HIV early detection (CD4 counts ≥350 cells/μL) is correlated with higher life expectancy among people living with HIV (PLHIV). Several factors, including physical, cultural, structural, and financial barriers, may limit early detection of HIV. This is a first-of-its-kind study on population-level differences in early detection of HIV across time within Tajikistan and any country in the Central Asia region. Utilizing the Tajikistan Ministry of Health\'s national HIV data (N = 10,700) spanning 2010 to 2023, we developed median regression models with the median CD4 cell count as the outcome and with the following predictors: time (years), region, age, gender, and area (urban/rural status). Individuals younger than 19 years old were detected early for HIV, whereas those older than 39 years were detected late. Females were detected earlier compared to their male counterparts regardless of region of residence. Rural populations were detected earlier in most years compared to their urban counterparts. The COVID-19 pandemic accelerated HIV early detection in 2021 but most regions have returned to near pre-pandemic levels of detection in 2022 and 2023. There were differences identified among different demographic and geographic groups which warrant further attention.

BACKGROUND: Isoniazid (INH, H) resistance is the most common drug-resistant TB pattern, with treatment success rates lower than those in drug-susceptible TB. The WHO recommends a 6-month regimen of rifampicin (RIF, R), ethambutol (EMB, E), pyrazinamide (PZA, Z), and levofloxacin (Lfx) (6REZLfx) for INH-resistant, RIF-susceptible TB (HRRS-TB). Uzbekistan has a high burden of TB (62/100,000 population) and multidrug-resistant TB (12/100,000 population).
METHODS: We conducted a retrospective, descriptive study of microbiologically confirmed HRRS-TB using routinely collected programmatic data from 2009 to 2020.
RESULTS: We included 854 HRRS-TB cases. Treatment success was 80.2% overall. For REZLfx, the treatment success rate was 92.0% over a short treatment duration, with no amplifications to RIF or second-line anti-TB drug resistance. We documented 46 regimens with REZLfx plus linezolid (success 87.0%) and 539 regimens using kanamycin or capreomycin (success 76.6%). We identified 37 treatment failures (4.3%), 30 deaths (3.5%), 25 resistance amplifications (2.9%), including eight to RIF (0.9%), and 99 lost to follow-up (LTFU) cases (11.6%). Unsuccessful outcomes were more common with older age, diabetes, chest X-ray cavities, smear positivity, smear-positive persistence, and male sex. LTFU was more common with injection-containing regimens.
CONCLUSIONS: REZLfx is a safe and effective first-line treatment for INH-resistant, RIF-susceptible TB. Treatment success was lower and LTFU was higher for injection-containing regimens.
BACKGROUND: La résistance à l\'isoniazide (INH, H) est la forme de TB pharmacorésistante la plus courante, avec des taux de réussite thérapeutique inférieurs à ceux de la TB pharmacosensible. L\'OMS recommande un traitement de six mois à base de rifampicine (RIF, R), d\'éthambutol (EMB, E), de pyrazinamide (PZA, Z) et de lévofloxacine (LFx) (6REZLfx) pour la TB résistante à l\'INH et sensible au RIF (HRRS-TB). En Ouzbékistan, la prévalence de la TB est élevée, avec un taux de 62 cas pour 100 000 habitants, ainsi que de la TB multirésistante, avec un taux de 12 cas pour 100 000 habitants.
UNASSIGNED: Une étude rétrospective et descriptive de la HRRS-TB confirmée microbiologiquement a été réalisée en utilisant des données programmatiques collectées de manière routinière de 2009 à 2020.
UNASSIGNED: Nous avons inclus 854 cas de HRRS-TB. Le taux de réussite du traitement global était de 80,2%. Pour le traitement avec REZLfx, le taux de réussite était de 92,0% sur une courte durée, sans résistance au RIF ni aux médicaments antituberculeux de deuxième ligne. Nous avons observé 46 schémas thérapeutiques associant REZLfx et linézolide avec un taux de réussite de 87,0%, ainsi que 539 schémas thérapeutiques utilisant la kanamycine ou la capréomycine avec un taux de réussite de 76,6 %. Nous avons enregistré 37 échecs thérapeutiques (4,3%), 30 décès (3,5%), 25 cas de résistance amplifiée (2,9%), dont huit au RIF (0,9%), et 99 cas de perte de suivi (LTFU, pour l’anglais « loss to follow-up ») (11,6%). Les échecs étaient plus fréquents chez les patients âgés, diabétiques, présentant des cavités à la radiographie thoracique, un frottis positif persistant et de sexe masculin. La prolongation de la durée d\'utilisation était plus fréquente avec les schémas contenant des injections.
CONCLUSIONS: REZLfx est un traitement de première intention sûr et efficace contre la TB résistante à l\'INH et sensible aux RIF. Le succès du traitement était plus faible et le nombre de LTFU était plus élevé pour les schémas contenant des injections.

Parabens (PBs) are used as preservatives in various products. They pollute the environment and penetrate living organisms, showing endocrine disrupting activity. Till now studies on long-term exposure of farm animals to PBs have not been performed. Among matrices using in PBs biomonitoring hair samples are becoming more and more important. During this study concentration levels of methyl paraben (MeP), ethyl paraben (EtP), propyl paraben (PrP) butyl paraben (BuP) and benzyl paraben (BeP) were evaluated using liquid chromatography-mass spectrometry (LC-MS) in hair samples collected from dairy cows bred in the Kyrgyz Republic. MeP was noted in 93.8% of samples (with mean concentration levels 62.2 ± 61.8 pg/mg), PrP in 16.7% of samples (12.4 ± 6.5 pg/mg) and EtP in 8.3% of samples (21.4 ± 11.9 pg/mg). BuP was found only in one sample (2.1%) and BeP was not detected in any sample included in the study. Some differences in MeP concentration levels in the hair samples depending on district, where cows were bred were noted. This study has shown that among PBs, dairy cows are exposed mainly to MeP, and hair samples may be a suitable matrix for research on PBs levels in farm animals.

UNASSIGNED: The maternal mortality indicator serves as a crucial reflection of a nation\'s overall healthcare, economic, and social standing. It is necessary to identify the variations in its impacts across diverse populations, especially those at higher risk, to effectively reduce maternal mortality and enhance maternal health. The global healthcare landscape has been significantly reshaped by the COVID-19 pandemic, pressing disparities and stalling progress toward achieving Sustainable Development Goals, particularly in maternal mortality reduction.
UNASSIGNED: This study investigates the determinants of maternal mortality in Kazakhstan from 2019 to 2020 and maternal mortality trends in 17 regions from 2000 to 2020, employing data extracted from national statistical reports. Stepwise linear regression analysis is utilized to explore trends in maternal mortality ratios in relation to socioeconomic factors and healthcare service indicators.
UNASSIGNED: The national maternal mortality ratio in Kazakhstan nearly tripled from 13.7 in 2019 to 36.5 per 100,000 live births in 2020. A remarkable decrease was observed from 2000 until around 2015 with rates spiked by 2020. Significant factors associated with maternal mortality include antenatal care coverage and the number of primary healthcare units. Additionally, socioeconomic factors such as secondary education enrollment and cases of domestic violence against women emerged as predictors of MMR. Moreover, the impact of the pandemic was evident in the shift of coefficients for certain predictors, such as antenatal care coverage in our case. In 2020, predictors of MMR continued to include secondary education enrollment and reported cases of domestic violence.
UNASSIGNED: Despite Kazakhstan\'s efforts and commitment toward achieving Sustainable Development Goals, particularly in maternal mortality reduction, the impact of the COVID-19 pandemic poses alarming challenges. Addressing these challenges and strengthening efforts to mitigate maternal mortality remains imperative for advancing maternal health outcomes in Kazakhstan.

BACKGROUND: In the World Health Organization European Region, an estimated 14 million people live with a chronic hepatitis B virus infection (HBV), and 12 million are affected by a hepatitis C virus infection (HCV). Uzbekistan bears a major burden of HBV and has one of the highest HCV prevalence in the region. Following a presidential decree in May 2022, significant funds were allocated to the viral hepatitis (VH) elimination program in Uzbekistan. The program expands VH testing to reach 500,000 people annually during 2022-2025 as part of the VH elimination strategy that includes the provision of free testing and affordable treatment. Exploring the existing barriers and facilitators to VH testing is pivotal for informing these interventions.
METHODS: This study uses a cross-sectional qualitative design to identify and explore the barriers and facilitators to VH testing among the general population in Uzbekistan. We collected data during October-November 2022 through semi-structured interviews with 12 key informants (KIs) and 7 focus group discussions with two target populations: the general population and healthcare workers (HCW) in Tashkent, Uzbekistan.
RESULTS: Following the capability-opportunity-motivation-behavior model (COM-B model) as a framework for the analysis, we identified major capability barriers to VH testing primarily linked to low health literacy and limited knowledge about VH types, symptoms, transmission, testing and treatment. Physical opportunity barriers included the time and financial costs associated with testing, diagnostics, and treatment. Sociocultural opportunity barriers involved anticipated negative reactions and stigmatization, particularly affecting women. Motivational barriers included a reluctance to be tested when asymptomatic and a general fear of receiving positive test results. The involvement of healthcare workers in promoting VH awareness and motivating the general population emerged as a facilitator.
CONCLUSIONS: A multi-pronged approach is recommended to achieve VH testing goals among the general population, focusing on raising awareness and health literacy and creating an enabling environment that ensures easy accessibility and minimizing VH testing-associated costs.

Eremurus was described at the beginning of the 19th century. However, due to limited sampling and the small number of gene markers to date, its phylogeny and evolution are largely unknown. In this study, we analyzed plastomes from 27 species belonging to 2 subgenera and 3 sections of Eremurus, which are found in Central Asia (its center of diversity) and China. We also analyzed nuclear DNA ITS of 33 species, encompassing all subgenera and sections of the genus in Central Asia, southwest Asia and China. Our findings revealed that the genus was monophyletic, although both subgenera Eremurus and Henningia were found to be paraphyletic. Both plastome and nrDNA-based phylogenetic trees had three clades that did not reflect the current taxonomy of the genus. Our biogeographical and time-calibrated trees suggest that Eremurus originated in the ancient Tethyan area in the second half of the Eocene. Diversification of Eremurus occurred from the early Oligocene to the late Miocene. Paratethys Sea retreat and several orogenetic events, such as the progressive uplift of the Qinghai-Tibet Plateau and surrounding mountain belts (Altai, Pamir, Tian Shan), caused serious topographic and climate (aridification) changes in Central Asia that may have triggered a split of clades and speciation. In this transformed Central Asia, speciation proceeded rapidly driven mainly by vicariance caused by numerous mountain chains and specialization to a variety of climatic, topographic and soil conditions that exist in this region.

Hybridization is one of the key processes shaping lineage diversification, particularly in regions that experienced strong climate oscillations. The alpine biome with its rich history of glacial-interglacial cycles and complex patterns of species distribution shifts offers an excellent system to investigate the impact of gene flow on population dynamics and speciation, important issues for evolutionary biology and biodiversity conservation. In this study, we combined genomic data (DArTseq), chloroplast markers, and morphology to examine phylogenetic relationships and the permeability of species boundaries and their evolutionary outcomes among the alpine extremophilic species of Puccinellia (Poaceae) in the Pamir Mountains, a part of the Mountains of Central Asia biodiversity hotspot. We determined the occurrence of interspecific hybrids between P. himalaica and P. pamirica, which demonstrated almost symmetric ancestry from their parental species and did not show signals of introgression. According to our integrative revision, the natural hybrids between P. himalaica and P. pamirica should be classified as Puccinellia ×vachanica (pro species). Using approximate Bayesian computation for population history inference, we uncovered that P. himalaica hybridized with P. pamirica independently in multiple localities over the Holocene. Hybrids inherited the fine-scale genetic structure from their parental species, which developed these patterns earlier, during the Late Pleistocene. Hybridization had different consequences for the involved parental lineages, likely playing an important role in a continuing decline of P. himalaica in the Pamir Mountains over the Holocene. Our results show that P. himalaica should be considered a critically endangered species in the Pamir Mountains and could also be retreating across its entire range of distribution in High Mountain Asia. Using a comparative phylogeographic framework, we revealed the risk of extinction of a cold-adapted alpine species in a global biodiversity hotspot. This study highlights that genomics could unravel diversity trends under climate change and provides valuable evidence for conservation management.

BACKGROUND: This study addresses the importance of identifying key characteristics influencing demographic indicators for urban populations, emphasizing the need to consider regional climatic features and ecological factors. The research utilized data from ten main regional cities across the Republic of Kazakhstan.
METHODS: This study involved a retrospective analysis based on secondary data from official sources spanning 2012-2020. We employed correlation analysis and multidimensional regression models.
RESULTS: Noteworthy predictors for crude birth rate included the influence of effective temperature (β = 0.842, p < 0.0001), marriage rate (β = 0.780, p < 0.0001), Gini coefficient (β = -27.342, p = 0.020) and divorce rate (β = -2.060, p < 0.0001), with overall strong model performance (R2 = 0.940). The degree of atmospheric pollution (β = -0.949, p = 0.044), effective temperature (β = -0.294, p < 0.0001) and Gini coefficient (β = 19.923, p = 0.015) were the predictors for crude mortality rate, with a high model fit (R2 = 0.796).
CONCLUSIONS: The study unveils significant relationships between demographic indicators (crude birth rate, mortality rate) and variables like effective temperature, marriage rate, divorce rate, Gini coefficient, physician density and others. This analysis of climatic, environmental, and socioeconomic factors influencing demographic indicators may help in promoting specific measures to address public health issues in Kazakhstan.

This work presents the dataset of stable water isotopes of oxygen and hydrogen measured in water samples from different sources (precipitation, surface water, groundwater, tap water) across Kazakhstan from 2017 to 2018 and from 2020 to 2023. The dataset includes results on isotopic composition of 399 water samples, namely precipitation: event-based (n = 108), cumulative monthly (n = 22); surface water: lakes, reservoirs, brooks, rivers, channels (n = 175), groundwater: shallow and artesian groundwater, spring (n = 85), tapwater (n = 9). For each sample name of the source, location, latitude, longitude and date of sampling, measurement uncertainty (one standard deviation) are available. The samples were assessed by plotting the data in dual δ18O vs. δ2H isotope space with reference to values found in the published literature and fitting a linear regression equation for Astana (event) precipitation. Overall, this is the first dataset covering wide range of sources across Kazakhstan, which could be used by global and regional water resource assessments and studies such as tracing water sources, hydrograph separation and end-member analyses, isotope mass balance, evapotranspiration partitioning, residence time analysis and groundwater recharge.

Central Asia (CA) is one of the world\'s most significant arid regions, which is markedly impacted by global warming. A better understanding of the dynamical processes governing its Holocene climate variability is critical for a better understanding of possible future impacts of climate change in the region. To date, most of the existing CA paleoclimate records are from the summer precipitation-dominated eastern CA (ECA), with few records from the winter precipitation-dominated western CA (WCA). Here, we present a precisely dated (~6‰) and highly resolved (<4-y) record of hydroclimatic variations from the WCA covering the period between 7,774 and 656 y BP. Utilizing multiple proxies (δ18O, δ13C, and Sr/Ca) derived from a stalagmite from the Fergana Valley, Kyrgyzstan, we reveal a long-term drying trend in WCA, which is in contrast with the wetting trend in ECA. We propose that different responses of winter and summer westerly jets to seasonal solar insolation over the past 8,000 y may have resulted in an antiphased precipitation relationship between the WCA and ECA. Our data contain dominant quasiperiodicities of 1,400, 50 to 70, and 20 to 30 y, indicating close connections between the WCA climate and the North Atlantic. We further identified a series of droughts and pluvials on centennial-to-decadal timescales, which may have influenced regional societies and trans-Eurasian culture exchanges during historical and prehistorical times.