Summary: Background: Cervical cancer is largely preventable, yet major gaps persist in detection and timely management of cervical precancer, particularly in low- and middle-income countries. Using data from the ESTAMPA multicentric study, we derived stratified absolute risk estimates for cervical precancer and cancer based on HPV testing, cervical cytology, and colposcopic impression. Methods: ESTAMPA is a multicenter cervical cancer screening study (NCT01881659) that recruited women aged 30–64 years across 12 centres, comprising primary and secondary care facilities, hospitals, laboratories, and universities, across nine Latin American countries: Argentina, Bolivia, Colombia, Costa Rica, Honduras, Mexico, Paraguay, Peru, and Uruguay. The aims of the study were (1) to investigate the performance of emerging cervical cancer screening and triage techniques among women 30 years and older and (2) to evaluate the feasibility of different approaches for implementation of organised HPV-based screening programmes. Women were screened with HPV testing and cervical cytology. Those with positive screening results were referred to colposcopy using a standardised protocol including colposcopic impression, directed biopsies, and treatment as indicated. Women with normal colposcopy or histology less than CIN2 were recalled after 18 months for repeat HPV testing and colposcopy if HPV-positive. Absolute risks of histologically confirmed CIN3+ detected at baseline or follow-up were estimated integrating HPV testing, cytology, and colposcopic impression. Findings: Between December 12, 2012, and August 31, 2022, 44,135 women with a valid HPV test were included, of whom 6236 (14.1%) were HPV-positive. Overall, 764 CIN3+ lesions were detected (1.73%; 95% CI 1.61–1.86). CIN3+ risk was 12.0% (747/6236; 95% CI 11.2–12.8) among HPV-positive women compared with 0.04% (17/37,899; 95% CI 0.03–0.07) among HPV-negative women. Among HPV-positive women, risk increased with cervical cytological severity, reaching 62.9% (95% CI 57.1–68.5) for HSIL+, 22.4% (95% CI 18.4–26.8) for LSIL, and 19.1% (95% CI 15.1–23.6) for ASC-US; a positive colposcopic impression further increased CIN3+ risk to 70.2% (95% CI 64.1–75.9), 28.5% (95% CI 23.5–34.0), and 24.5% (95% CI 19.4–30.2), respectively. Among HPV16/18-positive women, CIN3+ risk was 32.8% (95% CI 28.9–37.0) increasing to 46.2% (95% CI 40.8–51.6) when abnormal colposcopy was present. Interpretation: We confirmed a high underlying risk of CIN3+ in the Latin American population, with risk strongly stratified by HPV positivity, increasing cervical cytological severity, and positive colposcopic impression. These estimates may support WHO-aligned cervical screening and risk-based management strategies in LMICs and contribute to accelerating cervical cancer elimination. Funding: International Agency for Research on Cancer (IARC/WHO); UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP/WHO); Pan American Health Organization (PAHO); US National Cancer Institute (NCI); NCI Center for Global Health; National Agency for the Promotion of Research, Technological Development and Innovation and National Cancer Institute of Argentina; National Cancer Institute of Colombia; Costa Rican Social Security Fund (CCSS); National Council for Science and Technology (CONACYT), Paraguay; and other local funders.
Background Low- and middle-income countries (LMICs), particularly Sub-Saharan Africa, experience a high burden of surgical disease and a disproportionately high postoperative morbidity and mortality. Although machine learning based pediatric surgical risk calculators (SRCs) have been developed to support clinical decision making, most are derived from high-income settings and may not generalize well to LMIC populations. We previously developed a pediatric surgical risk calculator using multinational LMIC data; however, its performance in independent African cohorts remains unknown. Methods We conducted an external validation study of a previously developed pediatric surgical risk calculator using prospective data from children undergoing surgery at four tertiary referral hospitals in Ethiopia and Nigeria between July 2024 and February 2025. Model performance was assessed by evaluating discrimination (area under the receiver operating characteristic curve) and calibration (slope and intercept). Predicted risk was stratified into low, intermediate, and high-risk categories to enhance clinical applicability. Model recalibration was performed to optimize performance in the external cohort. Results A total of 1670 pediatric surgical patients were included from the four hospitals. In-hospital mortality was 6.8%. Mortality varied significantly by site, age, weight, sex, prematurity, preoperative sepsis, transfusion, supplemental oxygen use, antibiotic use, ASA class, type of surgery (emergent vs elective), need of ICU postoperatively and reoperation. The risk prediction model had good discrimination overall with an area under the curve (AUC) of 0.84, outperforming ASA classification alone (AUC = 0.77). Discrimination remained high for general pediatric surgery cases (AUC = 0.83) and was highest for emergency cases (AUC = 0.89), but was low in neonates (AUC = 0.64). The model demonstrated systematic miscalibration, which improved following logistic calibration. Patients were stratified into meaningful risk categories, which reliably distinguishes between low-and-hgih risk patients (LR = 0.1 and LR = 5.4 respectively). However, 66.5% fall in the intermediate risk group which is not useful in decision making (LR = 1.0). Conclusion The pediatric surgical risk calculator demonstrated good performance in the African context, with improved clinical utility following recalibration and risk stratification. Reduced performance in neonates suggests the need to incorporate additional risk factors and potentially separate models for this subgroup. Future efforts should focus on supporting the use of the SRC in risk communication, clinical decision making, and resource prioritization.
Antimicrobial resistance (AMR) is a critical global public health threat which is accelerated by the misuse and overuse of antimicrobials in humans, animals, and agriculture, as well as poor infection prevention and control measures. In Kuje Arae Council (KAC), AMR has silently become a neglected health burden leading to prolonged hospital stays, higher medical costs, and increased mortality. This study aimed at assessing the knowledge, awareness, and attitudes towards AMR among 403 public workers in KAC, FCT Abuja. This cross-sectional study assessed the knowledge, awareness, and attitudes towards AMR among 403 public workers in KAC, FCT Abuja, selected via multistage sampling. Data were collected using a validated questionnaire and analyzed with descriptive and inferential statistics. Findings revealed that public workers possessed adequate knowledge (p = 0.000) and a moderate awareness of AMR’s causes and consequences (p = 0.000). Their attitudes towards antimicrobial use and AMR management were moderately positive (p = 0.000). A significant, strong positive correlation was found between knowledge and attitudes (r = 0.879, p = 0.000). Healthcare professionals were identified as the most credible source of AMR information (66.8
There is growing interest in developing lightweight, low-atomic-number materials that combine efficient heat dissipation, insulation, and radiation shielding capabilities. These materials may be used to mitigate the challenges posed by high-atomic-number metals, which generate significant secondary radiation through bremsstrahlung and require more propulsive energy, thereby limiting their suitability for aerospace applications. Here, we present the results of attenuation efficiency of a multilayer polymer-ceramic composite made of aluminium oxide (Al2O3), hexagonal boron nitride (h-BN), and doum-fibre reinforced high-density polyethylene (dHDPE). Radiation attenuation efficiency of the multilayer composites was investigated via measurement of attenuation efficiency at different energies ranging from 6 to 15 MeV for beta particles generated by LINAC and 0.662-1.25 MeV for pointed gamma sources. The effects of density gradients and atomic number variation on the attenuation efficiency of the multilayer polymer-ceramic composites were investigated by varying the layer orientations of h-BN-Al2O3-dHDPE. The radiation attenuation efficiencies have been investigated for six-layer orientations (AHB, HBA, ABH, BAH, BHA and HAB). This study reveals that the BHA (boron, dHDPE, and aluminium) layer orientation exhibits superior radiation shielding efficiency, achieving beta attenuation efficiencies of similar to 99.20 % and similar to 95.42 % for 6 and 15 MeV beta particles, and gamma radiation attenuation efficiencies of 14.60 % and 17.19 % for Cs-137 and Co-60 sources. The findings highlight the importance of layer orientation in heterogeneous shielding materials, suggesting that careful design and optimization can enhance radiation shielding efficiency. Notably, BHA orientation is the most effective configuration, while AHB is the least effective, with other orientations showing moderate to high attenuation efficiencies, providing valuable insights for designing more effective radiation shielding materials and structures.
Aneurysmal subarachnoid haemorrhage (aSAH) results from the rupture of an intracranial aneurysm. The case-fatality after aSAH is approximately 40% and those who survive often have functional, cognitive or emotional sequelae. We prepared guidelines according to Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology, using data from meta-analyses, randomised trials, prospective observational and case-control studies, prospective registries with external validation and single-arm cohort studies with > 50 patients with aSAH. Based on high levels of evidence, we recommend oral administration of nimodipine and regular coiling over clipping if both aneurysm treatment options are equally suitable in patients who are in good clinical condition, and recommend against the routine use of antifibrinolytic drugs prior to aneurysm treatment and against the use of tirilazad, statins, magnesium sulphate or endothelin receptor antagonists. Because of lower levels of evidence, no evidence-based recommendations can be made for the prophylactic use of antiplatelet drugs or external lumbar drainage, hypertension induction, treatment of the ruptured aneurysm with endovascular devices other than coils or endovascular treatment of vasospasm. We formulated 37 expert-consensus statements, which include, among others, the suggestions to treat aSAH patients in a dedicated neuro-ICU or high care unit in a centre that treats at least 70 patients with aSAH per year or at least 35 patients with aSAH per year in geographically remote areas, and to treat the ruptured aneurysm within 24 h after ictus provided that the most dedicated team of experts is available. These guidelines present up-to-date recommendations and expert-consensus statements on key aspects in the management of aSAH patients.
