A prospective population-based study was undertaken in Ulaanbaatar, Mongolia, from 2019 to 2021 to determine stroke incidence and outcome, as quantifiable data on the stroke burden were unavailable.
In Ulaanbaatar, Mongolia's six urban districts, from January 1, 2019, to December 31, 2020 (population person-years, N=1,896,965), all stroke cases in adult residents (aged 16 years) were determined using standardized diagnostic criteria from multiple overlapping data sources on hospitalized, ambulatory, and deceased individuals. Microbial biodegradation Data sets were assembled encompassing sociodemographic characteristics, medical history details, and management methods. Calculations of both crude and standardized incidence were conducted for first-ever stroke and its main pathological sub-types, and reported alongside 95% confidence intervals. Outcomes encompassed 28-day case fatality ratios and functional recovery, measured using the modified Rankin scale, at both 90 days and one year post-intervention.
Among 3738 patients, 3803 stroke events were noted, comprising 2962 initial incidents (mean patient age 59 years [standard deviation 13], including 1161 female patients, representing 392% of the total). The crude annual incidence rate of a first-ever stroke, per 100,000 individuals, was 1561 (95% confidence interval 1505-1618). This rate rose to 1716 (1575-1856) when adjusted for the age distribution of the Mongolian population, and decreased to 1403 (1367-1439) when adjusted for the age distribution of the global population. Considering world-wide patterns, the incidence of ischaemic stroke stood at 666 (95% CI 648-683), intracerebral hemorrhage at 545 (530-561), and subarachnoid hemorrhage at 187 (183-191). Ischaemic stroke and intracerebral haemorrhage were observed more frequently in men than in women, yet the risk of subarachnoid haemorrhage exhibited symmetry across the genders; this pattern of disparity was consistent across all age groups. The most prominent risk factors identified were hypertension affecting 1363 (631%) of 2161 subjects; smoking (596, 268% of 2220); regular alcohol consumption (533, 240% of 2220); obesity (342, 161% of 2125); and diabetes (282, 127% of 2220). Thrombolysis, in the context of acute ischemic stroke, exhibited low utilization (9%) largely due to considerable delays in presentation after the start of symptoms. The median presentation delay was 160 hours, with an interquartile range of 30 to 480 hours. Analyzing data from a 28-day period, the overall case fatality rate was 361% (95% CI 343-379). Ischaemic stroke demonstrated a rate of 148% (128-167), significantly higher for intracerebral haemorrhage (529%, 499-558), and subarachnoid haemorrhage (543%, 494-591). Respectively, corresponding figures for poor functional outcome at one year, determined by mRS scores of 3-6 (signifying death or dependence), were 616% (95% CI 598-634), 475% (447-503), 770% (745-795), and 618% (570-665).
A considerable number of residents in Ulaanbaatar's urban areas of Mongolia encounter a high incidence of stroke, primarily manifesting as intracerebral hemorrhage and subarachnoid hemorrhage. Sadly, half of the patients perish within the first month, and over two-thirds are either deceased or reliant on care within three months. Although the overall stroke rates are akin to those of other countries, the average age of stroke occurrence stands at 60, marking a 10-year difference from high-income countries. Future stroke prevention initiatives, including primary and secondary interventions, and the arrangement of healthcare systems, can be shaped by these epidemiological findings.
The George Institute for Global Health, collaborating with the Science and Technology Foundation of Mongolia's Ministry of Education, Culture, and Science.
The George Institute for Global Health and the Science and Technology Foundation of Mongolia's Ministry of Education, Culture, and Science.

Childhood-onset chronic kidney disease, a progressively worsening condition, significantly impacts life expectancy and overall well-being. In evaluating the short-term risk of chronic kidney disease progression in children, we examined the utility of urinary Dickkopf-related protein 3 (DKK3), a marker of kidney tubular cell stress, to determine which patients would benefit from nephroprotective interventions.
This cohort study observed the association of urinary DKK3 with the combined renal endpoint (a 50% drop in estimated glomerular filtration rate [eGFR] or progression to end-stage renal disease) or kidney replacement therapy (dialysis or transplantation), as well as the interaction between this endpoint and intensive blood pressure control in the ESCAPE randomized controlled study. Quantifying urinary DKK3 and eGFR was performed in children aged 3 to 18 years with chronic kidney disease and available urine samples, enrolled in the prospective, multi-center ESCAPE (NCT00221845, derivation cohort) and 4C (NCT01046448, validation cohort) studies, at both the initial assessment and during six-monthly follow-up visits. Adjusting for age, sex, hypertension, systolic blood pressure SD score (SDS), BMI SDS, albuminuria, and eGFR, the analyses were modified.
For the analysis, 659 children were selected, 231 from the ESCAPE group and 428 from the 4C group. These groups involved 1173 and 2762 half-year blocks, respectively. In both participant groups, urinary DKK3 levels exceeding the median (i.e., greater than 1689 pg/mg creatinine) were linked to a substantially greater six-month decline in eGFR compared to urinary DKK3 levels at or below the median (-56% [95% CI -86 to -27] versus 10% [-19 to 39], p<0.00001, in ESCAPE; -62% [-73 to -50] versus -15% [-29 to -01], p<0.00001, in 4C), irrespective of the underlying condition, baseline eGFR, and albuminuria levels. The ESCAPE study demonstrated a restricted beneficial effect of enhanced blood pressure control, applicable only to children with urinary DKK3 levels exceeding 1689 pg/mg creatinine, concerning both the combined renal endpoint (HR 0.27 [95% CI 0.14 to 0.55], p=0.00003, number needed to treat 40 [95% CI 37 to 44] vs 2500 [669 to .]) and the requirement for renal replacement therapy (HR 0.33 [0.13 to 0.85], p=0.0021, number needed to treat 67 [61 to 72] vs 310 [274 to 359]). Within the 4C study, blocking the renin-angiotensin-aldosterone system resulted in significantly lower urinary DKK3 concentrations. Patients not on ACE inhibitors or ARBs showed a mean of 12235 pg/mg creatinine (95% confidence interval 10036-14433), while those receiving these inhibitors or blockers had a significantly lower mean of 6861 pg/mg creatinine (5616-8106), signifying statistical significance (p<0.00001).
The presence of DKK3 in the urine of children with chronic kidney disease points to a short-term risk of deteriorating kidney function and might permit a personalized approach to medicine by identifying patients who could respond positively to heightened pharmacological nephroprotection, such as more aggressive blood pressure control.
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Transgender women in sub-Saharan Africa, despite facing a substantial HIV burden, are not adequately represented in studies tracking their movement through the HIV care cascade in the region, to the best of our understanding. Through analysis of data from three South African metropolitan municipalities, this study aimed to assess HIV prevalence and to present information for the development of HIV care continuum indicators applicable to transgender women.
Transgender women, being sexually active in the metropolitan municipalities of Johannesburg, Buffalo City, and Cape Town, South Africa, participated in a survey to obtain biobehavioral data. In the study, respondent-driven sampling (RDS) was used to recruit participants who identified as transgender women, aged 18 years, and who reported consensual sexual activity with a male partner within the previous six months. CDDO-Me HIV status awareness was assessed with an interviewer-administered questionnaire; blood samples, obtained from dried blood spots, were analyzed for HIV antibodies, antiretroviral treatment (ART) exposure, and viral load suppression. The RDS Analyst software, coupled with individualised RDS weights, was used to generate population-based estimations of HIV's 95-95-95 cascade indicators. A multivariate stepwise backward logistic regression model was constructed to establish factors associated with each cascade indicator. The final analysis cohort included all participants who met the eligibility criteria.
The enrollment of 887 sexually active transgender women took place between July 26, 2018, and March 15, 2019, with 323 in Johannesburg, 305 in Buffalo City, and 259 in Cape Town. Electrophoresis Equipment HIV prevalence was highest in Johannesburg where a significant 229 (741%) of 309 tests indicated positive results (weighted prevalence estimate of 633%, with a 95% confidence interval of 555-705). Subsequently, Buffalo City demonstrated a prevalence of 121 (437%) positive results out of 277 tests (461%, 387-536). Lastly, Cape Town exhibited a prevalence of 122 (484%) positive results from 252 tests (456%, 367-547). An estimated 542% (95% confidence interval: 458-624) of transgender women with HIV in Johannesburg reported awareness of their HIV status, while this rate was 242% (154-358) in Cape Town, and 395% (271-534) in Buffalo City. According to the data, 821% (733-885) of those with known status in Johannesburg, 782% (579-903) in Cape Town, and 647% (452-802) in Buffalo City had access to antiretroviral therapy (ART). Viral suppression rates among those on ART in Johannesburg were 344% (272-424), 412% (307-526) in Cape Town, and 550% (407-684) in Buffalo City.
Innovative strategies are crucial for achieving prompt diagnosis and treatment, and viral load suppression, of transgender women living with HIV. The HIV cascade for South African transgender women, including those from racial groups other than Black South African, those with low levels of education, and those who have had minimal outreach, requires differentiated HIV services, along with innovative testing and adherence strategies.
The US Centers for Disease Control and Prevention, in partnership with the US President's Emergency Plan for AIDS Relief, are critical in the ongoing battle against AIDS.