Long-term outcomes of the global tuberculosis and COVID-19 co-infection cohort.

BACKGROUND: Longitudinal cohort data of patients with tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are lacking. In our global study, we describe long-term outcomes of patients affected by TB and COVID-19. METHODS: We collected data from 174 centres in 31 countries on all patients affected by COVID-19 and TB between 1 March 2020 and 30 September 2022. Patients were followed-up until cure, death or end of cohort time. All patients had TB and COVID-19; for analysis purposes, deaths were attributed to TB, COVID-19 or both. Survival analysis was performed using Cox proportional risk-regression models, and the log-rank test was used to compare survival and mortality attributed to TB, COVID-19 or both. RESULTS: Overall, 788 patients with COVID-19 and TB (active or sequelae) were recruited from 31 countries, and 10.8% (n=85) died during the observation period. Survival was significantly lower among patients whose death was attributed to TB and COVID-19 versus those dying because of either TB or COVID-19 alone (p<0.001). Significant adjusted risk factors for TB mortality were higher age (hazard ratio (HR) 1.05, 95% CI 1.03-1.07), HIV infection (HR 2.29, 95% CI 1.02-5.16) and invasive ventilation (HR 4.28, 95% CI 2.34-7.83). For COVID-19 mortality, the adjusted risks were higher age (HR 1.03, 95% CI 1.02-1.04), male sex (HR 2.21, 95% CI 1.24-3.91), oxygen requirement (HR 7.93, 95% CI 3.44-18.26) and invasive ventilation (HR 2.19, 95% CI 1.36-3.53). CONCLUSIONS: In our global cohort, death was the outcome in >10% of patients with TB and COVID-19. A range of demographic and clinical predictors are associated with adverse outcomes.

Standardized Multi-Institutional Mock Oral Examination: A Feasible and Valuable Educational Experience for General Surgery Residents.

INTRODUCTION: Mock oral examinations (MOE) are used to prepare residents and assess their readiness for the American Board of Surgery Certifying Exam (ABSCE). Delivery of MOEs varies by institution and previous studies have demonstrated significant implementation barriers such as availability of faculty examiners and exam scenarios. OBJECTIVE: To assess the value and participant satisfaction of a standardized multi-institutional MOE for general surgery residents. PARTICIPANTS: Thirty-three general surgery residents and 37 faculty members from 3 institutions participated in a regional MOE. Residents were examined in three 20-minute sessions. Faculty examiners were given a wide selection of prescripted exam scenarios and instructed to use standardized grading rubrics during a brief orientation on the day of the exam. All participants were surveyed on their overall experience. RESULTS: Of 33 participating residents, 26 (79%) passed the MOE (92% of R5, 91% R4, and 50% of R3). Response rates were 91% for residents, and 57% for faculty members respectively. Most respondents were satisfied with the overall exam experience (88%), standardized question quality (86%) and question variety (82%). A total of 92% of respondents agreed that the time, effort, and cost of the MOE was justified by its educational value to residents. Higher medical knowledge ratings assigned by faculty examiners correlated with stronger trainee performance (ß = 0.48; 95% confidence interval [CI] 0.29-0.66), while patient care and interpersonal communication skill ratings were not associated with trainee performance. The standardized grading rubric achieved moderate inter-rater reliability among examiner pairs with 70.6% agreement (Kappa 0.47). CONCLUSIONS: General Surgery residents and faculty perceived the standardized multi-institutional MOE to be a highly satisfactory educational experience and valuable assessment tool. Developing a repertoire of scripted exam scenarios made it feasible to recruit sufficient faculty participants, and standardizing grading rubrics allowed for a consistent exam experience with moderate inter-rater reliability.

The component leaching from decellularized pericardial bioscaffolds and its implication in the macrophage response.

The extracellular matrix molecules remaining in bioscaffolds derived from decellularized xenogeneic tissues appear to be important for inducing cell functions conducting tissue regeneration. Here, we studied whether decellularization methods, that is, detergent Triton X-100 (TX) alone and TX combined with reversible alkaline swelling (STX), applied to bovine pericardial tissue, could affect the bioscaffold components. The in vitro macrophage response, subdermal biodegradation, and cell infiltration were also studied. The results indicate a lower leaching of fibronectin, but a higher leaching of laminin and sulfated glycosaminoglycans from tissues decellularized with STX and TX, respectively. The in vitro secretion of interleukin-6 and monocyte chemoattractant protein by RAW264.7 macrophages is promoted by decellularized bioscaffold leachates. A lower polymorphonuclear cell density is observed around decellularized bioscaffolds at 1-day implantation; concurrently showing a higher cell infiltration in STX- than in TX-implant. Cells infiltrated into TX-implant show a fibroblastic morphology at 7-day implantation, concurrently the capillary formation is observed at 14-day. Pericardial bioscaffolds suffer biodegradation more pronounced in STX- than in TX-implant. Both TX and STX decellularization methods favor a high leaching of basal lamina components, which presumably promotes a faster macrophage stimulation compared to nondecellularized tissue, and appear to be associated with an increased host cell infiltration in a rat subdermal implantation. Meanwhile, the connective tissue components leaching from TX decellularized bioscaffolds, unlike the STX ones, appear to be associated with an enhanced angiogenesis accompanied by an early-promoted fibroblastic cell transition. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2810-2822, 2016.

Análise da avaliação do risco gestacional em pré-natal realizado na atenção primária no município de Corumbá-MS / Analysis of pregnancy risk assessment in prenatal care carried out in primary care in the city of Corumbá-MS

No Brasil, a redução das causas evitáveis da mortalidade materna constitui um grande desafio aos profissionais de saúde, haja vista a necessidade de melhorias na assistência ao prénatal, parto e nascimento. Mesmo com as diretrizes do Ministério da Saúde, que recomenda rotinas institucionais fundamentadas em critérios científicos visando a prevenção, diagnóstico e manejo de fatores que podem causar morbidade ou mortalidade materna ou neonatal, ainda assim nem todos os serviços as seguem. Assim, tem-se por objetivo analisar como é avaliado o risco gestacional em gestante, com pré-natal realizado na Atenção Primária à Saúde. Pesquisa descritiva, de abordagem quantitativa, aprovada pelo Comitê de Ética em pesquisas envolvendo seres humanos da Fiocruz. Foi realizada no município de Corumbá, Mato Grosso do Sul, em Unidades Básicas de Saúde da Família. Participaram 37 profissionais entre médicos e enfermeiros. Incluiu-se aqueles que realizam assistência pré-natal, localizados após no máximo três tentativas para a coleta de dados e somente os que atuavam em zona urbana. Solicitou-se a assinatura do termo de consentimento livre e esclarecido aos profissionais e às gestantes para autorizar a observação da consulta. Um instrumento para a caracterização dos profissionais e outro do tipo check-list guiou a coleta de dados, cujos procedimentos foram assinalados como: realizado, não realizado ou não se aplica. As variáveis do estudo constituíram todas aquelas recomendadas pelo Ministério da Saúde para a classificação de risco gestacional. Os dados foram digitados em planilhas do Excel e posteriormente receberam tratamento da estatística descritiva. Os resultados mais frequentes mostram que 70, 27% dos profissionais são do sexo feminino, com mais de 7 anos de formação (67, 5%), mais de 7 anos de trabalho com gestantes (62, 3%), com dúvidas quanto aos procedimentos a serem feitos na consulta pré-natal (72, 97%). Com relação a observação do que foi realizado nas consultas de pré-natal, que apresentaram a maior frequência estão: anotações em cartão da gestante (100%), a infecção urinária nas doenças preexistentes (41, 4%), o diabetes mellitus (22, 9%) dos antecedentes familiares, os sinais vitais foram aferidos em 94, 3%. Concluiu-se que os profissionais não seguem todas as recomendações propostas pelo Ministério da Saúde. A qualificação para o atendimento prénatal se deu mais no cotidiano, situação que requer a intervenção por meio da educação permanente. Recomenda-se a implementação de protocolo assistencial capaz de padronizar condutas a serem realizadas em consultas de pré-natal, desse modo a reorganização da atenção à saúde das gestantes.