Differential Treatment Research Articles

Differential diagnosis and treatment of enthesopathies

The article provides a review of the literature on the pathology of the periarticular structure of the enthesis - the site of attachment of a tendon or ligament to the bone. The anatomical and functional features of the fibrocartilaginous enthesis are presented in detail from the position of the “enthesis organ”, which includes the enthesis and the adjacent synovial membrane, bursae and adipose tissue. The issues of the occurrence of degenerative changes against the background of mechanical stress and inflammatory rheumatic pathological processes in the above structural and functional anatomical unit are analyzed. The anatomical zones whose entheses are most often affected are given. The terminology of degenerative and inflammatory lesions of the enthesis is considered, including from the standpoint of ICD-10 codes. The advantages and disadvantages of modern terms are discussed, current concepts corresponding to the etiology of the pathological process are proposed: degenerative-dystrophic or traumatic enthesopathy and inflammatory enthesitis. This division of concepts is aimed at adopting the correct diagnostic and treatment tactics for a doctor of any specialization. The differential diagnosis of these nosologies and approaches to conservative treatment are considered. The possibilities of local injection therapy for enthesitis and enthesopathies, the use of  anti-inflammatory and reparative techniques are discussed in detail. Based on our own clinical experience, the features of the treatment of various enthesopathies with glucocorticoids, autologous plasma, microinductive collagen, linear hyaluronates and polynucleotides are considered. Issues of priority methods in different clinical situations and the possibility of prolonging the therapeutic effect, as well as a combination of local and non-drug methods, were discussed. The tactics for ineffective local treatment, methods for correcting therapy and the choice of a leading specialist for various pathologies are discussed.

Patient with discogenic radiculopathy: diagnostic and treatment algorithms

Low back pain is one of the most common causes of seeking medical care, loss of ability to work, and is a heavy socio-economic burden for the country. In the vast majority of cases, the pain syndrome is musculoskeletal, associated with pathology of joints, muscles and ligaments and is benign in nature. Discogenic compression-ischemic radiculopathy is less common, but this pathology is associated with a wide range of issues in differential diagnosis and correct treatment tactics for patients. This article provides an overview of modern clinical guidelines for the diagnosis and treatment of discogenic radiculopathies. The diagnosis of discogenic radiculopathy is clinical. MRI of the spine is performed to exclude secondary causes of nerve root compression if treatment is ineffective. An important direction in the treatment of radiculopathy is non-drug treatment, which includes informing the patient about the benign nature of the disease, the possibility of spontaneous regression of a disc herniation, therapeutic exercises, maintaining the maximum tolerated amount of physical activity, social and professional activity Treatment of back pain is associated with an increased risk of side effects of non-steroidal anti-inflammatory drugs, which patients often use uncontrollably. The issue of safe relief of pain syndromes remains relevant. This can be achieved using a combination of non-steroidal anti-inflammatory drugs and high-dose B vitamins. B vitamins also have a neurotrophic effect, which allows the restoration of impaired neurological functions.

Discriminatory experiences among gay, bisexual, and other men who have sex with men, and transgender and non-binary individuals: a cross sectional analysis

Several systems of oppression combine in complex ways to impact the lives of minority populations. Following an intersectionality framework, we assessed the frequency and perceived reasons for discrimination among gay, bisexual, and other cisgender men who have sex with men (MSM) and transgender and non-binary individuals (TGNB), stratified by race. Online survey among MSM and TGNB ≥18 years living in Brazil, between November/2021 and January/2022. We used the 18-item Explicit Discrimination Scale to assess day-to-day experiences of differential treatment, and perceived discrimination. For each item, participants indicated their perceived reasons for differential treatment using 14 pre-defined options. Negative binomial regression models assessed if race was a significant predictor of discrimination. Subsequent models, stratified by race, examined associations of perceived reasons and number of reasons with perceived discrimination. Of 8464 MSM and TGNB, 4961 (58.6%) were White, 2173 (25.7%) Pardo (Brazil's official term for admixed populations), and 1024 (12.1%) Black. Black participants' scores for perceived discrimination (mean, standard deviation) were higher (10.2, 8.8) [Pardo (6.5, 6.8), White (5.2, 5.7)], and race was both the main reason for and the strongest predictor of perceived discrimination. The number of reasons participants used to interpret their discriminatory experiences was also a predictor of discrimination score among White, Pardo, and Black participants. LGBTQIA+phobia was highly prevalent among all participants. Additionally, our results indicated that Black MSM and TGNB participants were more frequently discriminated against than other racial groups, with racial discrimination uniquely contributing these experiences. Fundação Oswaldo Cruz, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro.

A rare presentation of Rosai-Dorfman-Destombes disease with central nervous system involvement and cutaneous wounds.

The aim of this case report is to investigate an uncommon presentation of Rosai-Dorfman-Destombes (RDD) disease, and discuss possible differential diagnoses and treatment options for this pathology. RDD is a rare disorder of histiocytes that typically presents in patients as painless cervical lymphadenopathy. However, this case involves a patient with the central nervous system (CNS) type of RDD who later developed cutaneous lesions. Several differential diagnoses were examined, including hidradenitis suppurativa, pilonidal cyst and pressure ulcers. It is important to be able to exclude these diagnoses based on the presentation, patient demographic and wound location. Biopsies verified the presence of RDD in the patient's suprasellar hypothalamic mass and skin lesions, confirming the patient had both CNS-RDD and cutaneous-RDD in the absence of lymphadenopathy. Recognising the unique manifestations of rare diseases such as RDD prevents delay of proper intervention and treatment.

Sample size and power calculation for testing treatment effect heterogeneity in cluster randomized crossover designs.

The cluster randomized crossover design has been proposed to improve efficiency over the traditional parallel-arm cluster randomized design. While statistical methods have been developed for designing cluster randomized crossover trials, they have exclusively focused on testing the overall average treatment effect, with little attention to differential treatment effects across subpopulations. Recently, interest has grown in understanding whether treatment effects may vary across pre-specified patient subpopulations, such as those defined by demographic or clinical characteristics. In this article, we consider the two-treatment two-period cluster randomized crossover design under either a cross-sectional or closed-cohort sampling scheme, where it is of interest to detect the heterogeneity of treatment effect via an interaction test. Assuming a patterned correlation structure for both the covariate and the outcome, we derive new sample size formulas for testing the heterogeneity of treatment effect with continuous outcomes based on linear mixed models. Our formulas also address unequal cluster sizes and therefore allow us to analytically assess the impact of unequal cluster sizes on the power of the interaction test in cluster randomized crossover designs. We conduct simulations to confirm the accuracy of the proposed methods, and illustrate their application in two real cluster randomized crossover trials.

From ICU Syndromes to ICU Subphenotypes: Consensus Report and Recommendations For Developing Precision Medicine in ICU.

Critical care uses syndromic definitions to describe patient groups for clinical practice and research. There is growing recognition that a "precision medicine" approach is required and that integrated biologic and physiologic data identify reproducible subpopulations that may respond differently to treatment. This article reviews the current state of the field and considers how to successfully transition to a precision medicine approach. In order to impact clinical care, identified subpopulations must do more than differentiate prognosis. They must differentiate response to treatment, ideally by defining subgroups with distinct functional or pathobiological mechanisms (endotypes). There are now multiple examples of reproducible subpopulations of sepsis, acute respiratory distress syndrome, and acute kidney or brain injury described using clinical, physiological, and/or biological data. Many of these subpopulations have demonstrated the potential to define differential treatment response, largely in retrospective studies, and that the same treatment-responsive subpopulations may cross multiple clinical syndromes (treatable traits). To bring about a change in clinical practice, a precision medicine approach must be evaluated in prospective clinical studies requiring novel adaptive trial designs. Several such studies are underway but there are multiple challenges to be tackled. Such subpopulations must be readily identifiable and be applicable to all critically ill populations around the world. Subdividing clinical syndromes into subpopulations will require large patient numbers. Global collaboration of investigators, clinicians, industry and patients over many years will therefore be required to transition to a precision medicine approach and ultimately realize treatment advances seen in other medical fields. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

A study on regional return to education in South Korea: comparison of male and female wages

ABSTRACT This study examines the return to education in South Korea by comparing metropolitan areas with non-metropolitan areas. It utilizes the Korean Labor and Income Panel Study from 2018 and 2019 for analysis, alongside the Mincer equation. The findings indicate that female workers have a higher return to education compared to male workers. The Oaxaca decomposition method reveals that private academies contribute to increasing differential treatment between men and women, whereas public education reduces the gap. Additionally, the regression discontinuity design method shows that the university premium is significantly different by region.

Comprehensiveness cuproptosis related genes study for prognosis and medication sensitiveness across cancers, and validation in prostate cancer

Cuproptosis-related genes (CRGs) are important for tumor development. However, the functions of CRGs across cancers remain obscure. We performed a pan-cancer investigation to reveal the roles of CRGs across cancers. In an analysis of 26 cancers, 12 CRGs were differentially expressed, and those CRGs were found to have prognostic value across different cancer types. The expression of CRGs exhibited varied among tumors of 6 immune subtypes and were significantly correlated with the 16 sensitivities of drugs. The expression of CRGs were highly correlated with immunological subtype and tumor microenvironment (TME) of prostate cancer. We also established CRGs-related prognostic signatures that closely correlated with prognosis and drug sensitivity of prostate cancer patients. Single-cell RNA-seq revealed that several CRGs were enriched in the cancer cells. Finally, an in vitro experiment showed that elesclomol, a cuproptosis inducer, targets ferredoxin 1 and suppress cell viability in prostate cancer cells. In conclusion, we carried out a comprehensive investigation for determining CRGs in differential expression, prognosis, immunological subtype, TME, and cancer treatment sensitivity across 26 malignancies; and validated the results in prostate cancer. Our research improves pan-cancer knowledge of CRGs and identifies more effective immunotherapy strategies.

Can the potential benefit of individualizing treatment be assessed using trial summary statistics alone?

Individualizing treatment assignment can improve outcomes for diseases with patient-to-patient variability in comparative treatment effects. When a clinical trial demonstrates that some patients improve on treatment while others do not, it is tempting to assume that treatment effect heterogeneity exists. However, if outcome variability is mainly driven by factors other than variability in the treatment effect, investigating the extent to which covariate data can predict differential treatment response is a potential waste of resources. Motivated by recent meta-analyses assessing the potential of individualizing treatment for major depressive disorder using only summary statistics, we provide a method that uses summary statistics widely available in published clinical trial results to bound the benefit of optimally assigning treatment to each patient. We also offer alternate bounds for settings in which trial results are stratified by another covariate. Our upper bounds can be especially informative when they are small, as there is then little benefit to collecting additional covariate data. We demonstrate our approach using summary statistics from a depression treatment trial. Our methods are implemented in the rct2otrbounds R package, which is available at https://github.com/ngalanter/rct2otrbounds.

Cutaneous adverse drug reactions in children with a focus on hypersensitivity to systemic drugs: A narrative review

Drug hypersensitivity in children is rare compared to adults. Children more frequently develop an infection-associated exanthema. Nevertheless, about 95% of children with drug hypersensitivity present with mucocutaneous involvement. Early recognition of typical clinical symptoms is important to reduce morbidity and mortality. We review relevant type I and type IV disorders of drug hypersensitivity in children and discuss their differential diagnoses and treatment.

Prior psychiatric morbidity and differential psychopharmacological treatment patterns: Exploring the heterogeneity of bipolar disorder in a nationwide study of 9594 patients.

Individuals with bipolar disorders (BD) have heterogenic pre-onset illness courses and responses to treatment. The pattern of illness preceding the diagnosis of BD may be a marker of future treatment response. Here, we examined associations between psychiatric morbidity preceding the diagnosis of BD and pharmacological treatment patterns in the 2 years following diagnosis. In this register-based study, we included all patients with a diagnosis of BD attending Danish Psychiatric Services between January 1, 2012 and December 31, 2016. We examined the association between a diagnosis of substance use disorder, psychosis (other than schizophrenia or schizoaffective disorder), unipolar depression, anxiety/OCD, PTSD, personality disorder, or ADHD preceding BD and pharmacological treatment patterns following the diagnosis of BD (lithium, valproate, lamotrigine, antidepressants, olanzapine, risperidone, and quetiapine) via multivariable Cox proportional hazards regression adjusted for age, sex, and year of BD diagnosis. We included 9594 patients with a median age of 39 years, 58% of whom were female. Antidepressants, quetiapine, and lamotrigine were the most commonly used medications in BD and were all linked to prior depressive illness and female sex. Lithium was used among patients with less diagnostic heterogeneity preceding BD, while valproate was more likely to be used for patients with prior substance use disorder or ADHD. The pharmacological treatment of BD is linked to psychiatric morbidity preceding its diagnosis. Assuming that these associations reflect well-informed clinical decisions, this knowledge may inform future clinical trials by taking participants' prior morbidity into account in treatment allocation.

Two prediction error systems in the nonlemniscal inferior colliculus: ‘spectral’ and ‘non-spectral’

According to the predictive processing framework, perception emerges from the reciprocal exchange of predictions and prediction errors (PE) between hierarchically organized neural circuits. The nonlemniscal division of the inferior colliculus (IC) is the earliest source of auditory PE signals, but their neuronal generators, properties and functional relevance have remained mostly undefined. We recorded single-unit mismatch responses to auditory oddball stimulation at different intensities, together with activity evoked by two sequences of alternating tones to control frequency-specific effects. Our results reveal a differential treatment of the unpredictable ‘many-standards’ control and the predictable ‘cascade’ control by lemniscal and nonlemniscal IC neurons that is not present in the auditory thalamus or cortex. Furthermore, we found that frequency response areas of nonlemniscal IC neurons reflect their role in subcortical predictive processing, distinguishing 3 hierarchical levels: (1) Nonlemniscal neurons with sharply tuned receptive fields exhibit mild repetition suppression without signaling PEs, thereby constituting the input level of the local predictive processing circuitry. (2) Neurons with broadly tuned receptive fields form the main, ‘spectral’ PE signaling system, which provides dynamic gain compensation to near-threshold unexpected sounds. This early enhancement of saliency reliant on spectral features was not observed in the auditory thalamus or cortex. (3) Untuned neurons form an accessory, ‘non-spectral’ PE signaling system, which reports all surprising auditory deviances in a robust and consistent manner, resembling nonlemniscal neurons in the auditory cortex. These nonlemniscal IC neurons show unstructured and unstable receptive fields that could result from inhibitory input controlled by corticofugal projections conveying top-down predictions.Significant StatementFrequency response areas of nonlemniscal neurons in the inferior colliculus correlate with certain predictive processing traits, distinguishing two prediction error systems. The 'spectral' system comprises neurons with broadly tuned receptive fields and is exclusively at play in the nonlemniscal inferior colliculus. It generates prediction errors only to low-intensity deviant sounds and is biased towards ascending changes in frequency. Hence, it provides early gain compensation to near-threshold but informative acoustic events, thereby facilitating efficient auditory discrimination under challenging conditions. The 'non-spectral' PE system reports on unexpected auditory events, uninfluenced by the acoustic spectral characteristics of deviant sounds. This accessory system comprises untuned neurons with disorganized and dynamic receptive fields, which conceivably receive top-down predictions from higher-order levels of the auditory hierarchy.

Neighbour-induced changes in root exudation patterns of buckwheat results in altered root architecture of redroot pigweed

Roots are crucial in plant adaptation through the exudation of various compounds which are influenced and modified by environmental factors. Buckwheat root exudate and root system response to neighbouring plants (buckwheat or redroot pigweed) and how these exudates affect redroot pigweed was investigated. Characterising root exudates in plant–plant interactions presents challenges, therefore a split-root system which enabled the application of differential treatments to parts of a single root system and non-destructive sampling was developed. Non-targeted metabolome profiling revealed that neighbour presence and identity induces systemic changes. Buckwheat and redroot pigweed neighbour presence upregulated 64 and 46 metabolites, respectively, with an overlap of only 7 metabolites. Root morphology analysis showed that, while the presence of redroot pigweed decreased the number of root tips in buckwheat, buckwheat decreased total root length and volume, surface area, number of root tips, and forks of redroot pigweed. Treatment with exudates (from the roots of buckwheat and redroot pigweed closely interacting) on redroot pigweed decreased the total root length and number of forks of redroot pigweed seedlings when compared to controls. These findings provide understanding of how plants modify their root exudate composition in the presence of neighbours and how this impacts each other’s root systems.

Finding the best subgroup with differential treatment effect with multiple outcomes.

Precision medicine aims to identify specific patient subgroups that may benefit the most from a particular treatment than the whole population. Existing definitions for the best subgroup in subgroup analysis are based on a single outcome and do not consider multiple outcomes; specifically, outcomes of different types. In this article, we introduce a definition for the best subgroup under a multiple-outcome setting with continuous, binary, and censored time-to-event outcomes. Our definition provides a trade-off between the subgroup size and the conditional average treatment effects (CATE) in the subgroup with respect to each of the outcomes while taking the relative contribution of the outcomes into account. We conduct simulations to illustrate the proposed definition. By examining the outcomes of urinary tract infection and renal scarring in the RIVUR clinical trial, we identify a subgroup of children that would benefit the most from long-term antimicrobial prophylaxis.

Performance and Consistency of ChatGPT-4 Versus Otolaryngologists: A Clinical CaseSeries.

To study the performance of Chatbot Generative Pretrained Transformer-4 (ChatGPT-4) in the management of cases in otolaryngology-head and neck surgery. Prospective case series. Multicenter University Hospitals. History, clinical, physical, and additional examinations of adult outpatients consulting in otolaryngology departments of CHU Saint-Pierre and Dour Medical Center were presented to ChatGPT-4, which was interrogated for differential diagnoses, management, and treatment(s). According to specialty, the ChatGPT-4 responses were assessed by 2distinct, blinded board-certified otolaryngologists with the Artificial Intelligence Performance Instrument. One hundred cases were presented to ChatGPT-4. ChaGPT-4 indicated a mean of 3.34 (95% confidence interval [CI]: 3.09, 3.59) additional examinations per patient versus 2.10 (95% CI: 1.76, 2.34; P = .001) for the practitioners. There was strong consistency (k > 0.600) between otolaryngologists and ChatGPT-4 for the indication of upper aerodigestive tract endoscopy, positron emission tomography and computed tomography, audiometry, tympanometry, and psychophysical evaluations. Primary diagnosis was correctly performed by ChatGPT-4 in 38% to 86% of cases depending on subspecialty. Additional examinations indicated by ChatGPT-4 were pertinent and necessary in 8% to 31% of cases, while the treatment regimen was pertinent in 12% to 44% of cases. The performance of ChatGPT-4 was not influenced by the human-reported level of difficulty of clinical cases. ChatGPT-4 may be a promising adjunctive tool in otolaryngology, providing extensive documentation about additional examinations, primary and differential diagnoses, and treatments. The ChatGPT-4 is more effective in providing a primary diagnosis, and less effective in the selection of additional examinations and treatments.

Diskriminierungserfahrungen und Angststörungen bei Latina-Mädchen: Amygdala-Volumen als indirekter neurobiologischer Pfad

AbstractEthnic–racial discrimination, the differential treatment of individuals based on ethnic or racial group membership, predicts poor mental health outcomes such as anxiety. This is supported by long-standing theories on the social determinants of health and minority stress. However, these theories are rarely expanded to neurobiological sciences, limiting our understanding of mechanisms underlying observed associations. One potential neurobiological pathway between ethnic–racial discrimination exposure and anxiety is that ongoing exposure to racially charged encounters presents imminent threats that may modify stress-sensitive neurocircuitry, like the amygdala.The current study evaluated whether amygdala volume mediated associations between ethnic–racial discrimination exposure and anxiety symptoms in Latina girls, a group exhibiting heightened levels of untreated anxiety and disproportionately subjected to ethnic–racial discrimination.Thirty predominantly Mexican-identifying Latina girls residing in Southern California (MAge = 9.76, SD = 1.11 years) completed a T1-weighted structural MRI scan. Using the Perceptions of Racism in Children and Youth, participants self-reported the prevalence and severity of various discriminatory experiences. Participants also self-reported their anxiety symptoms via the Screen for Child Anxiety and Related Emotional Disorders. Controlling for total intracranial volume and annual household income, an indirect effect of ethnic–racial discrimination on anxiety symptoms via left amygdala volume was observed, β = −0.28, SE = 0.17, BC 95% CI [−0.690, −0.017]. The current findings suggest that the left amygdala is sensitive to racialized threats in childhood and that stress-related alterations may, in part, contribute to elevated anxiety in Latina girls. Our data elucidate a potential mechanism by which this form of sociocultural stress can adversely impact mental health, particularly in the transition from middle childhood to early adolescence, a period marked by a host of interlinked neurophysiological and social changes.

Heterogeneous associations between interleukin-6 receptor variants and phenotypes across ancestries and implications for therapy

The Phenome-Wide Association Study (PheWAS) is increasingly used to broadly screen for potential treatment effects, e.g., IL6R variant as a proxy for IL6R antagonists. This approach offers an opportunity to address the limited power in clinical trials to study differential treatment effects across patient subgroups. However, limited methods exist to efficiently test for differences across subgroups in the thousands of multiple comparisons generated as part of a PheWAS. In this study, we developed an approach that maximizes the power to test for heterogeneous genotype–phenotype associations and applied this approach to an IL6R PheWAS among individuals of African (AFR) and European (EUR) ancestries. We identified 29 traits with differences in IL6R variant-phenotype associations, including a lower risk of type 2 diabetes in AFR (OR 0.96) vs EUR (OR 1.0, p-value for heterogeneity = 8.5 × 10–3), and higher white blood cell count (p-value for heterogeneity = 8.5 × 10–131). These data suggest a more salutary effect of IL6R blockade for T2D among individuals of AFR vs EUR ancestry and provide data to inform ongoing clinical trials targeting IL6 for an expanding number of conditions. Moreover, the method to test for heterogeneity of associations can be applied broadly to other large-scale genotype–phenotype screens in diverse populations.

Digital mental health interventions as stand-alone vs. augmented treatment as usual

BackgroundSmartphone-based digital mental health interventions (DMHI) have been described as a purported solution to meet growing healthcare demands and lack of providers, but studies often don’t account for whether patients are concurrently in another treatment modality.MethodsThis preregistered quasi-experimental intent-to-treat study with 354 patients enrolled in a therapist-supported DMHI examined the treatment effectiveness of the Meru Health Program (MHP) as a stand-alone treatment as compared to the MHP in combination with any other form of treatment, including (1) in-person therapy, (2) psychotropic medication use, and (3) in-person therapy and psychotropic medication use.ResultsPatients with higher baseline depressive and anxiety symptoms were more likely to self-select into multiple forms of treatment, an effect driven by patients in the MHP as adjunctive treatment to in-person therapy and psychotropic medication. Patients in combined treatments had significantly higher depressive and anxiety symptoms across treatment, but all treatment groups had similar decreasing depressive and anxiety symptom trajectories. Exploratory analyses revealed differential treatment outcomes across treatment combinations. Patients in the MHP in combination with another treatment had higher rates of major depressive episodes, psychiatric hospitalization, and attempted death by suicide at baseline.ConclusionsPatients with higher depressive and anxiety symptoms tend to self-select into using DMHI in addition to more traditional types of treatment, rather than as a stand-alone intervention, and have more severe clinical characteristics. The use the MHP alone was associated with improvement at a similar rate to those with higher baseline symptoms who are in traditional treatments and use MHP adjunctively.

Heterogeneity of primary and metastatic CAFs: From differential treatment outcomes to treatment opportunities (Review).

Compared with primary tumor sites, metastatic sites appear more resistant to treatments and respond differently to the treatment regimen. It may be due to the heterogeneity in the microenvironment between metastatic sites and primary tumors. Cancer‑associated fibroblasts (CAFs) are widely present in the tumor stroma as key components of the tumor microenvironment. Primary tumor CAFs (pCAFs) and metastatic CAFs (mCAFs) are heterogeneous in terms of source, activation mode, markers and functional phenotypes. They can shape the tumor microenvironment according to organ, showing heterogeneity between primary tumors and metastases, which may affect the sensitivity of these sites to treatment. It was hypothesized that understanding the heterogeneity between pCAFs and mCAFs can provide a glimpse into the difference in treatment outcomes, providing new ideas for improving the rate of metastasis control in various cancers.

Cultural Differences and Discrimination: Afghan Immigrants’ Experiences in Germany

The attitude of host societies toward immigrants plays a pivotal role in the successful integration of immigrant groups. The main purpose of this study is to find examples of discrimination against Afghan immigrants in Germany and to determine how cultural differences and discrimination affect the integration of Afghan immigrants. Employing a qualitative thematic analysis methodology, the research derives its findings from in-depth interviews with 25 Afghan migrants in Germany. Finding of this study shows that there are discrimination, racism, and ethnic prejudice against Afghan immigrants in Germany, such as hate speech, unequal job opportunities, and differential treatment in the educational system.