Measurements of Impoverishing and Catastrophic Surgical Health Expenditures in Low- and Middle-Income Countries and Reduction Interventions in the Last 30 Years: A Systematic Review.

INTRODUCTION: Approximately 33 million people suffer catastrophic health expenditure (CHE) from surgery and/or anesthesia costs. The aim of this systematic review is to evaluate catastrophic and impoverishing expenditure associated with surgery and anesthesia in low- and middle-income countries (LMICs). METHODS: We performed a systematic review of all studies from 1990 to 2021 that reported CHE in LMICs for treatment of a condition requiring surgical intervention, including cesarean section, trauma care, and other surgery. RESULTS: 77 studies met inclusion criteria. Tertiary facilities (23.4%) were the most frequently studied facility type. Only 11.7% of studies were conducted in exclusively rural health-care settings. Almost 60% of studies were retrospective in nature. The cost of procedures ranged widely, from $26 USD for a cesarean section in Mauritania in 2020 to $74,420 for a pancreaticoduodenectomy in India in 2018. GDP per capita had a narrower range from $315 USD in Malawi in 2019 to $9955 USD in Malaysia in 2015 (Median = $1605.50, interquartile range = $1208.74). 35 studies discussed interventions to reduce cost and catastrophic expenditure. Four of those studies stated that their intervention was not successful, 18 had an unknown or equivocal effect on cost and CHE, and 13 concluded that their intervention did help reduce cost and CHE. CONCLUSIONS: CHE from surgery is a worldwide problem that most acutely affects vulnerable patients in LMICs. Existing efforts are insufficient to meet the true need for affordable surgical care unless assistance for ancillary costs is given to patients and families most at risk from CHE.

Epidemiology of immune thrombocytopenia: study of adult patients at a referral hematology service in Northeastern Brazil.

Immune thrombocytopenia (ITP) is an acquired bleeding disorder observed in the clinical practice. Little is known about its epidemiology in Brazil. The present study was conducted at a hematology referral center which covers a population of over 8 million in 184 municipalities in the state of Ceará. The purpose of this study was to draw a demographic profile of adult ITP patients with regard to sex, age, geographical origin and distribution across the state, and the proportion of secondary ITP. Following ethics committee approval, information was collected with an ad hoc instrument. The sample consisted of 187 adult ITP patients attending the Walter Cantídio University Hospital in 2015. The median follow-up time was 67 months (range: 1 month to 29 years). Female sex (n = 154; 82.35 %) was strongly prevalent in all age brackets, with an overall female/male ratio of 4.7:1. The median age was 41 ± 16.1 with an interquartile range of 29-55.5 years; there was no difference between the genders. Secondary ITP (18/187; 9.6 %) displayed a bimodal distribution and a linear increase between 38 and >68 years of age. The results of this survey on the epidemiology of ITP in Brazil suggest that ethnic and geographical factors may have a great impact on age and sex distribution and on the distribution of secondary ITP.

Capacity Building in Peer-review: A Student-Led Journal Report.

Peer-review optimizes the quality of research articles; however, new strategies need to be implemented to enhance peer-review capacity. This report comprises the peer-review process of a medical student-led journal editorial board, detailing its challenges and the students' role. The peer education approach conducted a capacity-building activity, developing guidelines, and practicing critical appraisal and constructive feedback in manners that classroom research training cannot. Understandings of an effective peer-review brought to discussion from standardization and blinding to ethical and scientific competencies essential in researchers. All parties, including students, should be allowed to extend their capabilities to enhance scholarly publishing.

Rift Valley fever during the COVID-19 pandemic in Africa: A double burden for Africa's healthcare system.

A new rising incidence of Rift Valley fever (RVF) among livestock and humans in the African continent during the COVID-19 pandemic has become of increasing concern. We analyzed the different ways COVID-19 has contributed to the increase in RVF cases and how it has impacted the interventions allocated to the disease by comparing it with the status of the disease before the pandemic. There is enough evidence to conclude that the COVID-19 pandemic has impacted the efforts being taken to prevent outbreaks of RVF. Therefore, with no definitive treatment in place and inadequate preventive measures and disease control, RVF may potentially lead to a future epidemic unless addressed urgently.

Desenvolvimento de Líderes em Pesquisa e Extensão: o Papel de uma Associação de Representatividade Estudantil / Developing Leaders in Research and Extension: The Role of a Student Representative Association

A essência da extensão universitária se pauta na emancipação da sociedade, culminando na indissociabilidade entre ensino, pesquisa e extensão, aspecto de interesse das instituições de ensino superior e dos discentes, visando o exercício da cidadania. Assim, iniciativas que destaquem a relação entre pesquisa e extensão são de extrema relevância. Nesse contexto, a International Federation of Medical Students Associations of Brazil (IFMSA Brazil) é uma organização que trabalha com intuito de fortalecer o tripé universitário e engajar novas lideranças nessas áreas. O principal objetivo deste estudo é discorrer sobre a atuação do time nacional de publicação, pesquisa e extensão da IFMSA Brazil da gestão 2019 ­ 2020 como recurso humano para formação de líderes em pesquisa e extensão, analisando o impacto deste trabalho no âmbito estudantil e universitário, da saúde pública e da comunidade. Este estudo observacional descritivo e retrospectivo tem como objeto de análise as atividades realizadas por este time, no período entre dezembro de 2019 a junho de 2020, em prol da formação de lideranças estudantil no cenário da pesquisa e extensão. Com isso, este trabalho demonstra como esse time não apenas enaltece o acesso à educação em pesquisa e em extensão, através de capacitações, divulgação de oportunidades, materiais, entre outras estratégias, mas também fomenta a liderança estudantil em 220 escolas médicas com o propósito de consolidar a saúde pública, a tradução do conhecimento, a responsabilidade social e o letramento em saúde.

Promovendo equidade de gênero nas especialidades cirúrgicas: experiência de programa de mentoria na América Latina / Promoting gender equity in surgical specialties: experience from a mentorship program in Latin America

Resumo: Introdução: Cirurgia global é uma área que advoga por melhores desfechos e equidade para todos que demandam assistência cirúrgica, anestésica e obstétrica. No Brasil, embora as mulheres componham 46,6% da demografia médica em 2020, inequidades de gênero persistem nas especialidades cirúrgicas. O objetivo deste artigo é relatar a experiência do programa de mentoria do Gender Equity Initiative in Global Surgery como mecanismo de promoção de equidade de gênero. Relato de experiência: O programa almeja capacitar, empoderar e amplificar vozes de minorias de gênero, sendo voluntário e sem fins lucrativos. Baseia-se na criação de pequenos grupos heterogêneos, com diferentes graus de experiência acadêmica e pessoal. As inscrições ocorrem por formulário on-line, com perguntas relacionadas à identidade, a interesses e expectativas dos aplicantes, sendo os grupos organizados de acordo com essas informações. Os mentores são selecionados com base em: nível de treinamento, especialidade, identidade de gênero e expectativas. Realizam-se três acompanhamentos por preenchimento de questionário pelos participantes. Discussão: A necessidade de programas como este durante a pandemia é evidente, mostrando-se como uma iniciativa positiva para desenvolver estratégias de enfrentamento dos desafios vivenciados. Este relato fornece uma visão geral de como um programa de mentoria pode contribuir para que mais estudantes de Medicina sejam incentivados a seguir carreiras em cirurgia, anestesia e obstetrícia, de modo a promover equidade de gênero para além da perspectiva binária, e discute as principais dificuldades em se estabelecerem programas como esse na América Latina. Conclusão: É preciso reforçar que não basta apenas dar suporte a mulheres (cis e trans) e pessoas de gênero não binário, mas também educar a sociedade para compreender identidades de gênero além da perspectiva binária, reconhecendo os impactos nas relações de trabalho e perspectivas de carreira, especialmente dentro do campo cirúrgico.

Abstract: Introduction: Global surgery is an area that advocates for better outcomes and equity for everyone who requires surgical, anesthetic, and obstetric assistance. In Brazil, although women represent 46.6% of medical demographics in 2020, gender equity disparities persist in surgical specialties. The objective of this article is to report the experience of the mentoring program from the Gender Equity Initiative in Global Surgery as a mechanism for promoting gender equity. Experience report: The voluntary and non-profit program aims to train, empower, and amplify voices of gender minorities. It is based on the creation of small heterogeneous groups, with different degrees of academic and professional experience. Applications are made via an online form, with questions related to the identity, interests, and expectations of applicants, and the groups are organized according to this information. Mentors are selected based on the level of training, specialty, gender identity, and expectations. The participants then have three follow-up sessions conducted by completing questionnaires. Discussion: The need for programs like this during the pandemic is evident, proving to be a positive initiative to develop strategies to tackle the challenges experienced. This report provides an overview of how a mentoring program can contribute to greater adherence for medical students to pursue careers in surgery, anesthesia, and obstetrics, promoting gender equity beyond the binary perspective and discussing the main difficulties in establishing similar programs in Latin America. Conclusion: It is necessary to reinforce that educating and supporting women (cisgender and transgender) and non-binary gendered people are not enough, but to educate society to understand gender identities beyond the binary perspective, recognizing the impacts on work relationships and career perspectives, especially within the surgical field.

Proposal of treatment algorithm for immune thromocytopenia in adult patients of a hematology service at a referral center in Northeastern Brazil

ABSTRACT Introduction: The management of adult (≥18 years) immune thrombocytopenia patients relies on platelet count, the risk of bleeding and presence of bleeding. Objective: Confirming the diagnosis of immune thrombocytopenia and the start of therapy, our hematology service, a referral center, favors the establishment of this algorithm to treat those patients. Results: Presentation, recently diagnosed or recurrence - group 1: life-threatening bleeding: high-dose intravenous immunoglobulins with methylprednisolone or dexamethasone. Hospitalization and platelet transfusion are considered. Group 2: Platelets <30 × 109/L with bleeding or risk factor for bleeding, or platelets <20 × 109/L: prednisone or dexamethasone. No response, platelets <20 × 109/L: replace corticoid or increase doses. If platelets continue <20 × 109/L: immunization and splenectomy. Investigation of Helicobacter pylori, if positive: treatment for H. pylori. Chronic immune thrombocytopenia with platelets <20 × 109/L we propose two new groups (A and B): Group A: <65 years, no or low surgical risk, patient declines maintenance therapy or patient intends to get pregnant: immunization and splenectomy. Group B: failure of splenectomy (refractory) or no splenectomy indication or history of exposure to malaria or babesiosis and no response to corticoids or corticoid dependence: choose thrombopoietin receptor agonists: eltrombopag or romiplostim. Patient at high risk for arterial or venous thrombosis: recommend rituximab. After rituximab or thrombopoietin receptor agonists, if platelets continue <20 × 109/L: indicate immunosuppressants (azathioprine or cyclophosphamide), dapsone or mycophenolate mofetil or vinca alkaloids. The goals of treatment for chronic or refractory immune thrombocytopenia are to keep platelets >20 × 109/L and stop bleeding.

Proposal of treatment algorithm for immune thromocytopenia in adult patients of a hematology service at a referral center in Northeastern Brazil.

INTRODUCTION: The management of adult (≥18 years) immune thrombocytopenia patients relies on platelet count, the risk of bleeding and presence of bleeding. OBJECTIVE: Confirming the diagnosis of immune thrombocytopenia and the start of therapy, our hematology service, a referral center, favors the establishment of this algorithm to treat those patients. RESULTS: Presentation, recently diagnosed or recurrence - group 1: life-threatening bleeding: high-dose intravenous immunoglobulins with methylprednisolone or dexamethasone. Hospitalization and platelet transfusion are considered. Group 2: Platelets <30×109/L with bleeding or risk factor for bleeding, or platelets <20×109/L: prednisone or dexamethasone. No response, platelets <20×109/L: replace corticoid or increase doses. If platelets continue <20×109/L: immunization and splenectomy. Investigation of Helicobacter pylori, if positive: treatment for H. pylori. Chronic immune thrombocytopenia with platelets <20×109/L we propose two new groups (A and B): Group A: <65 years, no or low surgical risk, patient declines maintenance therapy or patient intends to get pregnant: immunization and splenectomy. Group B: failure of splenectomy (refractory) or no splenectomy indication or history of exposure to malaria or babesiosis and no response to corticoids or corticoid dependence: choose thrombopoietin receptor agonists: eltrombopag or romiplostim. Patient at high risk for arterial or venous thrombosis: recommend rituximab. After rituximab or thrombopoietin receptor agonists, if platelets continue <20×109/L: indicate immunosuppressants (azathioprine or cyclophosphamide), dapsone or mycophenolate mofetil or vinca alkaloids. The goals of treatment for chronic or refractory immune thrombocytopenia are to keep platelets >20×109/L and stop bleeding.