Treatment outcomes of MDR-TB and HIV co-infection in Europe

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Clinical Management of Multidrug-Resistant Tuberculosis in 16 European Countries.

Rationale: Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower. Objectives: To document the management and treatment outcome in patients with MDR-TB in Europe. Methods: We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR-TB in Europe. Treatment outcomes were compared by World Health Organization and alternative simplified definitions by the Tuberculosis Network European Trialsgroup (TBNET). Measurements and Main Results: A total of 380 patients with MDR-TB were recruited and followed up between 2010 and 2014 in 16 European countries. Patients in high-incidence countries compared with low-incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median, 111 vs. 28 d), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying World Health Organization outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high-incidence countries. Simplified outcome definitions that include 1 year of follow-up after the end of treatment showed similar frequency of relapse-free cure in low- (58.3%), intermediate- (55.8%), and high-incidence (57.1%) countries, but highest frequency of failure in high-incidence countries (24.1% vs. 14.6%). Conclusions: Conventional standard MDR-TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR-TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.German Center for Infection Researc

Painéis OSB fabricados com madeiras da caatinga do nordeste do Brasil

Este trabalho objetivou avaliar a viabilidade da produção de painéis OSB feitos com espécies de madeira da caatinga do nordeste do Brasil - marmeleiro (Croton sonderianus Muell. Arg.), jurema-branca (Piptadenia stipulacea (Benth.) Ducke) e catanduva (Piptadenia moniliformis Benth.) - e resina poliuretana bicomponente derivada de mamona. As propriedades investigadas foram: densidade aparente; inchamento em espessura e absorção de água, ambos em 2 h e 24 h; módulo de elasticidade e resistência na flexão, na direção paralela e na direção perpendicular ao painel; adesão interna e arrancamento de parafuso em relação à face, conforme as normas europeias EN. Os resultados das propriedades físicas e mecânicas obtidas evidenciaram a possibilidade da produção em laboratório de painéis OSB com as três espécies analisadas, conforme valores médios e variabilidade de propriedades equivalentes às chapas fabricadas em escala industrial, além de comparados aos requisitos da norma EN 300 (EUROPEAN..., 2006) para painéis dos tipos OSB/3 e OSB/4. Pela análise de variância, os painéis OSB fabricados com strands de madeiras de catanduva apresentaram os melhores resultados para as propriedades mecânicas; para as físicas, os melhores desempenhos foram provenientes dos painéis feitos com madeira de marmeleiro e jurema-branca

Screening policies, preventive measures and in-hospital infection of COVID-19 in global surgical practices

Background: In a surgical setting, COVID-19 patients may trigger in-hospital outbreaks and have worse postoperative outcomes. Despite these risks, there have been no consistent statements on surgical guidelines regarding the perioperative screening or management of COVID-19 patients, and we do not have objective global data that describe the current conditions surrounding this issue. This study aimed to clarify the current global surgical practice including COVID-19 screening, preventive measures and in-hospital infection under the COVID-19 pandemic, and to clarify the international gaps on infection control policies among countries worldwide. Methods: During April 2-8, 2020, a cross-sectional online survey on surgical practice was distributed to surgeons worldwide through international surgical societies, social media and personal contacts. Main outcome and measures included preventive measures and screening policies of COVID-19 in surgical practice and centers' experiences of in-hospital COVID-19 infection. Data were analyzed by country's cumulative deaths number by April 8, 2020 (high risk, >5000; intermediate risk, 100-5000; low risk, <100). Results: A total of 936 centers in 71 countries responded to the survey (high risk, 330 centers; intermediate risk, 242 centers; low risk, 364 centers). In the majority (71.9%) of the centers, local guidelines recommended preoperative testing based on symptoms or suspicious radiologic findings. Universal testing for every surgical patient was recommended in only 18.4% of the centers. In-hospital COVID-19 infection was reported from 31.5% of the centers, with higher rates in higher risk countries (high risk, 53.6%; intermediate risk, 26.4%; low risk, 14.8%; P < 0.001). Of the 295 centers that experienced in-hospital COVID-19 infection, 122 (41.4%) failed to trace it and 58 (19.7%) reported the infection originating from asymptomatic patients/staff members. Higher risk countries adopted more preventive measures including universal testing, routine testing of hospital staff and use of dedicated personal protective equipment in operation theatres, but there were remarkable discrepancies across the countries. Conclusions: This large international survey captured the global surgical practice under the COVID-19 pandemic and highlighted the insufficient preoperative screening of COVID-19 in the current surgical practice. More intensive screening programs will be necessary particularly in severely affected countries/institutions

Impact of asymptomatic COVID-19 patients in global surgical practice during the COVID-19 pandemic.

CorrespondenceImpact of asymptomatic COVID-19patients in global surgical practiceduring the COVID-19 pandemi