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ABSTRACTIntroduction Diabetes increases preventative sickness and costs healthcare and productivity. Type 2 diabetes and macrovascular disease consequences cause most diabetes-related costs. Type 2 diabetes greatly costs healthcare institutions, reducing economic productivity and efficiency. This cost of illness (COI) analysis examines the direct and indirect costs of treating and managing type 1 and type 2 diabetes mellitus.Methodology According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Cochrane, PubMed, Embase, CINAHL, Scopus, Medline Plus, and CENTRAL were searched for relevant articles on type 1 and type 2 diabetes illness costs. The inquiry returned 873 2011–2023 academic articles. The study included 42 papers after an abstract evaluation of 547 papers.Results Most articles originated in Asia and Europe, primarily on type 2 diabetes. The annual cost per patient ranged from USD87 to USD9,581. Prevalence-based cost estimates ranged from less than USD470 to more than USD3475, whereas annual pharmaceutical prices ranged from USD40 to more than USD450, with insulin exhibiting the greatest disparity. Care for complications was generally costly, although costs varied significantly by country and problem type.Discussion This study revealed substantial heterogeneity in diabetes treatment costs; some could be reduced by improving data collection, analysis, and reporting procedures. Diabetes is an expensive disease to treat in low- and middle-income countries, and attaining Universal Health Coverage should be a priority for the global health community.

Objective: The objective of this study was to gather information regarding the knowledge and attitude of students at Hamdard University about this disease. Methods: A cross-sectional study was conducted at Hamdard University, Karachi, after obtaining ethi- cal approval from the Ethical Committee of the Faculty of Pharmacy, Hamdard University, Karachi Campus. A total of 403 valid responses were included in the study. The sample size was calculated using Raosoft software using the standard formula of sample size calculation which was calculated to be 365. Data was collected from October to December 2023 for three months at Hamdard Univer- sity. Statistical analysis was performed using SPSS-20. The chi-square test was applied due to the non-normal distribution of the data. The response rate was less than 50%. Data was considered significant when p < 0.05. Results: A total of 403 student’s data is included in the study. The results showed that 62% of partici- pants had good knowledge about the disease and 70% showed a positive attitude. Data strongly de- pended on gender ( 2 = 3.9, p < 0.05 knowledge; ?2 = 6.78, p < 0.01 attitude) with female predominance. Type of profession ( 2 = 4.53, p < 0.05 knowledge; ?2 = 9.5, p < 0.01 attitude) where students of health-related professions showed better knowledge and positive attitude com- pared to students of the non-medic profession. Participants showed worry about the disease and were significantly willing to get vaccinated if provided ( ?2 = 10.83, p < 0.05) Conclusion: This study concludes that there is a gap in awareness and health facilities among uni- versity students along with inadequate budget allocation. This study stresses that awareness regard- ing infectious disease should be encouraged and a sound health policy should be formulated to overcome any emergency infectious disease burden.

Objective: The objective of this study was to gather information regarding the knowledge and attitude of students at Hamdard University about this disease. Methods: A cross-sectional study was conducted at Hamdard University, Karachi, after obtaining ethi- cal approval from the Ethical Committee of the Faculty of Pharmacy, Hamdard University, Karachi Campus. A total of 403 valid responses were included in the study. The sample size was calculated using Raosoft software using the standard formula of sample size calculation which was calculated to be 365. Data was collected from October to December 2023 for three months at Hamdard Univer- sity. Statistical analysis was performed using SPSS-20. The chi-square test was applied due to the non-normal distribution of the data. The response rate was less than 50%. Data was considered significant when p < 0.05. Results: A total of 403 student’s data is included in the study. The results showed that 62% of partici- pants had good knowledge about the disease and 70% showed a positive attitude. Data strongly de- pended on gender ( 2 = 3.9, p < 0.05 knowledge; ?2 = 6.78, p < 0.01 attitude) with female predominance. Type of profession ( 2 = 4.53, p < 0.05 knowledge; ?2 = 9.5, p < 0.01 attitude) where students of health-related professions showed better knowledge and positive attitude com- pared to students of the non-medic profession. Participants showed worry about the disease and were significantly willing to get vaccinated if provided ( ?2 = 10.83, p < 0.05) Conclusion: This study concludes that there is a gap in awareness and health facilities among uni- versity students along with inadequate budget allocation. This study stresses that awareness regard- ing infectious disease should be encouraged and a sound health policy should be formulated to overcome any emergency infectious disease burden.

Objective: The objective of this study was to gather information regarding the knowledge and attitude of students at Hamdard University about this disease. Methods: A cross-sectional study was conducted at Hamdard University, Karachi, after obtaining ethi- cal approval from the Ethical Committee of the Faculty of Pharmacy, Hamdard University, Karachi Campus. A total of 403 valid responses were included in the study. The sample size was calculated using Raosoft software using the standard formula of sample size calculation which was calculated to be 365. Data was collected from October to December 2023 for three months at Hamdard Univer- sity. Statistical analysis was performed using SPSS-20. The chi-square test was applied due to the non-normal distribution of the data. The response rate was less than 50%. Data was considered significant when p < 0.05. Results: A total of 403 student’s data is included in the study. The results showed that 62% of partici- pants had good knowledge about the disease and 70% showed a positive attitude. Data strongly de- pended on gender ( 2 = 3.9, p < 0.05 knowledge; ?2 = 6.78, p < 0.01 attitude) with female predominance. Type of profession ( 2 = 4.53, p < 0.05 knowledge; ?2 = 9.5, p < 0.01 attitude) where students of health-related professions showed better knowledge and positive attitude com- pared to students of the non-medic profession. Participants showed worry about the disease and were significantly willing to get vaccinated if provided ( ?2 = 10.83, p < 0.05) Conclusion: This study concludes that there is a gap in awareness and health facilities among uni- versity students along with inadequate budget allocation. This study stresses that awareness regard- ing infectious disease should be encouraged and a sound health policy should be formulated to overcome any emergency infectious disease burden.

Introduction: While older adults generally mount weaker antibody responses to a primary COVID-19 vaccine series, T-cell responses remain less well characterized in this population. We compared SARS-CoV-2 spike-specific T-cell responses after 2- and 3-dose COVID-19 mRNA vaccination and subsequent breakthrough infection in older and younger adults. Methods: We quantified CD4+ and CD8+ T-cells reactive to overlapping peptides spanning the ancestral SARS-CoV-2 spike protein in 40 older adults (median age 79) and 50 younger health care workers (median age 39), all COVID-19 naive, using an activation-induced marker assay. T-cell responses were further assessed in 24 participants, including 8 older adults, who subsequently experienced their first SARS-CoV-2 breakthrough infection. Results: A third COVID-19 mRNA vaccine dose significantly boosted spike-specific CD4+ and CD8+ T-cell frequencies to above 2-dose levels in older and younger adults. T-cell frequencies did not significantly differ between older and younger adults after either dose. Multivariable analyses adjusting for sociodemographic, health, and vaccine-related variables confirmed that older age was not associated with impaired cellular responses. Instead, the strongest predictors of CD4+ and CD8+ T-cell frequencies post-third-dose were their corresponding post-second-dose frequencies. Breakthrough infection significantly increased both CD4+ and CD8+ T-cell frequencies, to comparable levels in older and younger adults. Exploratory analyses revealed an association between HLA-A*02:03 and higher post-vaccination CD8+ T-cell frequencies, which may be attributable to numerous strong-binding HLA-A*02:03-specific CD8+ T-cell epitopes in the spike protein. Conclusion: Older adults mount robust T-cell responses to 2- and 3-dose COVID-19 mRNA vaccination, which are further boosted following breakthrough infection.

Abstract Humoral responses to COVID-19 vaccines in people living with HIV (PLWH) remain incompletely characterized. We measured circulating antibodies against the SARS-CoV-2 spike protein receptor-binding domain (RBD), ACE2 displacement and viral neutralization activities one month following the first and second COVID-19 vaccine doses, and again 3 months following the second dose, in 100 adult PLWH and 152 controls. All PLWH were receiving suppressive antiretroviral therapy, with median CD4+ T-cell counts of 710 (IQR 525–935) cells/mm3, though nadir CD4+ T-cell counts ranged as low as

SARS-CoV-2 Omicron infections are common among individuals who are vaccinated or have recovered from prior variant infection, but few reports have immunologically assessed serial Omicron infections. We characterized SARS-CoV-2 humoral responses in an individual who acquired laboratory-confirmed Omicron BA.1.15 ten weeks after a third dose of BNT162b2, and BA.2 thirteen weeks later. Responses were compared to 124 COVID-19-naive vaccinees. One month post-second and -third vaccine doses, the participant’s wild-type and BA.1-specific IgG, ACE2-displacement and virus neutralization activities were average for a COVID-19-naive triple-vaccinated individual. BA.1 infection boosted the participant’s responses to the cohort ≥95th percentile, but even this strong “hybrid” immunity failed to protect against BA.2. Reinfection increased BA.1 and BA.2-specific responses only modestly. Though vaccines clearly protect against severe disease, results highlight the continued importance of maintaining additional protective measures to counteract the immune-evasive Omicron variant, particularly as vaccine-induced immune responses naturally decline over time.