Obesity results from the interaction of polygenic susceptibility and environmental factors. Given this complex etiology, physical activity (PA) remains a cornerstone of cost-effective intervention strategies. This longitudinal natural experiment investigated how PA modifies the effects of genetic predisposition on obesity in Chinese youth. We conducted a 4-year natural experiment leveraging curriculum-driven PA disparities in a specialized arts school (n = 591), creating distinct high-PA (HPA) and low-PA (LPA) exposure groups. Weighted genetic risk scores (WGRSs) were calculated from 13 Asian-derived obesity-related single-nucleotide polymorphisms. Annual anthropometric, metabolic, and lifestyle data were analyzed using generalized linear mixed models to assess gene-PA interactions on obesity. The WGRS predicted baseline obesity measures, with each unit increase associated with a 0.21-kg/m² higher BMI. Over the natural experiment period, BMI increases in the HPA group were smaller than in the LPA group. After adjusting for age, sex, ethnicity, and dietary factors, significant WGRS-PA interactions were observed for BMI trajectories. Participants with higher genetic risk for obesity experienced greater BMI and weight reduction benefits from sustained long-term PA. In summary, the present study identified a significant interaction effect between PA levels and WGRS in modifying BMI trajectories. Genetic susceptibility significantly modifies the protective effects of long-term PA on BMI progression in this cohort of Chinese youth.

Esophageal cancer remains a major public health concern, yet data on its long-term burden in Xiamen, China, are limited. This study assessed incidence, mortality, survival rates, and their temporal trends from 2011 to 2020. Population-based cancer registry data were analyzed for all newly diagnosed esophageal cancer cases in Xiamen between 2011 and 2020, with follow-up through September 2023. Age-standardized incidence and mortality rates (ASIR, ASMR) were calculated using Segi's world population. Relative survival (RS) and age-standardized relative survival (ARS) were estimated using registry follow-up data. Trends were evaluated using Joinpoint regression. A total of 5,318 incident cases and 4,445 deaths were recorded. The ASIR and ASMR were 18.96 and 15.61 per 100,000, respectively, with significantly higher rates in males and in rural areas. Both incidence (AAPC = -4.20%, p = 0.001) and mortality (AAPC = -5.07%, p = 0.024) declined over the study period. The 5-year ARS was 19.2% (95% CI 17.9-20.5%), higher in females than males (28.2% vs. 17.7%), but comparable between urban and rural residents. Yearly survival rates fluctuated without a significant upward trend. From 2011 to 2020, esophageal cancer incidence and mortality in Xiamen declined, but survival rates remained low. The persistent burden highlights the need for strengthened prevention, early detection, and cost-effective treatment strategies, particularly for high-risk populations.

Contamination of water resources by organic dyes is a major environmental issue associated with industrial activities. Methylene blue (MB), a widely used cationic aromatic dye, is particularly problematic due to its high chemical stability and toxicity, highlighting the need for efficient and cost-effective treatment strategies. In this study, a magnetic amino-functionalized hyper-crosslinked resin (Fe3O4@XDV-NH2) was synthesized and evaluated as an efficient adsorbent for MB removal from aqueous solutions. The material was prepared via post-synthetic amino functionalization of a hyper-crosslinked polymer followed by in situ deposition of Fe3O4 nanoparticles, combining high surface area, permanent porosity, and chemical stability with easy magnetic separation. Structural and magnetic characterizations confirmed the uniform incorporation of Fe3O4 without significant loss of porosity. Amino functionalization enhanced hydrophilicity and introduced polar active sites, promoting strong interactions with MB. Batch adsorption experiments revealed a maximum adsorption capacity of 79.60mg/g at 298K and pH 9 and 0.06g L-1 adsorbent dosage. Adsorption kinetics followed the pseudo-second-order model (R2 = 0.976). Equilibrium data were best fitted by the Langmuir isotherm model (R2 = 0.996), indicating monolayer adsorption with a maximum theoretical capacity of 183.48mg/g. Thermodynamic analysis showed that MB adsorption was spontaneous and exothermic. High removal efficiencies were maintained in complex matrices such as tap water (94.11%) and synthetic wastewater (78.41%). Moreover, the adsorbent retained approximately 89% of its initial capacity after six adsorption-desorption cycles, demonstrating good reusability. These results indicate that Fe3O4@XDV-NH2 is a promising and sustainable adsorbent for dye-contaminated wastewater treatment.

Synthetic dyes discharged from the textile and dyeing industry present a significant environmental and health hazard due to their inherent toxicity, environmental persistence, and potential carcinogenicity. Microbial degradation has garnered significant interest as a cost-effective and eco-friendly strategy for dye wastewater treatment in recent years. The study systematically evaluated the decolorization performance, degradation pathways, and detoxification effects of three bacterial strains, including Rhodopseudomonas palustris gh32, Bacillus cereus HL7, and Bacillus safensis X64, on the dye indigo carmine (IC) and three azo dyes: reactive black 5 (RB5), direct black G (DBG), and direct blue 15 (DB15). The degradation mechanisms were elucidated through UV-Vis spectroscopy, UPLC-Orbitrap-HRMS analysis, and enzyme activity assays. Molecular docking simulations were employed to investigate the interactions between key redox enzymes (such as laccase, tyrosinase, and azoreductase) and the dye molecules. The results demonstrated that the strain-specific enzymatic systems effectively disrupted the dye structures. Significant detoxification effects were further confirmed through a series of bio toxicity assays involving Escherichia coli, Bacillus subtilis, plant seeds, and erythrocytes. The addition of Fe3+, sodium citrate, or yeast extract significantly enhanced both the decolorization efficiency and enzyme activity. This study provides an in-depth understanding of the bacterial dye degradation process at the mechanistic level, highlighting the potential of customized bacterial systems for eco-friendly dye wastewater treatment. It offers theoretical support for elucidating the mechanisms of bacterial dye degradation and advancing bioremediation technologies.

Chronic lymphocytic leukaemia (CLL) is a common adult leukaemia, and selecting the most effective first-line treatment is crucial for optimising patient outcomes and managing healthcare costs. While chemoimmunotherapy (CIT) has been the standard approach, targeted therapies offer promising alternatives for treatment-naïve CLL patients. The objective of this study was to evaluate the cost effectiveness of chemoimmunotherapy compared to targeted therapies for treatment-naïve CLL patients in South Africa. A cost-effectiveness analysis was conducted using a Markov model based on three health states: progression-free survival (PFS), progression, and death. The model employed a 15-year time horizon and a 1-month cycle length. Patient-level data were reconstructed, and parametric estimation was used to project long-term clinical outcomes. Cost estimates were derived from national tariffs, reflecting a South African public healthcare perspective, while utilities were sourced from published literature. Outcomes were measured in total costs and quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios (ICERs) were calculated and compared to a willingness-to-pay (WTP) threshold, and sensitivity analyses were conducted to test the robustness of the results. Among the evaluated treatment strategies, chlorambucil-plus-obinutuzumab (ClbO) had the lowest cost and served as the reference comparator. Both CIT regimens were cost effective, with fludarabine, cyclophosphamide, and rituximab (FCR) yielding an ICER of US$1645.52 per QALY gained and bendamustine-plus-rituximab (BR) had an ICER of US$1716.79 per QALY gained, both below the US$3407 WTP threshold, under the model assumptions. Ibrutinib generated the highest QALYs but at a higher cost, resulting in an ICER of US$19,679.52 per QALY gained and a 0% probability of being cost effective at the WTP threshold, while venetoclax-plus-obinutuzumab (VenO) was extendedly dominated, and therefore eliminated from the results. Sensitivity analyses confirmed the robustness of the findings across variations in key parameters. In the South African public healthcare setting, CIT regimens (FCR and BR) represent cost-effective first-line treatment strategies for symptomatic, treatment-naïve CLL. Bendamustine-plus-rituximab emerged as the most decision-robust option under uncertainty, while FCR yielded the lowest point-estimate ICER. Among CIT regimens, FCR may be preferred in fit patients, while BR represents a more decision-robust option in older or unfit populations. Targeted therapies such as ibrutinib and VenO, despite superior clinical efficacy, are not cost effective at current prices. Substantial price reductions, generic entry, or targeted use in high-risk subgroups may improve their value and enable equitable access within South Africa's resource-constrained health system.

Chronic respiratory diseases are important contributors to the rising burden of non-communicable diseases globally. Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which can improve exercise capacity, reduce dyspnea, enhance health-related quality of life, stands as one of the most cost-effective treatment strategies. To better guide clinical practice in pulmonary rehabilitation of chronic respiratory diseases, Pulmonary Rehabilitation Committee of Chinese Association of Rehabilitation Medicine, Pulmonary Rehabilitation Group (preparatory) of Chinese Thoracic Society, Chinese Association of Chest Physician, jointly organized experts from multiple fields to systematically evaluated relevant guidelines and evidence from evidence-based medical research on pulmonary rehabilitation of chronic respiratory diseases published in China and abroad in the recent years. Based on the "Guidelines for respiratory rehabilitation management of chronic respiratory diseases in China (2021)", they formulated the "Guidelines for pulmonary rehabilitation of chronic respiratory diseases in China (2026 edition)" using the Delphi method. These guidelines cover the pulmonary rehabilitation defination and eligible individuals, optimal timing for initiation of pulmonary rehabilitation, pulmonary rehabilitation techniques, multimorbidity assessment and rehabilitation goals in elderly patients with CRD, education of patients and caregivers, inhalation technique, nutritional management, psychological assessment and intervention, use of assistant equipment, novel models of pulmonary rehabilitation and telerehabilitation, management of adverse events in pulmonary rehabilitation. Altogether 19 recommendations were formulated during this revision.

ABSTRACT The discharge of Lead(II) ions (Pb2+) from bauxite mining effluents poses serious environmental and health risks, requiring cost-effective and sustainable treatment strategies. This study evaluates T. catappa leaf biomass as a low-cost biosorbent for Pb(II) removal from bauxite wastewater, quantified using Differential Pulse Adsorptive Stripping Voltammetry (DPAdSV). The biosorbent was prepared through drying, grinding, and chemical activation (100–150 µm). FTIR analysis confirmed hydroxyl, carboxyl, carbonyl, nitrogen, and polysaccharide groups involved in Pb(II) binding. Batch experiments showed an optimum pH of 5.0 and equilibrium at 24 h. At 120 mg L−1 initial concentration and 0.15 g L−1 dosage, adsorption reached 88.29 mg L−1. Langmuir modeling indicated a maximum capacity of 2.2 mg g−1 (R2 = 0.98), suggesting monolayer adsorption, while kinetics followed the pseudo-second-order model, indicating chemisorption. In fixed-bed columns (0.5–1.5 cm; 3 mL min−1), breakthrough time increased with bed height, and the Thomas model best described the data (32.11 mg g−1). Treatment of real wastewater spiked with 25 mg L−1 Pb(II) achieved >70% removal despite competing ions. Regeneration with 0.5 M HCl enabled >85% desorption and >70% efficiency after three cycles. These results demonstrate the potential of T. catappa biomass as an eco-friendly and reusable biosorbent.

Cost-effectiveness of open biceps tenodesis for superior labral tears in patients younger than 30 years: a Markov analysis.

• Nanoparticle synthesis, characterization, and wastewater applications systematically reviewed. • Structure–property–performance relationships governing contaminant removal elucidated. • Green and biogenic nanoparticle routes highlighted for sustainable remediation. • Scalability, environmental risks, and future research directions critically assessed. Currently, the demand for safe and clean water is increasing dramatically worldwide. Therefore, the recycling and reuse of wastewater effluents play a crucial role in supplementing the limited availability of clean water. To protect the environment and public health, wastewater treatment is a vital process. Therefore, it is essential to develop and implement advanced wastewater treatment methods that are both highly efficient and economical. Researchers have employed various innovative approaches for treating wastewater. However, Conventional methods for wastewater treatment are costly, require high energy consumption, and often require large land areas, making them unsuitable for many regions. To obtain desirable solutions to these problems, researchers have recently turned to the use of nanoparticles. Nanoparticles present a promising option for water treatment, offering their extensive surface area and improved chemical properties. Recent studies summarized in this review indicate that nanoparticle-based treatment systems frequently achieve removal efficiencies above 90 - 99% for heavy metals and more than 72 - 99.9% degradation efficiency for dyes and organic contaminants under optimized conditions. Despite ongoing research, our understanding in this domain remains relatively limited. This review provides a comprehensive knowledge of the synthesis routes, including physicochemical and green routes, characterization techniques, and the diverse classes of nanoparticles employed in wastewater remediation. Special emphasis is placed on zerovalent metals, metal oxides, carbon-based nanomaterials, and biopolymer-derived nanoparticles for removing toxic metals, organic contaminants, dyes, pharmaceuticals, and pathogens from polluted water sources. Reported studies further demonstrate that magnetic and photocatalytic nanoparticles enable rapid pollutant removal with improved recovery and reuse potential, enhancing process sustainability and reducing operational costs. This study also explores the prospective advancements in nanotechnology and the potential of nanoparticles in enhancing wastewater treatment efficiency, capitalizing on their unique surface properties, chemical characteristics, and tunable surface modification. Overall, nanoparticle-assisted treatment approaches show strong potential for scalable wastewater remediation with reduced treatment time and improved contaminant removal performance compared to many conventional systems. Through a comprehensive review of various classes of nanomaterials, this manuscript aims to explain the advancements in nanotechnology for wastewater management, thereby contributing to knowledge in this field and offering insights into sustainable and cost-effective wastewater treatment strategies.

BackgroundYoung adults are experiencing rising levels of mental health concerns and low well-being, which is exacerbated for around 20% of the population who are high in sensory processing sensitivity (SPS), a distinguishable, partly heritable trait associated with poorer mental health. However, despite this worrying increase in mental health issues among young adults, individuals who score highly on beauty appreciation tend to enjoy better well-being and improved mental and physical health. Several studies have shown that beauty appreciation can be taught and may serve as a cost-effective and enjoyable intervention strategy that can be easily implemented.MethodsThis study has two main aims: (1) to evaluate the effectiveness of an art-based beauty appreciation intervention on enhancing beauty appreciation (primary outcome), and (2) to determine whether increasing beauty appreciation has a causal effect on reducing psychological distress and increasing mental well-being (secondary outcomes) when compared to an active matched control condition designed to isolate beauty appreciation skill development. To assess this, we will conduct a mixed-method randomised controlled trial (RCT) across three measurement points: enrollment, post-intervention, and a 4-week follow-up. N = 114 young adults, including those high in SPS, will be blinded and randomly allocated to the intervention or control group (~ N = 57/group). Our primary hypothesis is that the intervention condition will exhibit higher levels of beauty appreciation compared to the control group at the post-test while accounting for baseline differences. Our secondary hypotheses address mental well-being and psychological distress. A follow-up analysis will assess if individuals with high SPS can especially benefit and qualitative analysis will address mechanisms, barriers and facilitators between intervention and control, as well as in a high SPS subgroup.DiscussionThe study aims to provide evidence that beauty appreciation skills specifically can lead to increased well-being and decreased psychological distress by including an active matched control condition that isolates this skill development. Based on positive results, the evidence will support the implementation of such interventions for young adults and highly sensitive individuals, which would be widely accessible and easy to incorporate into day-to-day life. Trial registrationClinicalTrials.gov Registry Number: NCT06788496 (2024-12-22).

Constructed wetlands offer an eco-friendly, phytoremediation-based solution for managing industrial effluents. Hybrid constructed wetlands are gaining attention for improved pollutant removal, yet the role of flow configuration remains insufficiently explored. This study compares two hybrid vertical-horizontal flow and horizontal-vertical flow constructed wetlands for treating textile wastewater under identical operational conditions. Performance was evaluated based on pollutant removal and the physiological responses of Phragmites karka. The vertical-horizontal flow to horizontal-vertical flow system showed higher removal efficiencies for chemical oxygen demand (85.07%), color (60.6%), chloride (69.66%), bicarbonate (93.12%), calcium (66.83%), sodium (73.08%), and potassium (79.18%), also plants in this unit exhibited greater pigment, protein, starch, and sugar contents, while antioxidative enzymes were lower, indicating reduced oxidative stress. These results suggest that initiating treatment with a vertical flow stage promotes better oxygenation, enhanced microbial activity, and healthier plant performance. Overall, the vertical-horizontal flow to horizontal-vertical flow configuration represents a more effective and biologically favorable hybrid constructed wetland design for sustainable textile wastewater treatment. Extended pilot- and field-scale assessments coupled with integrated eco-technologies and cost analysis are needed to refine key design variables and validate system performance under real-world conditions, to support the development of scalable, cost-effective, and sustainable treatment strategies for large-scale applications.

Patients with HER2-positive (HER2+) breast cancer (BC) who have residual invasive disease after neoadjuvant therapy remain at a significantly increased risk of recurrence. Updated results from the KATHERINE trial demonstrated the clinical benefit of trastuzumab-emtansine (T-DM1), showing a significant improvement in event-free survival. However, in budget-constrained settings, assessing the cost-effectiveness of TDM-1 is essential to guide sustainable adoption. To evaluate the cost-effectiveness analysis of adjuvant T-DM1 compared with trastuzumab in HER2+ early BC patients and residual disease, following neoadjuvant treatment, from the Colombian Health System perspective. We conducted a Markov model with a lifetime horizon to evaluate the cost-effectiveness of T-DM1 using the updated results of the KATHERINE trial (8.4-year follow-up). The model comprises 6 health states: patients with residual invasive disease on adjuvant treatment, non-metastatic recurrence, remission after non-metastatic recurrence, metastatic disease (first-line [1LmBC] and subsequent lines [2LmBC]), and death. Direct medical costs were included. The primary outcome was quality-adjusted life-years, with both costs and effects discounted annually at a 5% rate. Model assumptions were based on current guidelines and validated by local experts. Sensitivity and scenario analysis were performed to confirm the reliability of the results. Prices are shown in 2024 US dollars (4071.35 Colombian pesos = US $1). Under a willingness-to-pay threshold of 86% of the 2024 gross domestic product per capita (US -30 510) and 2LmBC (US $-6317). The probabilistic sensitivity analysis confirmed T-DM1 dominance in 81.2% of the 1000 Monte Carlo simulations, demonstrating consistency across settings. T-DM1 is a cost-effective and dominant strategy for the adjuvant treatment of residual invasive HER2+ early BC in Colombia, driven by cost savings from reduced high-cost recurrences. These findings support the adoption of T-DM1 to improve outcomes while ensuring efficient use of healthcare resources.

Background: Patients with HER2-positive (HER2+) breast cancer (BC) who have residual invasive disease after neoadjuvant therapy remain at a significantly increased risk of recurrence. Updated results from the KATHERINE trial demonstrated the clinical benefit of trastuzumab-emtansine (T-DM1), showing a significant improvement in event-free survival. However, in budget-constrained settings, assessing the cost-effectiveness of TDM-1 is essential to guide sustainable adoption. Objective: To evaluate the cost-effectiveness analysis of adjuvant T-DM1 compared with trastuzumab in HER2+ early BC patients and residual disease, following neoadjuvant treatment, from the Colombian Health System perspective. Methods: We conducted a Markov model with a lifetime horizon to evaluate the cost-effectiveness of T-DM1 using the updated results of the KATHERINE trial (8.4-year follow-up). The model comprises 6 health states: patients with residual invasive disease on adjuvant treatment, non-metastatic recurrence, remission after non-metastatic recurrence, metastatic disease (first-line [1LmBC] and subsequent lines [2LmBC]), and death. Direct medical costs were included. The primary outcome was quality-adjusted life-years, with both costs and effects discounted annually at a 5% rate. Model assumptions were based on current guidelines and validated by local experts. Sensitivity and scenario analysis were performed to confirm the reliability of the results. Prices are shown in 2024 US dollars (4071.35 Colombian pesos = US $1) Results: Under a willingness-to-pay threshold of 86% of the 2024 gross domestic product per capita (US $6831), T-DM1 was dominant over trastuzumab. Cost savings were mainly driven by a reduction in recurrences (>50%), particularly in high-cost settings: 1LmBC (US $−30 510) and 2LmBC (US $−6317). The probabilistic sensitivity analysis confirmed T-DM1 dominance in 81.2% of the 1000 Monte Carlo simulations, demonstrating consistency across settings. Conclusion: T-DM1 is a cost-effective and dominant strategy for the adjuvant treatment of residual invasive HER2+ early BC in Colombia, driven by cost savings from reduced high-cost recurrences. These findings support the adoption of T-DM1 to improve outcomes while ensuring efficient use of healthcare resources.

Potassium competitive acid blockers (PCABs) are superior to proton pump inhibitors (PPIs) for healing of Los Angeles (LA) class C/D erosive esophagitis and are approved for nonerosive gastroesophageal reflux disease (GERD) given their efficacy measured by heartburn-free days. However, they are more expensive than PPIs. We estimated the cost-effectiveness of PCABs compared with PPIs for the management of GERD. A decision tree was constructed for the base case of a patient with GERD. We tested scenarios in which nonerosive reflux disease, LA A/B, or LA C/D esophagitis was present, comparing PCABs with PPIs as first-line therapy, including step up therapy and/or class switching if symptoms persisted. Using publicly available cost estimates, quality-adjusted life years (QALYs) were compared using a willingness-to-pay threshold of $100,000/QALY from a societal perspective at 6 months. The cost of PCABs for GERD was $3,240 more than PPIs, with an incremental cost-effectiveness ratio of $144,208/QALY. When evaluating GERD phenotypes separately, the incremental cost-effectiveness ratio was consistently over our willingness-to-pay threshold. One-way analyses showed the most influential parameters were PCAB cost and efficacy for heartburn-free days. Probabilistic sensitivity analysis favored PPIs 71.7% out of 100,000 iterations. Reducing one-week costs to below $91 would make PCABs a cost effective first-line strategy across all GERD phenotypes. Despite PCAB efficacy, PPIs are a cost-effective strategy for GERD treatment, and can be positioned ahead of PCAB escalation on this basis. Reducing PCAB costs or accepting a higher willingness-to-pay threshold would influence this finding, although PCABs may be favored in some current situations as evidenced by probabilistic sensitivity results.

Background: Overweight (OW) and obesity (OB) are major public health challenges associated with metabolic disorders, chronic diseases, and rising healthcare costs. Low-carbohydrate diets (LCDs) have emerged as cost-effective strategies for prevention and treatment. Objective: The objective of the study is to evaluate the effects of an LCD (≤130 g/day) on anthropometric, metabolic, hepatic, and renal parameters in OW and obese adults over 12 months. Methods: This open-label, non-randomized, self-controlled clinical trial included 34 adults with body mass index (BMI) ≥ 25 kg/m2 who received individualized nutritional counseling and followed an LCD for up to 12 months. Clinical and laboratory parameters were assessed at baseline and during follow-up (3–6 months and 7–12 months). Statistical analyses included generalized estimating equations and non-parametric tests with Bonferroni correction. Results: Participants achieved a mean weight loss of 10%, with reductions in BMI (−2.9 kg/m2), waist circumference (−5.4 cm), and body fat percentage. Glycated hemoglobin decreased at 7–12 months (p<0.05), while insulin levels and insulin resistance declined at 3–6 months (p=0.0497 and p=0.037). Fasting glucose remained stable. Low-density lipoprotein cholesterol increased modestly at 7–12 months (p=0.035), whereas other lipid parameters showed no significant changes. Gamma-glutamyl transferase levels decreased (p=0.0341), with no adverse effects on renal or hepatic markers. Conclusion: An LCD was associated with improvements in glycemic control, body composition, insulin sensitivity, and liver enzymes without compromising renal function or lipid profiles, supporting its role in OB management and cardiometabolic risk reduction in primary care.

Most data supporting current knowledge about thrombotic thrombocytopenic purpura (TTP) come from high-income regions, while little is known about treatment access and prognosis in low- and middle-income countries. To address this gap, we conducted a multicenter prospective study that included 85 TTP patients in Brazil between 2018 and 2024, with a 12-month follow-up. The median age was 37years (IQR 27-45) and 76% were female. The median PLASMIC score was six (IQR 6.0-7.0), and ADAMTS13 activity was tested in 62.4% of patients (all <10%). The median time from symptom onset to hospital admission was 8days. Neurological manifestations were the most frequent (75.3%), followed by bleeding symptoms (58.8%) and abdominal pain (32.9%). Seventy-four patients (87.1%) underwent therapeutic plasma exchange (TPE), which was initiated within one day of admission (IQR 1-2). Corticosteroids were administered in 95.3% and rituximab in 56.5% of patients. Twenty-three patients (27.1%) required advanced life support and 13 (15.3%) died during hospitalization. In-hospital mortality was associated with older age and hemodynamic instability upon admission. Among survivors, 26% experienced exacerbation or relapse, and 22.4% developed chronic sequelae, mostly neurological and psychiatric symptoms. Rituximab use was protective against TTP relapses. In conclusion, TTP mortality in Brazil is higher than that observed in recent cohorts. TTP diagnosis and treatment in the country are delayed and outdated, negatively affecting disease prognosis. Ensuring rapid diagnosis and the availability of TPE and rituximab, a cost-effective treatment strategy, is essential for improving outcomes and reducing morbidity, including in low- and middle-income countries.

Rationale and design of the FREEDOM study: A hybrid type 1 optimization-implementation trial to improve type 2 diabetes management in primary care.

Abstract Background Acute kidney injury often occurs after ischemia – reperfusion and is one of the main kidney diseases with high mortality. Accordingly, the aim of the current study was evaluated and compare the effectiveness of treatment with platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in renal ischemia – reperfusion rat model. Material and methods Forty rats were grouped as control, ischemia/reperfusion, ischemia/reperfusion plus PRP and ischemia/reperfusion plus PRF. Kidney histopathology indexes and the level of kidney function biomarkers including, BUN, Creatinine, Na, K, LDH, ALP and inflammatory markers and also protein expression of KM1 assessed in all groups. Results The obtained results of the current study showed that kidney ischemia – reperfusion caused to significant increases of BUN and creatinine level which was in line with destruction of kidney tissue structure. The pro-inflammatory marker significantly increased in renal ischemia group compare to the control rats which was associated with up-regulation of KM1 protein in kidney tissue. PRF treatment group showed a more efficacy in improved renal function with suppressed inflammatory process and decreases KM1 gene expression compare to PRP administration. Conclusion The current study reported promising results regarding the more potent efficacy of PRF as a simple, safe, rapid and cost-effective treatment strategy in the treatment of renal dysfunction compare to the PRP. Graphical Abstract

Benign Prostatic Hyperplasia (BPH) is a common condition among ageing men, characterized by lower urinary tract symptoms that significantly impact the quality of life and economic productivity of affected individuals. The financial burden of BPH extends beyond direct medical expenses to include direct non-medical costs and productivity losses. In Ghana, limited data exist on the cost implications of BPH, leaving a critical gap in healthcare planning and resource allocation. We aimed to determine the cost and productivity losses associated with diagnosing and managing BPH at the Ho Teaching Hospital. A cross-sectional cost-of-illness study was conducted at the Urology Unit of the Ho Teaching Hospital. Data was collected from 105 patients diagnosed with BPH using structured questionnaires from 11th June 2024–30th September 2024. Direct monthly medical costs, including consultation, diagnostics, medication, and surgical interventions, were calculated using a bottom-up approach. Direct monthly non-medical costs covered transportation, food, lodging, and caregiver expenses, while productivity losses were estimated based on absenteeism and reduced working hours, using the human capital approach. The mean monthly direct medical cost per patient was GHS 890.11 (USD 60.35), with surgeries accounting for 30% of total expenses. The total direct non-medical costs, dominated by transportation (66.3%), amounted to GHS 9,842.00 (USD 667.25). Productivity losses due to absenteeism and caregiving responsibilities totalled GHS 4,746.28 (USD 321.78), with 30% of employed patients missing work. Notably, direct medical costs contributed the highest economic burden (86.5%), surpassing direct non-medical costs (9.1%) and productivity losses (4.4%). BPH imposes a significant financial burden on patients and households in Ghana, driven by high out-of-pocket medical costs, non-medical expenses, and lost productivity. The findings underscore the need for cost-effective treatment strategies, improved health insurance coverage, and targeted interventions to alleviate financial hardships associated with BPH management.

Benign Prostatic Hyperplasia (BPH) is a common condition among ageing men, characterized by lower urinary tract symptoms that significantly impact the quality of life and economic productivity of affected individuals. The financial burden of BPH extends beyond direct medical expenses to include direct non-medical costs and productivity losses. In Ghana, limited data exist on the cost implications of BPH, leaving a critical gap in healthcare planning and resource allocation. We aimed to determine the cost and productivity losses associated with diagnosing and managing BPH at the Ho Teaching Hospital. A cross-sectional cost-of-illness study was conducted at the Urology Unit of the Ho Teaching Hospital. Data was collected from 105 patients diagnosed with BPH using structured questionnaires from 11th June 2024-30th September 2024. Direct monthly medical costs, including consultation, diagnostics, medication, and surgical interventions, were calculated using a bottom-up approach. Direct monthly non-medical costs covered transportation, food, lodging, and caregiver expenses, while productivity losses were estimated based on absenteeism and reduced working hours, using the human capital approach. The mean monthly direct medical cost per patient was GHS 890.11 (USD 60.35), with surgeries accounting for 30% of total expenses. The total direct non-medical costs, dominated by transportation (66.3%), amounted to GHS 9,842.00 (USD 667.25). Productivity losses due to absenteeism and caregiving responsibilities totalled GHS 4,746.28 (USD 321.78), with 30% of employed patients missing work. Notably, direct medical costs contributed the highest economic burden (86.5%), surpassing direct non-medical costs (9.1%) and productivity losses (4.4%). BPH imposes a significant financial burden on patients and households in Ghana, driven by high out-of-pocket medical costs, non-medical expenses, and lost productivity. The findings underscore the need for cost-effective treatment strategies, improved health insurance coverage, and targeted interventions to alleviate financial hardships associated with BPH management.