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In South Africa >60% of female sex workers (FSW) are living with HIV, the majority of whom are not virally suppressed. Identifying multi-level determinants of viral suppression is central to developing implementation strategies to promote retention in HIV care and viral suppression among FSW with unmet treatment needs. Adult cisgender FSW living with HIV for ≥6 months, conducting sex work as their primary source of income, and residing in Durban (South Africa) were enrolled into the Siyaphambili Study, a sequential multiple assignment randomized trial. Baseline viral load and CD4 were assessed, and an interviewer-administered survey was conducted, capturing socio-demographic, reproductive and sexual history and behaviors, vulnerabilities, substance use, mental health, and stigma. We assessed baseline determinants of viral suppression (

Background Hematological conditions like pancytopenia are widespread in our lab. Diagnosis and therapy of pancytopenia require etiology analysis. Most pancytopenia causes are determined by the Absolute Reticulocyte Count (ARC), which has been neglected. The aim of this study is to determine the importance of the Absolute Reticulocyte Count (ARC) in assessing the etiology of pancytopenia, with a focus on its role in distinguishing between different causes of this hematological condition. Materials and Methods The study was conducted in a tertiary health care institution in Bihar, India. Over the course of 1 year (April 2021 to March 2022), a descriptive cross-sectional study was carried out. Complete blood counts (CBC), reticulocyte count including ARC and peripheral blood smear (PBS) examination were performed in all cases of pancytopenia. Serum ferritin, Serum vitamin B12 level and serum folate were also estimated. Bone marrow examination was done in all cases. Results A total of 200 pancytopenia cases were assessed, and the findings were recorded. In cases of aplastic anemia, ARC was found to be 100x109 /L was seen in neoplastic disorders. Lower ARC values were associated with conditions like aplastic anemia, while higher ARC values were indicative of acute leukemia and metastatic deposits, making ARC a valuable diagnostic tool. Conclusion It was concluded that ARC is crucial in distinguishing between different causes of pancytopenia, and it must be a regular part of work-up to prevent needless invasive bone marrow examinations in cases of pancytopenia. Recommendation This study suggests that pancytopenia patients be routinely assessed with Absolute Reticulocyte Count (ARC). ARC helps identify pancytopenia etiologies, preventing needless bone marrow exams. Pancytopenia diagnosis and treatment can be improved by adding ARC to diagnostic techniques.

Background Hemoglobinopathies are a growing global health issue. These hereditary diseases are most common worldwide. WHO says the Middle East and India have the highest incidence. HPLC is a good way to screen hemoglobin variants such HbF and HbA2. The present study was carried out to diagnose hemoglobinopathies and thalassemias by the use of HPLC in Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. Materials and Methods A retrospective descriptive research assessed 550 patients for thalassaemia or other hemoglobin structural abnormalities. This investigation included all cases of microcytic hypochromic anemia (MCV< 80 fl, MCH< 27 pg) with a clinical suspicion of hemoglobinopathy that did not respond to usual treatment. The trial excluded patients who had blood transfusions within three months. Results This study included 550 cases, 310 boys and 240 females, aged 2 months to 40 years. HPLC analysis revealed abnormal hemoglobin fractions in 96 cases. One person had delta thalassemia, one had delta with beta-thalassemia, one had hemoglobin D Iran, two had HbE with beta, six had HbE trait, eight (1%) had beta major, and less than 1% had HbE homozygous. Of the cases, 72 (13%) had beta thalassemia. The HPLC pattern was normal in 48%. In all cases, peripheral blood smears showed target cells, microcytosis, and hypochromia. The majority of patients had increased RBCs. Conclusion Hemoglobinopathies can be quickly, accurately, and effectively diagnosed with HPLC. It is a valuable diagnostic technique for beta thalassemia characteristics, particularly in impoverished nations like India where hemoglobinopathies are difficult to identify. Prompt diagnosis could aid in appropriate and targeted treatment. Recommendation This study emphasizes the need of HPLC for hemoglobinopathy diagnosis, especially in high-burden countries like India. HPLC screening and diagnosis can help combat hemoglobinopathies' global health issues by enabling early detection and focused treatment.

Summary: The World Health Organization (WHO) South East Asia Region (SEAR) comprises 11 countries, which are one of the most culturally, topographically, and socially diverse areas worldwide, undergoing an epidemiological transition towards non-communicable diseases, including stroke and other cardiovascular diseases (CVDs). This region accounts for over 40% of the global stroke mortality. Few well-designed population-based epidemiological studies on stroke are available from SEAR countries, with considerable variations among them. Ischemic stroke, a common stroke subtype, has higher frequencies of intracerebral hemorrhage in many countries. Along with an aging population, the increased prevalence of risk factors such as hypertension, diabetes mellitus, tobacco and alcohol consumption, lack of physical activity, high ambient pollution, heat, and humidity contribute to the high burden of stroke in this region. SEAR's many unique and uncommon stroke etiologies include cerebral venous thrombosis, tuberculosis, dengue, scrub typhus, falciparum malaria, snake bite, scorpion sting, etc. Current data on stroke burden and risk factors is lacking, compelling an urgent need for high-quality hospital-level and population-level data in all SEAR countries. Strategies towards a consolidated approach for implementing improved stroke prevention measures, stroke surveillance, and established stroke systems of care are the path to bridging the gaps in stroke care.

Summary: The Southeast Asia Region (SEAR) accounts for nearly 50% of the developing world's stroke burden. With various commonalities across its countries concerning health services, user awareness, and healthcare-seeking behavior, SEAR still presents profound diversities in stroke-related services across the continuum of care. This review highlights the numerous systems and challenges in access to stroke care, acute stroke care services, and health care systems, including rehabilitation. The paper has also attempted to compile information on the availability of stroke specialized centers, Intravenous thrombolysis (IVT) ready centers, Endovascular therapy (EVT) ready centers, rehabilitation centers, and workforce against a backdrop of each country's population. Lastly, the efforts of WHO (SEARO)-CMCL (World Health Organization-South East Asia region, Christian Medical College & Hospital Ludhiana) collaboration towards improving stroke services and capacity among the SEAR have been described.

Summary: Surveillance of stroke is critical to track its burden and assess progress in prevention and treatment. We reviewed the literature to evaluate stroke surveillance efforts in the South-East Asia Region (SEAR) countries, identify progress and assess gaps. Epidemiological data on all the major parameters such as the incidence, prevalence and mortality of stroke were available for India and Thailand but for none of the other SEAR countries. Most of the epidemiological data came from investigator-initiated studies. National stroke surveillance was present only in India in the form of a National Stroke Registry Programme and Thailand has a national database that was used to obtain epidemiological data for stroke. Research on novel methods for stroke registration, such as using information technology, was absent. This review identified serious gaps in the monitoring and surveillance of stroke in SEAR countries. Systematic efforts are needed to fill those gaps.

Abstract Background In South Africa, 60% of female sex workers (FSW) are living with HIV, many of whom experience structural and individual barriers to antiretroviral therapy (ART) initiation and adherence. Community-based decentralized treatment provision (DTP) may mitigate these barriers. To characterize optimal implementation strategies, we explored preferences for DTP among FSW living with HIV in Durban, South Africa. Methods Thirty-nine semi-structured in-depth interviews were conducted with FSW living with HIV (n = 24), and key informants (n = 15) including HIV program implementers, security personnel, and brothel managers. Participants were recruited using maximum variation and snowball sampling. Interviews were conducted in English or isiZulu between September–November 2017 and analyzed using grounded theory in Atlas.ti 8. Results DTP was described as an intervention that could address barriers to ART adherence and retention, minimizing transport costs, time and wage loss from clinic visits, and act as a safety net to address FSW mobility and clinic access challenges. Respondents highlighted contextual considerations for DTP and suggested that DTP should be venue-based, scheduled during less busy times and days, and integrate comprehensive health services including psychological, reproductive, and non-communicable disease services. ART packaging and storage were important for community-based delivery, and participants suggested DTP should be implemented by sex work sensitized staff with discrete uniform and vehicle branding. Conclusions Incorporating FSW preferences may support implementation optimization and requires balancing of tensions between preferences and feasibility. These data suggest the potential utility of DTP for FSW as a strategy to address those most marginalized from current ART programs in South Africa.

Sex cord–stromal tumors are very rare ovarian tumors. Primary ovarian fibrosarcomas are a very rare type of sex cord–stromal tumors. They arise from superficial or deep connective tissues of fascia, tendon, periosteum, and scar. They can grow either slowly or rapidly forming a giant abdominal mass similar to epithelial tumors of the ovary. Fibrosarcomas are difficult to diagnose preoperatively. Tumor marker and radiological techniques play a trivial role in preoperative diagnosis of this rare variety of sex cord–stromal tumor. Often final diagnosis is made on histopathological and immunohistochemistry reporting. Histopathological features such as high mitotic count, nuclear atypia, and herringbone pattern arrangement of spindle cells confirm a diagnosis of malignant fibrosarcoma. Ki-67 index is considered a prognostic factor for fibromatous lesions of the ovary showing aggressive nature of tumor. We report a rare case of giant ovarian fibrosarcoma in a 40-year-old woman whose diagnosis was made histopathologically due to rarity of tumor.

Giant ovarian mature cystic teratomas (MCTs) are sparsely reported and that too at extreme of age like in premenarchal or postmenopausal age group. We hereby report a case of huge MCT in a 11-year-old premenarchal girl who presented with abdominal pain and lump. Ovarian tumor in adolescent may have malignant potential and requires appropriate and vigilant preoperative work-up and counseling for optimal management with concern of preservation of fertility and potential for childbearing.

Expansion of tuberculous preventive therapy (TPT) is essential to curb TB incidence and mortality among people with HIV (PWH), yet implementation has been slow. Innovative strategies to operationalize TPT are urgently needed. Here we present an evaluation of community-based identification and referral of PWH on completion of a six-month course of isoniazid in a highly prevalent region in rural South Africa. Using a community-based TB/HIV intensive case finding strategy, a team of nurses and lay workers identified community members with HIV who were without fever, night sweats, weight loss, or cough and referred them to the government primary care clinics for daily oral isoniazid, the only available TPT regimen. We measured monthly adherence and six-month treatment completion in the community-based identification and referral (CBR) group compared to those already engaged in HIV care. Adherence was measured by self-report and urine isoniazid metabolite testing. A multivariable analysis was performed to identify independent predictors of TPT completion. Among 240 participants, 81.7% were female, median age 35 years (IQR 30-44), and 24.6% had previously been treated for TB. The median CD4 count in the CBR group was 457 (IQR 301-648), significantly higher than the clinic-based comparison group median CD4 of 344 (IQR 186-495, p

Expansion of tuberculous preventive therapy (TPT) is essential to curb TB incidence and mortality among people with HIV (PWH), yet implementation has been slow. Innovative strategies to operationalize TPT are urgently needed. Here we present an evaluation of community-based identification and referral of PWH on completion of a six-month course of isoniazid in a highly prevalent region in rural South Africa. Using a community-based TB/HIV intensive case finding strategy, a team of nurses and lay workers identified community members with HIV who were without fever, night sweats, weight loss, or cough and referred them to the government primary care clinics for daily oral isoniazid, the only available TPT regimen. We measured monthly adherence and six-month treatment completion in the community-based identification and referral (CBR) group compared to those already engaged in HIV care. Adherence was measured by self-report and urine isoniazid metabolite testing. A multivariable analysis was performed to identify independent predictors of TPT completion. Among 240 participants, 81.7% were female, median age 35 years (IQR 30–44), and 24.6% had previously been treated for TB. The median CD4 count in the CBR group was 457 (IQR 301–648), significantly higher than the clinic-based comparison group median CD4 of 344 (IQR 186–495, p