Reducing the burden of Tuberculosis: an emphasis on improving awareness among caregivers

Background: Tuberculosis (TB) is one of the common communicable disease affecting human beings since ancient times. Though effective chemotherapy emerged during 20th century had raised hope towards eliminating TB burden, it still remains as a distant goal. Awareness about TB among close contacts of active disease is of paramount importance in preventing its spread and promoting early diagnosis and treatment. This study aimed to assess the knowledge about tuberculosis among caregivers of tuberculosis patients.Methods: This was a cross sectional study that enrolled 300 subjects who were then caregivers of tuberculosis patients admitted in the Department of Pulmonary Medicine. Subjects were interviewed according to a predesigned panel of questions meant to assess their basic knowledge and perceptions about tuberculosis symptomatology, diagnostic modalities, treatment and prevention.Results: About 90.3% (n=271) of subjects had heard about TB previously and about 37.7% (n=113) considered themselves to be well aware of it. Most of them believed TB to be communicable (90.3%, n=271). Majority believed that TB affects lungs only (n=206, 68.7%), with most commonly perceived symptom being cough (n=285, 95%). Knowledge regarding disposal of sputum was poor (n=110, 36.7%). About 168 (56%) subjects considered usage of face mask by the patient as an effective tool for TB prevention.Conclusions: Caregivers of tuberculosis patients lack proper knowledge about major aspects of the disease. Public awareness and care giver education programs needs to be implemented along with standard TB care to reduce transmission of TB among close contacts

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society