, these protocols have limited applicability to the majority of spoke sites due to the limitations of resources, equipment, and personnel, further contributing to inequities in CS care. In this review, we seek to provide a blueprint for a generalizable approach to CS, an algorithm for intrahospital care escalation based on CS severity, and an example protocol detailing stabilization and monitoring strategies, independent of multidisciplinary CS teams.

IntroductionNursing leadership is pivotal for sustainable healthcare, yet the interplay of entrepreneurial leadership (EL), sustainable leadership (SL), team psychological safety (TPS), and sustainable development behavior (SDB) remained underexplored, particularly in resource-constrained hierarchical contexts such as Egyptian nursing.ObjectivesThis study investigated how EL promoted SDB by examining the mediating role of TPS and the moderating effect of SL based on job demands-resources and social cognitive theories, in alignment with the United Nations Sustainable Development Goals (SDGs).MethodsA quantitative cross-sectional design was employed, utilizing data collected from an administered survey. A convenience sample of 318 nurses from different university hospitals participated in the study. Descriptive statistics and inferential techniques, such as Pearson’s correlation, multiple regression, and moderation-mediation analyses, were used to analyze the data.ResultsNurses exhibited strong positive associations among EL, SL, TPS, and SDB, collectively accounting for substantial variance in sustainable behaviors. TPS partially mediated the EL-SDB pathway, explaining a meaningful portion of the effect, while SL significantly moderated this relationship, amplifying EL’s influence under high sustainable leadership conditions.ConclusionsBy integrating entrepreneurial innovation with ethical sustainability and psychological safety, this model addresses critical gaps in the impact of relational leadership on workforce behavior, team resilience, and patient-centered outcomes in global health systems. Practically, nurse training programs should emphasize EL-SL synergies and TPS cultivation to embed SDG-aligned practices, such as eco-friendly care protocols and interdisciplinary collaboration.

Mother's experiences of perinatal grief: A qualitative study in Spain.

This study aimed to describe the role and perceptions of clinical pharmacologists (CPs) in conducting economic evaluations of health technologies within the Spanish National Health System from a healthcare provider perspective. We conducted a cross-sectional descriptive study using an online survey distributed to members of the Spanish Society of Clinical Pharmacology between September 2024 and September 2025. Eligible participants were CPs working within or linked to the Spanish National Health System. The questionnaire included four sections addressing respondent characteristics, direct involvement in economic evaluations, economic evaluations conducted by other professionals, and training and opinions. Data were analyzed using descriptive statistics. Of 106 eligible CPs working within or linked to the Spanish National Health System, 48 completed the survey (response rate: 45.3%). The mean age was 51 years, and 56.3% were women. More than half of respondents (54.2%) reported conducting or having conducted economic evaluations, mainly cost-effectiveness and cost-minimisation analyses, often in collaboration with other healthcare professionals. Results were integrated into care protocols in 15 cases, although follow-up and outcome verification were performed in 7 cases. Among CPs not directly involved, 63.7% reported that economic evaluations are conducted at their centres by other professionals. Despite 91.7% of respondents considered that economic evaluation of health technologies is an activity that should be conducted in their centres, and all considered that a CP should participate in these evaluations, only 35.4% felt sufficiently trained, while 77.1% expressed interest in further training. Among the surveyed CPs, there is active involvement and a high level of motivation to participate in economic evaluations of health technologies in Spain. Strengthening training opportunities and collaborative networks could enhance their contribution to value-based healthcare.

Virtual Reality for Dual Relief of Pain and Sleep Disturbance in Burn Patients: A Randomized Clinical Trial.

Recovery after extremity fracture is influenced by injury-related impairments, functional capacity, symptom severity and psychosocial well-being, emphasising the need for patient-reported outcome measures (PROMs). Despite increasing adoption of Patient-Reported Outcomes Measurement Information System (PROMIS) and legacy PROMs in orthopaedic research, substantial knowledge gaps remain regarding their measurement properties, comparability and clinical utility, particularly in fracture populations. Our aim is to develop meaningful guidance to clinicians regarding the use of PROMs in treating orthopaedic fracture patients. A prospective cohort of 1500 patients across 14 centres presenting with isolated extremity fractures being treated operatively or non-operatively will be recruited prospectively. We will aim to recruit 300 patients for each of five fracture types: isolated hip, tibial shaft, ankle/pilon, proximal humerus and distal radius fracture. All procedures and management will be performed according to the site's standard of care and treatment protocol. For patients treated non-operatively, the index visit (first study assessment) will be performed at the first orthopaedic treatment encounter (eg, emergency department visit or outpatient fracture clinic). Surgically treated patients will have PROMs collected anytime from the day of the surgery up to discharge from hospital for the index visit. Follow-up visits will be performed at 2-3 weeks, 6-8 weeks, 10-13 weeks, 6 months and 1 year after the index visit. At baseline, we will document injury data, demographic and sociodemographic data, and radiographic classification using the AO classification system. Patient-perceived functioning will be assessed with PROMIS Physical Function (PF), PROMIS Upper Extremity, PROMIS Global Health, Knee and Injury Osteoarthritis Outcome Score-12, Hip Disability and Osteoarthritis Outcome Score-12, Foot and Ankle Ability Measure and Quick Disabilities of the Arm, Shoulder and Hand. The following domains and PROMs will also be captured: symptoms of anxiety and depression (PROMIS Anxiety; PROMIS Depression), patient activation (Patient Activation Measures (PAM)-10) and a patient's ability to fulfil social roles (PROMIS Social Roles).The range and normative limits of the PROMs collected will be defined using standard descriptive statistics. We will crosswalk or validate PROMIS measures with legacy instruments for PF using an Item Response Theory (IRT)-based linking model and compare it to non-IRT models (such as equipercentile linking). Lastly, we will assess the PROM-based recovery trajectory after fracture, overall and after adjusting for relevant demographic, clinical or biopsychosocial factors. Ethics approval for this study was granted from the local Ethics Committees or Institutional Review Board at each of the participating sites prior to patient enrolment. Austin: Institutional Review Board University of Texas at Austin, STUDY00000262; Boston: Mass General Brigham, 2019P000397; Los Angeles: Cedars-Sinai, Office of Research Compliance and Quality Improvement, STUDY00000081; Miami: University of Miami Human Subject Research Office, 20221353; Bogotá: Comité Corporativo de Ética en Investigación, CCEI-15607-2023; Berlin: GoFitFast: under Homburg approval; Recovery/Linking: Ethikkommission Charité Universitätsmedizin Berlin, EA2/026/21; Homburg: GoFitFast: Ethikkommission der Ärztekammer des Saarlandes, 232/19; Recovery/Linking: under Charité approval; Murnau: under umbrella from Homburg and Charité, GoFitFast: under Homburg approval, Recovery/Linking: under Charité approval; Tübingen: GoFitFast: Ethik-Kommission, Universitätsklinikum Tübingen, 393/2022BO2; Freiburg: Ethik-Kommission Albert-Ludwigs-Universität Freiburg, 21-1401; Rostock: Ethikkommission an der Universitätsmedizin Rostock, A 2024-0113; Innsbruck: Ethikkommission der Medizinischen Universität Innsbruck, 1258/2021; Oxford: HRA and Health and Care Research Wales, 20/EE/0051; London: HRA and Health and Care Research Wales, 20/EE/0051; Groningen: Medical Ethics Review Board University Medical Center Groningen, METc 2023/187 16882; Non-WMO waiver; Zwolle: Medical Ethics Review Board University Medical Center Groningen, METc 2023/187 16882; Non-WMO waiver. The results of this study will be published in peer-reviewed journals and presented at different conferences. NCT04113044.

The burden of cardiometabolic diseases (CMDs) is rising in people with HIV (PWH). While extensive data exist on CMD prevalence in PWH receiving antiretroviral therapy (ART), comprehensive data on ART-naïve PWH are scarce. We aimed to estimate the global prevalence of hypertension, diabetes, obesity and dyslipidaemia among ART-naïve PWH and compare estimates with those on ART and HIV-negative populations. This systematic review and meta-analysis included a search of PubMed-MEDLINE, CINAHL, SCOPUS, Academic Search Premier, Africa-Wide Information and Africa-Journals Online for original articles published up to June 2024. Cross-sectional, cohort and case-control studies providing baseline data on CMD prevalence were included. Studies had to include ART-naïve PWH aged ≥15 years. Two independent reviewers conducted studies screening, data extraction and methodological quality assessment. A random-effects meta-analysis with double arc-sine transformation was used for prevalence estimates. The study was registered with PROSPERO (CRD42021226001). We included 184 studies published between 2000 and 2024, involving a total of 424 629 participants. The global pooled prevalence among ART-naïve PWH was 14.2% (95% CI: 12.4-16.1) for hypertension, 3.6% (2.9-4.3) for diabetes, 11.5% (10.3-12.9) for body mass index-based obesity, 18.3% (12.7-24.6) for waist circumference-based obesity, 14.8% (12.1-17.8) for elevated total cholesterol, 17.6% (11.3-24.8) for elevated low-density lipoprotein cholesterol, 22.9% (19.3-26.7) for elevated triglycerides and 54.6% (48.2-61.0) for low high-density lipoprotein cholesterol, all with high heterogeneity. Significant regional variations in the prevalence of diabetes, obesity and dyslipidaemia were observed according to UNAIDS regions. We found a notable prevalence of CMDs in ART-naïve PWH, with significant regional variations in the prevalence of diabetes, obesity and dyslipidaemia. This highlights the need for targeted interventions and early screening to address the growing CMD burden among PWH. ART-naïve PWH face a considerable CMD burden, emphasizing the importance of early detection and management. Regional differences in CMD prevalence call for tailored public health strategies and integration of CMD prevention into HIV care protocols.

Background: Umbilical cord blood (UCB) represents a valuable biological matrix for assessing neonatal exposure to maternal infections and immune status at birth. In resource-limited settings such as Cameroon, its diagnostic potential remains underutilized, particularly for the detection of vertically transmitted infections within the TORCH complex ˗ Toxoplasma gondii, Rubella virus (Rubivirus rubellae), Cytomegalovirus (CMV)/ Human Herpesvirus 5 (HHV-5), and Herpes Simplex Virus types 1 and 2 (HSV-1/2). Objectives: This study aimed to determine the seroprevalence of TORCH infections in maternal venous blood and UCB, and to compare cytokine profiles in order to characterize neonatal immune activation at birth. Methods: A cross-sectional study was conducted from June to December 2024 across two referral hospitals in Yaoundé, Cameroon. A total of 108 mother-newborn pairs were enrolled consecutively. Paired maternal venous blood and UCB samples were tested using EVANCARE IgM/IgG TORCH rapid diagnostic tests (RDT), and ELISA-based ProcartaPlex™ multiplex cytokine profiling (12 analytes). Results: TORCH seroprevalence in UCB reflected maternal infection status, with high concordance for Toxoplasma gondii (90.0%; maternal 77.5% vs. UCB 72.5%) and CMV (70.0%; maternal 55.0% vs. UCB 50.0%). Cytokine profiling revealed that 10 of 12 analytes differed between compartments; IL-6 was significantly higher in maternal plasma (33.94 vs. 25.01 pg/mL; p &lt; 0.0001) while IL-2 was significantly elevated in UCB (17.43 vs. 16.54 pg/mL; p = 0.04), with IL-4 and IL-5 showing identical values across both compartments. Conclusion: Maternal TORCH infections exert a measurable burden on neonatal infectious and immunological status at birth. UCB represents a non-invasive and ethically advantageous specimen for neonatal assessment. These findings support the integration of TORCH screening and UCB cytokine analysis into routine antenatal care protocols in low-resource settings to reduce neonatal morbidity.

In 2021, Ghana's National Comprehensive Abortion Care Standards and Protocols recognised telemedicine as an approved delivery model for early medical abortion (EMA). Following a successful pilot in Accra, MSI Reproductive Choices Ghana expanded their telemedicine model to more rural areas and broadened their package of sexual and reproductive health (SRH) services to include fertility evaluation. This study evaluates the expanded model. A mixed-methods evaluation (January 2024 to March 2025) drew on routine clinical data, courier and call centre tracking, client feedback surveys, and qualitative, individual in-depth interviews with telemedicine clients to assess clinical safety, service utilisation and user experience. Quantitative analysis included descriptive statistics and unadjusted logistic and ordinal regression. Qualitative interviews with clients explored feasibility, acceptability and implementation challenges. A deductive, thematic analysis was conducted with the support of Delve qualitative research software and guided by the Consolidated Framework for Implementation Research. A total of 2721 clients accessed telemedicine services, with 70.0% receiving EMA and 29.5% short-term contraceptive methods. Among EMA clients reached for follow-up, 96.9% reported complete abortion with no further intervention. Satisfaction was high: 89.4% would recommend the service, and 78.2% would use it again. Qualitative findings highlighted that clients valued privacy, convenience and autonomy, particularly in stigmatised or crowded spaces. Barriers to accessing services included unclear eligibility criteria, limited digital access and misperceptions that the service was for abortion only. Most clients contacted the service between 4 and 6 weeks' gestation. Post-abortion contraception uptake was 24.8%, with no significant variation by age or location. Nearly half of clients reported having no other way to access care. Telemedicine is a feasible, safe and acceptable model for SRH delivery in Ghana. Findings will inform national scale-up and strategies to strengthen equity, communication and service integration.