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BACKGROUND: TB is a leading infectious cause of death worldwide. The COVID-19 pandemic raised concerns that the burden of TB disease and death would increase due to the synergy between the two conditions. METHODS: We used individual-level data submitted to the WHO Global Clinical Platform for COVID-19 on hospitalised patients to explore associations of TB with mortality using multivariable logistic regression. RESULTS: Data were available from 453,233 persons with COVID-19 and known TB status and mortality outcomes from 62 countries (96% SARS-CoV-2 test-positive). Of these, 48% were male, and the median age was 53 years (IQR 38-67). There were 8,214 cases with current TB reported by 46 countries, mainly from Africa. Of people with current TB, 31.4% were admitted with severe illness, and 24.5% died. Current TB was independently associated with higher mortality when adjusted for age, sex, HIV status, illness severity at hospital admission, and underlying conditions (adjusted RR 1.47, 95% CI 1.35-1.61). CONCLUSION: Current or past TB were independent risk factors for in-hospital mortality regardless of illness severity at admission. Caveats for interpretation include changes during the data collection period (viral variation, vaccination coverage) and opportunistic sampling. However, the platform exemplifies how timely, coordinated global reporting can inform our understanding of health emergencies and the vulnerable populations affected.
CONTEXTE: La TB est l'une des principales causes infectieuses de décès dans le monde. La pandémie de COVID-19 a fait craindre que le fardeau de la TB et des décès n'augmente en raison de la synergie entre les deux maladies. MÉTHODES: Nous avons utilisé les données individuelles soumises à la Plateforme clinique mondiale de l'OMS pour la COVID-19 sur les patients hospitalisés pour explorer les associations entre la TB et la mortalité à l'aide d'une régression logistique multivariée. RÉSULTATS: Des données étaient disponibles sur 453 233 personnes atteintes de COVID-19 et connues pour le statut de TB et les résultats de mortalité dans 62 pays (96% de tests positifs au SRAS-CoV-2). Parmi eux, 48% étaient des hommes et l'âge médian était de 53 ans (IQR 3867). Un total de 8 214 cas de TB ont été signalés par 46 pays, principalement en Afrique. Parmi les personnes atteintes de TB actuelle, 31,4% ont été admises avec une maladie grave et 24,5% sont décédées. La TB actuelle était indépendamment associée à une mortalité plus élevée lorsqu'elle était ajustée en fonction de l'âge, du sexe, du statut VIH, de la gravité de la maladie à l'admission à l'hôpital et des affections sous-jacentes (RR ajusté 1,47 ; IC à 95% 1,351,61). CONCLUSION: La TB actuelle ou passée était un facteur de risque indépendant de mortalité à l'hôpital, quelle que soit la gravité de la maladie à l'admission. Les mises en garde concernant l'interprétation comprennent les changements au cours de la période de collecte des données (variation virale, couverture vaccinale) et l'échantillonnage opportuniste. Cependant, la plateforme illustre comment des rapports mondiaux opportuns et coordonnés peuvent éclairer notre compréhension des urgences sanitaires et des populations vulnérables touchées.
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BACKGROUND: The call for women-centred approaches to reduce labour interventions, particularly primary caesarean section, has renewed an interest in gaining a better understanding of natural labour progression. OBJECTIVE: To synthesise available data on the cervical dilatation patterns during spontaneous labour of 'low-risk' women with normal perinatal outcomes. SEARCH STRATEGY: PubMed, EMBASE, CINAHL, POPLINE, Global Health Library, and reference lists of eligible studies. SELECTION CRITERIA: Observational studies and other study designs. DATA COLLECTION AND ANALYSIS: Two authors extracted data on: maternal characteristics; labour interventions; the duration of labour centimetre by centimetre; and the duration of labour from dilatation at admission through to 10 cm. We pooled data across studies using weighted medians and employed the Bootstrap-t method to generate the corresponding confidence bounds. MAIN RESULTS: Seven observational studies describing labour patterns for 99 971 women met our inclusion criteria. The median time to advance by 1 cm in nulliparous women was longer than 1 hour until a dilatation of 5 cm was reached, with markedly rapid progress after 6 cm. Similar labour progression patterns were observed in parous women. The 95th percentiles for both parity groups suggest that it was not uncommon for some women to reach 10 cm, despite dilatation rates that were much slower than the 1-cm/hour threshold for most part of their first stage of labours. CONCLUSION: An expectation of a minimum cervical dilatation threshold of 1 cm/hour throughout the first stage of labour is unrealistic for most healthy nulliparous and parous women. Our findings call into question the universal application of clinical standards that are conceptually based on an expectation of linear labour progress in all women. FUNDING: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, and the United States Agency for International Development (USAID). TWEETABLE ABSTRACT: Cervical dilatation threshold of 1 cm/hour throughout labour is unrealistic for most women, regardless of parity.
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Primeira Fase do Trabalho de Parto/fisiologia , Adulto , Feminino , Humanos , Paridade , Gravidez , Resultado da Gravidez , Fatores de Risco , Fatores de Tempo , Adulto JovemRESUMO
The cystic artery (CA) is known to exhibit variations in its origin and branching pattern. This is attributed to the developmental changes occurring in the primitive ventral splanchnic arteries. During routine dissection of a male cadaver, we observed that the CA originated from the middle hepatic artery (MHA) at a distance of about 1 cm from its origin, and the MHA originated from the right hepatic artery at a distance of 2.1 cm from its origin. The CA traversed for a distance of 1.5 cm, giving off a branch to the cystic duct. It then passed anterior to the cystic duct. The origin of the CA was located to the left of the common hepatic duct, outside the Calot's triangle. The topographical anatomy of the arterial system of the hepatobiliary region and their anomalous origin should be considered during hepatobiliary surgeries. This knowledge is also important for interventional radiologists in routine clinical practice.
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Artéria Hepática/anatomia & histologia , Ducto Hepático Comum/anatomia & histologia , Cadáver , Colecistectomia/métodos , Ducto Cístico/anatomia & histologia , Vesícula Biliar/anatomia & histologia , Artéria Hepática/anormalidades , Ducto Hepático Comum/anormalidades , Humanos , Laparoscopia/métodos , Masculino , Modelos AnatômicosRESUMO
We report a unique variation in the origin and branches of both the left and right external carotid artery (ECA) found during the dissection of a human cadaver. Knowledge of the possible anatomical variations of the ECA is especially important in facio-maxillary and neck surgeries. Surgeons need to be aware of the possibility of encountering such variations, as they may lead to difficulties in differentiating between the external and internal carotid arteries, and in identifying the branches and origins. This knowledge is also important for radiologists in the image interpretation of the face and neck regions.
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Artéria Carótida Externa/anormalidades , Artéria Carótida Externa/anatomia & histologia , Cadáver , Artéria Carótida Primitiva/anormalidades , Artéria Carótida Primitiva/anatomia & histologia , Humanos , Pescoço/anatomia & histologia , Pescoço/irrigação sanguíneaRESUMO
OBJECTIVE: Our purpose was to evaluate the antimicrobial therapy effect on clinical and laboratory findings among women at risk for endometritis. STUDY DESIGN: A prospective antimicrobial treatment trial of 153 women was performed to characterize subacute endometritis and to determine the treatment effect on endometritis resolution. RESULTS: After antimicrobial treatment, significant reductions occurred in abnormal bleeding (60% vs 29%), mucopurulent cervicitis (20% vs 6%), uterine tenderness (20% vs 6%), and histologic endometritis (38% vs 4%), all P<.001. In women with prior pelvic inflammatory disease (PID), endometritis was present in 43% with and 28% without current Chlamydia trachomatis or Neisseria gonorrhoeae. In women without prior PID, endometritis was present in 23% with and 12% without current C trachomatis or N gonorrhoeae (P=.002 for trend). CONCLUSIONS: In women without a clinical diagnosis of PID, antimicrobial therapy decreased abnormal clinical findings and histologic endometritis. Prior PID is additive with current cervical infection as a risk for endometritis.
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Endometrite/tratamento farmacológico , Endometrite/microbiologia , Adulto , Antibacterianos , Biópsia , Infecções por Chlamydia/complicações , Chlamydia trachomatis , Quimioterapia Combinada/uso terapêutico , Endometrite/patologia , Endométrio/patologia , Feminino , Gonorreia/complicações , Humanos , Neisseria gonorrhoeae , Estudos ProspectivosRESUMO
OBJECTIVE: To estimate the prevalence, risk factors, clinical symptoms and signs, and response to antimicrobial therapy of histologic endometritis in human immunodeficiency virus (HIV)-infected women without clinical salpingitis. METHODS: This was a cross-sectional study of 42 HIV-infected women enrolled from a single clinic. Subjects underwent standardized history, examination, and laboratory determinations, including endometrial biopsy. Women with suspected pelvic inflammatory disease were excluded. All women were given antibiotics and repeat evaluation in 5-7 weeks. Histologic endometritis was defined by at least one stromal plasma cell per 120x field and five or more surface polymorphonuclear leukocytes per 400x field. Chi-square and Fisher exact tests were used as appropriate. RESULTS: Histologic endometritis was present among 16 (38%) of 42 evaluable HIV-infected women, none of whom had Chlamydia trachomatis or Neisseria gonorrhoeae. Douching three or more times per month, history of ectopic pregnancy, and two or more prior urinary tract infections were associated with endometritis, as was elevated erythrocyte sedimentation rate (P < or = .05). Physical examination findings and mean CD4+ lymphocyte count were similar among those with and without endometritis. In the nine HIV-infected women with a repeat biopsy, endometritis decreased from four (44%) to two (22%) after treatment (P = .30). CONCLUSION: The prevalence of histologic endometritis in HIV-infected women was high despite few examination findings and no demonstrated pathogens. Endometritis in HIV-infected women might be related to pathogens not evaluated, to prior infection, or to reduced immunity from HIV.
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Endometrite/epidemiologia , Infecções por HIV , Adulto , Anti-Infecciosos/uso terapêutico , Estudos Transversais , Endometrite/tratamento farmacológico , Endometrite/etiologia , Endometrite/patologia , Feminino , Humanos , Prevalência , Fatores de Risco , Washington/epidemiologiaRESUMO
The objective of this study was to examine the effect of oral contraceptive (OC) use on vaginal discharge, epithelium, and flora. Thirty women who planned to use OC for contraception were evaluated before and 2 months after the start of OC use. At both visits, genital symptoms and exposures were assessed by questionnaire; vaginal signs were assessed by speculum examination and colposcopy; vaginal microflora was evaluated by quantitative culture; and a vaginal biopsy was obtained for histopathologic evaluation. Variables were compared between the initial visit and after 2 months of OC use. It was found that OC use did not change the gross, colposcopic, or histologic appearance of the vaginal epithelium or characteristics of vaginal or cervical discharge. Vaginal flora essentially remained unchanged after 2 months of OC use, except that a small decrease occurred in the number of subjects with > or =10(5) colony forming units/mL of H(2)O(2) producing Lactobacillus from 16 at baseline to 9 (p = 0.04) and in the total number of subjects with Ureaplasma urealyticum from 17 at baseline to 10 of 29 (p = 0.04). The results indicate minimal effect of OC use on the vaginal epithelium and vaginal and cervical discharge, and a small effect on vaginal flora.
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Anticoncepcionais Orais Hormonais/farmacologia , Vagina/microbiologia , Adolescente , Adulto , Animais , Epitélio/efeitos dos fármacos , Feminino , Humanos , Lactobacillus/isolamento & purificação , Macaca mulatta , Comportamento SexualRESUMO
OBJECTIVE: The aim of our study was to examine vaginal tissue during 3 phases of the menstrual cycle for the number of cell layers and epithelial immune cells. STUDY DESIGN: Vaginal biopsies were performed during 3 phases of the normal menstrual cycle (menstrual, days 1-5; preovulatory, days 7-12; and postovulatory, days 19-24) in 74 subjects. A subset of women had vaginal tissues stained with specific monoclonal antibody markers for Langerhans cells (CD1a), macrophages (KP1), T and B lymphocytes (CD4, CD8, CD21) and neutrophils (CD15). The number of cell layers and the number of immune cells in the vaginal tissue biopsy specimen were determined by a single observer who was blinded to clinical data. RESULTS: At 3 phases of the normal menstrual cycle, the mean number of epithelial cell layers underwent a small but statistically significant decrease from 27.8 +/- 0.7 on days 1-5 and 28.1 +/- 0.6 on days 7-12 to 26.0 +/- 0.7 on days 19-24 of the cycle (P =.01). Nonovulating women had a reduced mean epithelial cell layer count on days 7-12 (23.7 +/- 1. 4) compared with the epithelial cell layer count in ovulating women (28.8 +/- 0.7; P =.005). No significant changes were observed in the mean number per high-power field of Langerhans cells, macrophages, CD4 or CD8 lymphocytes, and neutrophil cell populations during the 3 phases of the cycle. B lymphocytes were not observed in the vaginal tissues. CONCLUSION: A small but statistically significant reduction in the number of vaginal epithelial cells was observed over the menstrual cycle. This reduction is not likely to be clinically significant. Immune cell populations in the vaginal tissues appeared stable throughout the menstrual cycle.
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Sistema Imunitário/citologia , Ciclo Menstrual/fisiologia , Vagina/citologia , Adulto , Linfócitos T CD4-Positivos/citologia , Linfócitos T CD8-Positivos/citologia , Contagem de Células , Células Epiteliais/citologia , Feminino , Fase Folicular/fisiologia , Humanos , Células de Langerhans/citologia , Fase Luteal/fisiologia , Macrófagos/citologia , Neutrófilos/citologia , Valores de ReferênciaRESUMO
OBJECTIVE: To identify the effects of depomedroxyprogesterone acetate (DMPA) on vaginal microbial flora and epithelium. METHODS: Women who desired DMPA for contraception were evaluated before and at 3 and 6 months after initiation of 150-mg DMPA injections every 3 months. At each visit, we assessed genital symptoms, vaginal signs, vaginal microflora, and histopathology by vaginal biopsies. RESULTS: Among 38 women observed for 6 months, there was significant reduction in mean serum estradiol level (99.9 +/- 9.3 pg/mL to 26.6 +/- 1.6 pg/mL, P <.001). The number of subjects with any Lactobacillus did not change, but the number with hydrogen peroxide (H(2)O(2))-positive Lactobacillus decreased from 20% before to 12% after 6 months of DMPA (P =.005). The log concentration in colony-forming units per milliliter of vaginal fluid of H(2)O(2)-positive Lactobacillus decreased in a linear manner from 4. 0 +/- 0.6 at baseline to 2.5 +/- 0.6 after 6 months of DMPA use (P =. 006). The mean number of cell layers in the epithelium was reduced slightly from 28.1 +/- 0.7 to 25.9 +/- 0.9 (P =.05), epithelial thickness decreased from 1.02 +/- 0.04 mm to 0.89 +/- 0.05 mm (P =. 005), and the glycogen-positive thickness decreased from 0.81 +/- 0. 04 mm at baseline to 0.66 +/- 0.05 after 6 months of DMPA use (P =. 005). CONCLUSION: Depomedroxyprogesterone acetate produced a systemic hypoestrogenic state associated with decreased H(2)O(2)-positive Lactobacillus colonization and slight thinning of the glycogen vaginal epithelial layer. Such changes possibly compromise the vaginal barrier to infection.
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Anticoncepcionais Femininos/efeitos adversos , Estrogênios/deficiência , Acetato de Medroxiprogesterona/efeitos adversos , Vagina/efeitos dos fármacos , Adolescente , Adulto , Contagem de Colônia Microbiana , Anticoncepcionais Femininos/administração & dosagem , Esquema de Medicação , Epitélio/efeitos dos fármacos , Epitélio/microbiologia , Epitélio/patologia , Feminino , Seguimentos , Humanos , Injeções Intramusculares , Lactobacillus/efeitos dos fármacos , Acetato de Medroxiprogesterona/administração & dosagem , Vagina/microbiologia , Vagina/patologiaRESUMO
The objective of this study was to examine genital tissue, vaginal fluid, and vaginal microbial flora at 3 phases of the menstrual cycle in asymptomatic women. Vaginal examinations were performed 3 times in 74 women: at the menstrual phase (days 1-5), the preovulatory phase (days 7-12), and the postovulatory phase (days 19-24). Flora of 50 women without bacterial vaginosis (BV) was analyzed separately from flora of 24 women with BV. The volume of vaginal discharge increased and the amount of cervical mucus decreased over the menstrual cycle. Among subjects without BV, the rate of recovery of any Lactobacillus changed little (range, 82% to 98%; P = .2); however, a small increase occurred in the rate of recovery of heavy (3+ to 4+ semiquantitative) growth of Lactobacillus over the menstrual cycle (P = .04). A linear decrease occurred in the rate of recovery of heavy growth of any non-Lactobacillus species, from 72% at days 1-5 to 40% at days 19-24 (P = .002). A linear decrease also occurred in the rate of recovery of Prevotella species, from 56% on days 1-5 to 28% on days 19-24 (P =. 007), while a small linear increase occurred in the rate of recovery of Bacteroides fragilis (P=.05). Among subjects with BV, the only significant change was an increase in the rate of recovery of Lactobacillus, from 33% at days 1-5 to 54% at days 19-24 (P = .008). Among all subjects, the rate of recovery of heavy growth of Lactobacillus increased over the menstrual cycle and, in contrast, the concentration of non-Lactobacillus species tended to be higher at menses, which is evidence that the vaginal flora becomes less stable at this time.
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Bactérias/isolamento & purificação , Ciclo Menstrual/fisiologia , Vagina/microbiologia , Vagina/fisiologia , Descarga Vaginal/microbiologia , Adulto , Bactérias/classificação , Candidíase/microbiologia , Feminino , Humanos , Vaginose Bacteriana/microbiologiaRESUMO
This study evaluated the relationship of vaginal Escherichia coli colonization to birth weight <1500 g and other perinatal complications in a cross-sectional study of 2646 women at the University of Washington Medical Center, Seattle, between October 1992 and January 1995. Vaginal E. coli colonization was more strongly associated with delivery at <34 weeks (relative risk [RR], 1.7; 95% confidence interval [CI], 1.3-2.3) and very low birth weight (RR, 1.9; 95% CI, 1.3-2.7) than with prematurity between 34 and 36 weeks or low birth weight. Heavy growth of E. coli had a higher risk of very low birth weight than light growth (RR, 2.4; 95% CI, 1.0-6.2). It may be important to screen and treat pregnant women for genital tract colonization with E. coli during prenatal care.
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Infecções por Escherichia coli/complicações , Complicações Infecciosas na Gravidez/microbiologia , Vaginite/complicações , Escherichia coli/patogenicidade , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Perinatologia , Gravidez , Fatores de Risco , Infecções Estreptocócicas/complicações , Streptococcus agalactiae , Vaginite/microbiologiaRESUMO
Stimulation of primary cultures of rat astrocytes with appropriate agents results in the mobilization of arachidonic acid from intracellular lipid pools and the synthesis of eicosanoids. Thromboxane A2 is one of the major prostanoids released upon stimulation with calcium ionophore, phorbol esters, and ATP; but a number of other predicted effectors are inactive. In an attempt to understand the pathophysiological significance of eicosanoid release from astrocytes, primary cultures have been derived from human astrocytic glioma biopsies. The majority of cells in the cultures expressed glial fibrillary acidic protein (GFAP), frequently in conjunction with vimentin and fibronectin. Cell sorting revealed that a significant proportion of cells in the cultures from the high-grade (malignant) tumors expressed epidermal growth factor receptor, indicative of neoplastic cells. Both effective and ineffective agents in rat cultures were tested for their ability to stimulate release of thromboxane from these gliomas, and also from cultures of medulloblastoma and ependymoma which contained significant numbers of GFAP-positive cells. Only cells from the high-grade tumors released thromboxane in response to the known effective stimuli. While the muscarinic agonist carbachol was ineffective, norepinephrine evoked thromboxane release from malignant astrocytomas. These data show that cells derived from malignant human gliomas retain the ability to release thromboxane upon stimulation and suggest that a transformation in receptor coupling might accompany neoplasia, such that the cells now respond to a previously ineffective agonist.