Tuberculosis is a major health concern in several countries, and effective diagnostic algorithms for use in human immunodeficiency virus (HIV)–positive patients are urgently needed. At prescription of antiretroviral therapy, all patients in 3 Mozambican health centers were screened for tuberculosis, with a combined approach: World Health Organization (WHO) 4-symptom screening (fever, cough, night sweats, and weight loss), a rapid test detecting mycobacterial lipoarabinomannan in urine (Determine TB LAM), and a molecular assay performed on a sputum sample (Xpert MTB/RIF; repeated if first result was negative). Patients with positive LAM or Xpert MTB/RIF results were referred for tuberculosis treatment. Among 972 patients with a complete diagnostic algorithm (58.5% female; median CD4 cell count, 278/μL; WHO HIV stage I, 66.8%), 98 (10.1%) tested positive with Xpert (90, 9.3%) or LAM (34, 3.5%) assays. Compared with a single-test Xpert strategy, dual Xpert tests improved case finding by 21.6%, LAM testing alone improved it by 13.5%, and dual Xpert tests plus LAM testing improved it by 32.4%. Rifampicin resistance in Xpert-positive patients was infrequent (2.5%). Among patients with positive results, 22 of 98 (22.4%) had no symptoms at WHO 4-symptom screening. Patients with tuberculosis diagnosed had significantly lower CD4 cell counts and hemoglobin levels, more advanced WHO stage, and higher HIV RNA levels. Fifteen (15.3%) did not start tuberculosis treatment, mostly owing to rapidly deteriorating clinical conditions or logistical constraints. The median interval between start of the diagnostic algorithm and start of tuberculosis treatment was 7 days. The prevalence of tuberculosis among Mozambican HIV-positive patients starting antiretroviral therapy was 10%, with limited rifampicin resistance. Use of combined point-of-care tests increased case finding, with a short time to treatment. Interventions are needed to remove logistical barriers and prevent presentation in very advanced HIV/tuberculosis disease.

Serum albumin levels are strongly associated with the morbidity, prognosis, and mortality rates of patients with hypoalbuminemia, which is a frequent problem during hospitalization. An observational retrospective study was carried out to analyze changes in albumin levels in hospitalized patients at the “Fondazione Policlinico Tor Vergata—PTV” in 2018. The prevalence of preexisting hypoalbuminemia at the time of discharge from hospital was investigated using a sample of 9428 patients. Information was collected from the discharge files recorded in the central informatics system of the hospital. Analysis of albumin levels at admission and at discharge was conducted by classes of albuminemia and then stratified by age. At the time of admission, hypoalbuminemia was found to be present in more than half of the sample, with no sex differences. The serum albumin level tended to decrease with age, with pathologic levels appearing from 50 years and progressive worsening thereafter. The condition of marked and mild hypoalbuminemia was more prevalent in patients over 65 years of age. Our findings suggest that hypoalbuminemia should be considered a dangerous condition in itself and a serious public health problem. We aimed to emphasize the role of albumin as useful marker of the in-hospital malnutrition and frailty, to be integrated in the routinely assessment of patients for reconsidering ad hoc healthcare pathways after discharge from hospital, especially when dealing with fragile populations.

HIV-infected patients have increased risk of noncommunicable diseases (NCDs). HIV+ patients in Africa are experiencing growing comorbidities due to increase in life expectancy and long-time antiretroviral therapy (ART). HIV prevalence in Malawi is one of highest in the world (10.8% in women and 6.4% in men); few data are available about NCDs epidemiology in HIV+ elderly patients in Malawi. A retrospective analysis of routine medical records in 14 health centers run by Disease Relief through Excellent and Advanced Means (DREAM) program in Malawi was carried out. All HIV+ patients aged >40 years in care in the period January 01, 2017–December 31, 2018 were included. Clinical and laboratory features were collected in the last visit of the study period. Files from 7,071 patients (62.1% women) in ART were analyzed, 362 (5.1%) were aged >65 years. Median time on ART was 98.9 (64.8–118.0) months; median body mass index, haemoglobin (HB), and CD4 count were, respectively, 21.63 kg/m ² (19.5–24.5), 13 mg/dL (12–14), and 457 cell/mm ³ (328–613). Elderly patients >65 years were more likely to be malnourished (odds ratio [OR] = 2.0, confidence interval [CI]: 1.54–2.59), diagnosed with arterial hypertension (OR = 2.5, CI: 1.94–3.43), affected with diabetes (OR = 2.7, CI: 1.25–6.22), have macrocytic anemia (OR = 2.5, CI: 2.00–3.35), and increased serum creatinine (OR = 1.5, CI: 1.03–2.43]). Other factors were associated with NCD burden, but age remained always independently related. Two concomitant chronic conditions in addition to HIV were present in 19.2% (66/343) of elderly people and 5.2% (338/6.454) of patients aged 3 years were associated with the presence of two or more comorbidities (OR = 2.1 1.54–2.96, OR = 2.6 1.87–3.71, and OR = 1.7 1.12–2.84). Our data show the burden of NCDs in aging HIV+ patients in Malawi. The expansion of HIV treatment programs will require special attention to such comorbidities in elderly patients.

Background: Heat waves are correlated with increased mortality in the aged population. Social isolation is known as a vulnerability factor. This study aims at evaluating the correlation between an intervention to reduce social isolation and the increase in mortality in the population over 80 during heat waves. Methods: This study adopted a retrospective ecologic design. We compared the excess mortality rate (EMR) in the over-80 population during heat waves in urban areas of Rome (Italy) where a program to reduce social isolation was implemented, to others where it was not implemented. We measured the mortality of the summer periods from 2015 to 2019 compared with 2014 (a year without heat waves). Winter mortality, cadastral income, and the proportion of people over 90 were included in the multivariate Poisson regression. Results: The EMR in the intervention and controls was 2.70% and 3.81%, respectively. The rate ratio was 0.70 (c.i. 0.54–0.92, p-value 0.01). The incidence rate ratio (IRR) of the interventions, with respect to the controls, was 0.76 (c.i. 0.59–0.98). After adjusting for other variables, the IRR was 0.44 (c.i. 0.32–0.60). Conclusions: Reducing social isolation could limit the impact of heat waves on the mortality of the elderly population.

Armed conflicts profoundly undermine vaccination efforts, disrupting healthcare systems, displacing populations, and enabling the resurgence of vaccine-preventable diseases (VPDs). This narrative review explores the relationship between conflict and immunization coverage through an analysis of 18 studies across diverse regions, including Syria, Nigeria, Afghanistan, Iraq, and Ukraine. Evidence reveals that countries affected by war account for a disproportionate share of global polio and measles cases, often due to damaged infrastructure, interrupted cold chains, and vaccine hesitancy exacerbated by political instability and misinformation. Refugee populations, particularly children, face additional barriers such as poor access, low vaccine literacy, and economic hardship. Despite these challenges, innovative responses have emerged: mobile vaccination teams, negotiated access with armed groups, integration with other humanitarian services, and the use of digital tracking technologies have helped mitigate immunization gaps. However, these are often temporary solutions. Sustainable vaccination coverage requires not only emergency interventions but also long-term conflict resolution. Ceasefires and humanitarian pauses have allowed short-term immunization campaigns, yet their effectiveness is limited without durable peace and systemic rebuilding. The findings highlight the need for coordinated global efforts to protect immunization programs in conflict zones and to uphold vaccination as both a public health priority and a human right.

Epidemiological transition theory aims to describe changes in epidemiological scenarios at the global and national level. The assumption is the shift from infectious diseases (IDs) to non-communicable diseases (NCDs). Some authors argue that this theory failed to describe epidemiology in sub-Saharan Africa. We considered the case of Mozambique, where is occurring a rapid demographic change, with dramatic growth of the population. According to the data, we concluded that NCDs are increasing in Mozambique, but due to the vast predominance of IDs, a double burden of disease model is more accurate to describe the actual epidemiological context of the country. Consequently, health funding focusing on IDs should take into account the concomitant epidemiological scenario and try to encompass other health challenges.