Prevalence of human immunodeficiency virus infection among transgender men in Rawalpindi (Pakistan)

Abstract Background Transgender males are at high risk for sexually transmitted diseases including AIDS caused by the notorious Human Immunodeficiency Virus (HIV), yet little consideration is given by the policy makers, researchers and non-governmental organizations (NGOs) towards this sensitive issue in Pakistan. Methods In this study, we have investigated the prevalence of HIV infection among 306 transgender males with a median age of 29 years (range 15–64 years) residing in Rawalpindi, Pakistan. Rapid HIV antibody-screening methods including the strip test and Enzyme Linked Immuno-absorbent tests were employed to detect HIV antibodies among the subjects. For further confirmation, Polymerase Chain Reaction (PCR) was carried out. Statistical analytical techniques utilized included logistic regression and chi-square. Results HIV-1 was found to be the predominant viral subtype. PCR confirmed 21.6% (Confidence Interval 0.17-0.26) of the respondents were reported being HIV positive. 15.7% of the transgender men who shave at home and 13.7% of the transgender men who were educated below 5th grade were found to have HIV. Conclusion This study shows a very high prevalence of HIV among transgender males. Unawareness among these individuals about the ramifications of this infection owes largely to lack of education. The spread rate is alarming and HIV epidemic is imminent if awareness is not widespread.</p

Cadmium (Cd) and copper (Cu) exposure and bioaccumulation arrays in farm ruminants: impact of forage ecotypes, ecological sites and body organs

Copper (Cu) and cadmium (Cd) metal distribution in soil–plant ecosystems and their public health risk impact on ruminants (cows, buffalo, and sheep) are explored in the present investigation. Five different forage crops were selected, and the foraging responses of three types of ruminants (cows, buffalo, and sheep) at three ecological sites were evaluated. The soil of these three ecological sites was metal polluted (due to wastewater irrigation) and was studied to evaluate the metal contamination and pollution load index. For the assessment of Cd and Cu, soil, vegetation, blood, hair, and feces samples were collected and analysed using an atomic absorption spectrophotometer. High consumption of fodder crops (Sorghum bicolor Kuntze, Sesbania bispinosa (Jacq.) W. Wight, Cynodon dactylon (L.) Pers., Suaeda fruticosa (L.) Forssk., and Tribulus terrestris L.) by cows and buffalo at site-III resulted in an increase in daily Cu and Cd intake. The pollution load index was higher at site-II and site-III, indicating a severe health risk scenario for local inhabitants. Cd and Cu were at their maximum levels in fodder crops. A significant increase in the concentrations of Cd and Cu was found in the blood, hair, and feces of cows and buffalo at site-III. Ecological indicators such as the bioaccumulation factor, the pollution load index, and the enrichment factor were found to be higher in buffalo than cows. The Cd level in forages was highest at the site-III Cd level and in the order of S. bispinosa > S. fruticosa > T. terresteris > C. dactylon > S. bicolor. Although these levels were lower than the permissible maximum limit, they were generally higher in the forage crops. Exposure of local inhabitants to the consumption of milk and meat from these cattle showed the serious health risks consequences. This situation can be properly managed by general monitoring of soil and vegetation pollution, avoiding metal contamination in the soil and food chain components, and using treated waste water and other alternate water sources for forage irrigation.King Saud University | Ref. RSP-2021/173Princess Nourah bint Abdulrahman University, Riyadh | Ref. PNURSP2022R186Higher Education Commission of Pakistan | Ref. #2484/1

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)