Livingstone Hospital

Anaemia remains a major comorbidity among children living with HIV (CLHIV) in sub-Saharan Africa, yet sex-specific risk factors are poorly characterized. This study investigated the prevalence and sex-based determinants of anaemia among CLHIV in the Southern Province, Zambia. A retrospective cross-sectional study was conducted using medical records from 321 CLHIV aged 0–14 years. Data on demographic, clinical, and anthropometric variables were analysed. Sex-stratified multivariable logistic regression identified factors associated with anaemia (Hb < 10.9 g/dL). Overall anaemia prevalence was 47.0% (151/321), with a higher, though not statistically significant, burden in males (52.6%) than females (41.9%). Younger age was a strong, independent risk factor across both sexes. Distinct sex-specific determinants were identified. In males, no statistically significant association between CTX use and anaemia was observed (Adjusted Odds Ratio, AOR = 3.04; 95% CI: 0.95–9.74). Care provided by an aunt was significantly associated with lower odds of anaemia compared to other caregiving arrangement (AOR = 0.10; 95% CI: 0.01–0.90). Poor anthropometric indices (height and weight) were significantly associated with anaemia in both sexes. The study findings reveal a high prevalence of anaemia among CLHIV in Zambia, with nuanced sex-based differences in its determinants. The findings advocate for differentiated, gender-sensitive intervention strategies. For boys, careful review of CTX prophylaxis is warranted, while for girls, enhancing supportive caregiving environments may be protective. Integrating these sex-specific approaches into paediatric HIV programs is crucial for reducing the anaemia burden and improving clinical outcomes.

Background/Objectives: The 15-item Quality of Recovery questionnaire (QoR-15) is a widely adopted patient-reported outcome measure (PROM) in perioperative care. Although its validity and reliability have been confirmed across languages and surgical populations, no bibliometric analysis has systematically assessed its research impact, trends, and collaborative networks. Methods: We performed a bibliometric analysis of QoR-15 literature using the Scopus database (2013–June 2025). Eligible studies reporting on QoR-15 in perioperative or postoperative settings were included. Data were analyzed using VOS viewer (version 1.6.20) and CiteSpace (version 6.3) to evaluate co-authorship, keyword co-occurrence, citation patterns, bibliographic coupling, and co-citation networks. Results: Of 366 records screened, 341 articles were included. A total of 1901 authors, 999 organizations, and 43 countries contributed to the development of the QoR-15 literature. China produced the most publications (n = 164, 952 citations), whereas Australia generated fewer papers (n = 16) but with the highest citation impact (1479 citations). The most cited article was Myles et al. (year 2018, 219 citations). Co-occurrence mapping highlighted clusters in translation/validation studies, enhanced recovery pathways, and regional anesthesia applications. CiteSpace cluster analysis revealed emerging research in opioid-free anesthesia, pediatric adaptations, and frailty populations. Conclusions: This first bibliometric analysis of QoR-15 literature demonstrates rapid global adoption, with substantial contributions from Asia and high-impact outputs from Australia and Europe. Trends indicate increasing use of QoR-15 in regional and opioid-sparing strategies, emergency surgery, and pediatric care. These findings highlight QoR-15 as a robust, patient-centered endpoint and provide direction for future perioperative and pain research.

ABSTRACTAlzheimer's Disease (AD) is a global health issue, affecting over 6 million people in the United States, with that number expected to increase as the population ages. As a neurodegenerative disorder that affects memory and cognitive functions, it is well established that AD is associated with cardiovascular risk factors beyond only cerebral decline. In this study, we measured hemodynamic parameters related to cardiovascular and cerebrovascular function in 5xFAD mice with AD and their littermates. Specifically, we measured cardiovascular pulse wave velocity parameters, a marker of arterial stiffness and cardiovascular risk, and cerebrovascular pulse wave velocity, a novel technique to measure cerebral arterial stiffness. Our results showed that while 5xFAD mice exhibited significant differences in ejection time, pulse pressure, and Tei index, many other cardiovascular and cerebral parameters were not different. Despite reports that amyloid plaque deposition begins at an early age of 1.5 months in 5xFAD mice, our results did not indicate significant cardiovascular changes. Studies to elucidate cardiovascular and cerebrovascular parametric changes should be done at later ages where the underlying changes are more profound.

Hypertensive heart disease (HHD) is characterized by pressure overload-induced cardiac remodeling, in which mitochondrial dysfunction has emerged as a central contributor to pathophysiology. Mitochondria occupy roughly one-third of the volume of a cardiomyocyte and serve as the primary source of ATP for the constantly active heart, while also regulating calcium homeostasis, redox balance, and apoptotic signaling. Chronic hypertension imposes energetic and oxidative stress on cardiomyocytes, disrupting mitochondrial structure and function. Key mitochondrial quality control processes including organelle fusion-fission dynamics, biogenesis, and mitophagy become dysregulated in HHD, leading to impaired energy production and heightened cell injury. This unstructured review discusses the physiological roles of mitochondria in cardiac muscle and examines how altered mitochondrial dynamics contribute to hypertensive cardiac damage. We detail mechanisms of mitochondrial dysfunction in HHD, such as excessive fission, cristae disruption, and oxidative stress, and how these changes are exacerbated by aging. Age-related mitochondrial remodeling such as loss of cristae and decreased organelle volume may synergistically worsen hypertensive cardiac injury. We further integrate findings from recent studies in animal and human models, including advanced three-dimensional ultrastructural analyses and molecular investigations that illuminate new aspects of mitochondrial network organization, the mitochondrial contact site and cristae organizing system (MICOS), cristae maintenance complex, and quality control pathways in HHD. Understanding mitochondrial dysfunction in HHD reveals potential therapeutic avenues targeting mitochondrial quality and dynamics to preserve cardiac function in hypertension.

Salt sensitivity is a well-recognized contributor to cardiovascular risk, traditionally linked to elevated blood pressure. However, emerging evidence suggests that high dietary sodium may also promote myocardial fibrosis through non-hemodynamic mechanisms, including the activation of redox-sensitive and profibrotic pathways. Despite growing mechanistic insights, the connection between salt sensitivity and myocardial fibrosis remains underexplored, particularly in human studies. This review synthesizes current experimental and translational evidence linking dietary salt intake to myocardial fibrosis, with a focus on molecular signaling cascades, tissue sodium compartmentalization, and the clinical implications of salt-sensitive physiology. We discuss the relevance of these mechanisms to the development of diastolic dysfunction and their potential contribution to heart failure with preserved ejection fraction (HFpEF). In addition, we highlight findings from animal models and the emerging application of sodium magnetic resonance imaging (23Na-MRI) as a novel imaging tool for visualizing myocardial sodium overload and its association with fibrotic remodeling. Finally, we explore future therapeutic strategies that extend beyond traditional antihypertensives, including mineralocorticoid receptor antagonists (MRAs), angiotensin receptor blockers (ARBs), sodium-glucose cotransport 2 (SGLT2) inhibitors, and sodium-modulating interventions. Together, these insights offer new opportunities for early detection and targeted treatment in salt-sensitive cardiovascular disease.

BackgroundCervical cancer is a common cancer worldwide, with > 85% of deaths occurring in Lower- and Middle-Income Countries where resources for screening programs are limited. Women living with HIV (WLHIV) are at increased risk. HPV test-and-treat is a screening strategy where women with HPV are offered ablative treatment of the cervix to reduce the risk of invasive cancer. WLHIV tend to have more extensive cervical lesions, necessitating more specialised surgical treatments.MethodACTG A5282 was a randomised, open-label, Phase 2 trial conducted in seven countries that compared a cytology-based screening strategy to HPV test-and-treat for cervical cancer prevention in WLHIV. Women with cervical lesions inappropriate for ablative treatment were assigned to Arm C and underwent colposcopy and directed biopsies. Loop electro-excision procedure was performed if high-grade lesions (bHSIL) were present on cervical biopsies. Women were followed 26 weeks later for repeat evaluations. The Clopper-Pearson exact method was used to construct the 95% confidence interval for the proportion of WLHIV with lesions inappropriate for cryotherapy. Logistic regression models were used to assess the factors associated with these lesions.ResultsOf 1046 women screened, 156 (88%) were Black/Non-Hispanic, with a median age of 36 years; 80% were on ART, and 73% had an HIV-1 RNA < 200 copies/mL. On cervical colposcopy, 17% (179/1046, 95% CI 14.9–19.4%) had cervical lesions inappropriate for cervical ablation. Among 428 (44%) women with High-risk HPV (hrHPV) detected, 112 (26%, 95% CI 22.2%, 30.5%) had cervical lesions inappropriate for ablative therapy. hrHPV was found more commonly among women having lesions inappropriate for ablative therapy as compared to lesions appropriate for ablative therapy (70% vs 54%, p < .001). Among 128 women with extensive cervical lesions undergoing colposcopic biopsies, 43 (34%) had bHSIL detected. Among women undergoing LEEP treatment of bHSIL, 24% had bHSIL detected 26 weeks later.ConclusionCervical lesions inappropriate for ablative therapy were common among WLHIV. This has implications for cervical cancer programs as these lesions can only be optimally treated with surgical therapies such as loop electroexcision procedures, and the capacity for this procedure should be increased to maximise cervical cancer prevention outcomes.

The use of data for healthcare decision-making has numerous benefits, including increasing knowledge of user demographics and needs, enabling adequate planning of healthcare resources and services, and providing a roadmap of decisions made to ensure stakeholder accountability. Despite these clear benefits, frameworks and theories guiding decision making in healthcare remain under-utilised. This paper presents three decision-making theories that focus on data. Classical Decision Theory and its modern iterations emphasize the decision-making process and the use of data in this process. The Ottawa Decision Support Framework is employed when the decision relates to new diagnoses or treatments or when extensive deliberation is needed in uncertain circumstances. Lastly, Bayesian Decision Theory considers existing knowledge and cost functions in decision-making. The context in which these theories were developed and applied is discussed, and their future applications in healthcare decision-making are explored.