Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Curso “Participação popular, movimentos sociais e direito à saúde”: uma experiência de educação popular em Saúde na Bahia a partir do MobilizaSUS

Os Movimentos Sociais de base popular têm tido importante papel na luta pelo direito à saúde e consolidação do SUS. As práticas educativas vivenciadas por estes movimentos referenciados na educação popular em saúde contribuem para o fortalecimento do controle social e da participação popular na saúde. O curso foi construído de forma participativa, entre movimentos sociais, SESAB e ISC/UFBA, tendo como objetivo central fortalecer a atuação dos movimentos sociais na arena política da saúde na Bahia. Realizou-se duas turmas de cinco módulos cada uma, totalizando 60 participantes. As atividades orientaram-se pelos pressupostos da educação popular: diálogo, participação, valorização da experiência, autonomia e reflexão crítica. Possibilitou pensar e construir estratégias para incorporação de demandas dos coletivos na agenda do Estado, constituindo-se enquanto espaço potente de debate sobre a realidade e necessidades de saúde dos povos

O papel do conselheiro municipal de saúde na fiscalização do orçamento público

Este estudo tem por objetivo analisar o conhecimento de conselheiros municipais de saúde sobre os seus papéis na fiscalização do orçamento público. É um estudo descritivo-exploratório, realizado com seis conselheiros do município de Jequié-BA. Os dados foram coletados através de questionário e entrevista semiestruturada, e analisados pela técnica de análise de conteúdo de Bardin (2009). Da análise, emergiram quatro categorias temáticas, através das quais se verificou que os conselheiros demonstraram consciência dos seus papéis de fiscalizar e acompanhar os recursos financeiros do Sistema Único de Saúde (SUS) e de favorecer a efetivação do controle social na fiscalização do orçamento público

O papel do conselheiro municipal de saúde na fiscalização do orçamento público

Este estudo tem por objetivo analisar o conhecimento de conselheiros municipais de saúde sobre os seus papéis na fiscalização do orçamento público. É um estudo descritivo-exploratório, realizado com seis conselheiros do município de Jequié-BA. Os dados foram coletados através de questionário e entrevista semiestruturada, e analisados pela técnica de análise de conteúdo de Bardin (2009). Da análise, emergiram quatro categorias temáticas, através das quais se verificou que os conselheiros demonstraram consciência dos seus papéis de fiscalizar e acompanhar os recursos financeiros do Sistema Único de Saúde (SUS) e de favorecer a efetivação do controle social na fiscalização do orçamento público

Chitosan and cottonseed processing method association on carcass traits and meat quality of feedlot lambs.

The objective of this study was to evaluate the effects of the association of cottonseed processing method with chitosan on carcass traits and meat quality of lambs finished in feedlot. Eighty lambs with an average body weight of 20.6 kg, with 04 months of age, were distributed in a completely randomized design, in a 2 x 2 factorial arrangement. The factors were represented by two cottonseed processing method (whole or ground) and two levels of chitosan (0 and 136 mg/kg BW). The association of cottonseed processing method with chitosan in the lamb diet did not affect (P>0.05) carcasses traits. The pH, color, cooking losses, shear force, and proximate composition of meat were also not affected (P>0.05) by the processing method of cottonseed or its association with chitosan in the lamb diets. There was an increase in palmitoleic (c9-C16:1; P = 0.01) and conjugated linoleic (P = 0.02) fatty acids when ground cottonseed was associated with chitosan. Ground cottonseed associated with chitosan increases the concentration of unsaturated fatty acids in the meat of feedlot lambs

En el territorio del enemigo: las Unidades de Policía de Pacificación (UPP) en una favela de Río de Janeiro, Brasil

This article analyzes how 38 Units of the Pacification Police (UPP) were mounted in some favelas in Río de Janeiro, especially the Santa Marta favela. The aim of the operation was to end the territorial control exerted by gangs of drugs-traffickers, guarantee the return of the State and promote the integration of the favelas into the city as a whole. After describing the context in which these operations take place, the article discusses the results of this intervention in the favela of Santa Marta and speaks of how the soldiers who undertook the operations thought of them. The definition of the favela as a territory in which the enemy lives and the mutual suspicion between the inhabitants of the favela and the UPP characterize the relations between the residents and the soldiers, which are anchored in a model of policing in which the notion of the internal enemy continues to shape the modus operandi of the armed forces, an aspect which reveals the weak points of the new policing models, which are ambitious and visionary but lack the needed reforms.El artículo analiza cómo se llevó a cabo la instalación de 38 Unidades de Policía de Pacificación (UPP) en algunas favelas de Río de Janeiro, especialmente en la de Santa Marta. El objetivo de la operación fue acabar con el control territorial ejercido por las facciones dedicadas al tráfico de droga, garantizar el retorno del Estado y favorecer la integración de las favelas con el resto de la ciudad. Después de describir el contexto en el que se desarrollan estas operaciones, el artículo presenta los resultados de la intervención en la favela de Santa Marta y da cuenta de cómo los soldados implicados en las operaciones las representan. La definición de la favela como territorio en el que el enemigo habita, sumada a la sospecha que nace entre habitantes y UPP, caracterizan las relaciones entre residentes y soldados, relaciones ancladas en un modelo de policía en el que la noción de enemigo interno sigue vehiculando el modus operandi de las fuerzas del orden, cuestión que revela los puntos débiles de los nuevos modelos policivos, ambiciosos y visionarios, que no cuentan con las reformas necesarias

Análise espaço-temporal da doença de Chagas e seus fatores de risco ambientais e demográficos no município de Barcarena, Pará, Brasil

To the Federal University of Pará (UFPA), to the Laboratory of Epidemiology and Geoprocessing (EpiGeo) of the University of the State of Pará (UEPA), to the Laboratory of Geoprocessing of the Evandro Chagas Institute (LabGeo/IEC), to the Health Department of the Municipality of Barcarena (SESMUB), to the Coordination for the Improvement of Higher Education Personnel (CAPES) and the National Council for Scientific and Technological Development (CNPq).Universidade do Estado do Pará. Belém, PA, Brazil.Universidade do Estado do Pará. Belém, PA, Brazil.Universidade do Estado do Pará. Belém, PA, Brazil.Universidade do Estado do Pará. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Secretaria Municipal de Saúde de Barcarena. Barcarena, PA, Brazil.Universidade do Estado do Pará. Belém, PA, Brazil.Universidade do Estado do Pará. Belém, PA, Brazil.Introduction: Chagas disease is a parasitosis considered a serious problem of public health. In the municipality of Barcarena, Pará, from 2007 to 2014, occurred the highest prevalence of this disease in Brazil. Objective: To analyze the disease distribution related to epidemiological, environmental and demographic variables, in the area and period of the study. Methods: Epidemiological and demographic data of Barcarena Health Department and satellite images from the National Institute For Space Research (INPE) were used. The deforestation data were obtained through satellite image classification, using artificial neural network. The statistical significance was done with the χ2 test, and the spatial dependence tests among the variables were done using Kernel and Moran techniques. Results: The epidemiological curve indicated a disease seasonal pattern. The major percentage of the cases were in male, brown skin color, adult, illiterate, urban areas and with probable oral contamination. It was confirmed the spatial dependence of the disease cases with the different types of deforestation identified in the municipality, as well as agglomerations of cases in urban and rural areas. Discussion: The disease distribution did not occur homogeneously, possibly due to the municipality demographic dynamics, with intense migratory flows that generates the deforestation. Conclusion: Different relationships among the variables studied and the occurrence of the disease in the municipality were observed. The technologies used were satisfactory to construct the disease epidemiological scenarios