Unsaturated Polyester Resin Composite With Sugar Cane Bagasse: Influence Of Treatment On The Fibers Properties [compósito De Resina De Poliéster Insaturado Com Bagaço De Cana-de-açúcar: Influência Do Tratamento Das Fibras Nas Propriedades]

The aim of this work is to evaluate the influence of the sugar cane bagasse NaOH treatment in the mechanical and dynamic-mechanical properties, in the thermal stability, density and water absorption, when used in unsaturated polyester resin/sugar cane bagasse composite. The sugar cane bagasse was submitted to the chemical treatment with alkaline solution of NaOH. The treatment improves the impact and flexural elasticity modulus when compared with resin without fibers, in addition to the adhesion of the fibers with the matrices, but does not improve significantly the tensile elasticity modulus. The surfaces of the impact fracture were analyzed by SEM.203194200Marcovich, N.E., Aranguren, M.I., Reboredo, M.M., (2001) Polymer., 42, p. 815Manfredi, L.B., Rodríguez, E.S., Wladyka-Przybylak, M., Vázquez, A., (2006) Polymer. Degradation and Stability, 91, p. 255Idicula, M., Boudenne, A., Umadevi, L., Ibos, L., Candau, Y., Thomas, S., (2006) Composites Science and Technology, 66, p. 2719Athijayamani, A., Thiruchitrambalam, M., Natarajan, U., Pazhanivel, B., (2009) Materials Science and Engineering A, 517, p. 344De Silva, F.A., Chawla, N., De Toledo Filho, R.D., (2008) Composites Science and Technology, 68, p. 3438Joseph, K., Medeiros, E.S., Carvalho, L.H., (1999) Polímeros, Out/Dez, p. 136Carvalho, L.H., Cavalcanti, W.S., (2006) Polímeros, 16, p. 33Paiva, J.M.F., Frollini, E., (2002) Journal of Applied Polymer. Science, 83, p. 880Tita, S.P.S., Paiva, J.M.F., Frollini, E., (2002) Polímeros, 12, p. 228Hoareau, W., Trindade, W.G., Siegmund, B., Castellana, A., Frollini, E., (2004) Polymer. Degradation and Stability, 86, p. 567Bertoti, A.R., Luporini, S., Esperidião, M.C.A., (2009) Carbohydrate Polymers, 77, p. 20Joshi, S.V., Drzal, L.T., Mohanty, A.K., Arora, S., (2004) Composites: Part A, 35, p. 371Estevez, A.G., Gálvez, L., De La Osa, O., (1997) Sugar Cane Bagasse. Utilization for Prodution of Composites. The State of the Art in Cuba, , in: Lignocellulosic - Plastics Composites, Leão, A. L.Carvalho, F. X. & Frollini, E. ed., UNESP, São Paulo, BrasilCarvalho, L.F.M., (2004) Fibras de Palha de Carnaúba: Caracterização Térmica e Aplicações Em Compósitos, , Dissertação de Mestrado, Universidade Federal do Piauí, BrasilBledzki, A.K., Gassan, J., (1999) Prog. Polym. Sci., 24, p. 221Razera, I.A.T., Frollini, E., (2004) Journal of Applied Polymer. Science, 91, p. 1077Barker, B., Owen, N.L., (1999) J. Chem. Ed., 76, p. 1706Rong, M.Z., Zhang, M.Q., Liu, Y., Yang, G.C., Zeng, H.M., (2001) Composites Science and Technology, 61, p. 1437Paul, A., Joseph, K., Thomas, S., (1997) Composites Science and Technology, 57, p. 67Cavani, C.S., Sanchez, E.M.S., Leal, C.V., Sánchez, C.G., Compósito de Resina de Poliéster com Bagaço de Cana: Influência de Tratamento das Fibras na Resistência ao Impacto (2003) Anais Do 7° Congresso Brasileiro de Polímeros, , Belo Horizonte, MGSanchez, E.M.S., Zavaglia, C.A.C., Felisberti, M.I., (2000) Polymer., 41, p. 76

Biocompatibility And Osteo-differentiation Study Of Poly (ε-caprolactone) And β-tricalcium Phosphate Composite Membranes

The Tissue Engineering appears with a modern proposal for the treatment of damages or diseases. The study of materials and methods for tissues and organs regeneration by the patient cells culture had been developed on the last years but still couldn't be used for all different tissues. In this multidisciplinary research field, the present work joins the biodegradability of poly(ε-caprolactone) (PCL) with the osteoconductive properties of β-tricalcium phosphate (β-TCP) in order to create a composite which acts as a temporary support for cell culture without a second surgery to remove the biomaterial. This work evaluates three membranes types, obtained by casting in chloroform, on the biocompatibility and differentiation on mesenquimal stem cells (hMSC). These analyses showed cell viability with the rezasurin method and the alkaline phosphatase activity (ALP). DMA analyses, MEV and OPM were performed.396-398399402Hutmacher, D. W. J Biomater Sei Polym. V. 12 (2001), p. 107-124Pitt, C.G., (1981) Biomaterials, 2, pp. 215-220Gabelnick, H. L. In: Mishell, D. R. Advanced in human fertility and reproductive endocrinology: 2: Long actin steroid contraception New York: Raven press, p.149-73 (1983)Meyer, U. et al. Oral. Maxillofac. Surg. V. 33 (2004), p. 325-332Rezwan, K., (2006) Biomaterials, 27, pp. 3413-3431Sun, J.S., (1997) J. Biomed. Mater. Res, 37, pp. 324-334Brown, S., (2001) Bioceramics 14: Proceedings of the 14th international symposium on ceramics in medicine, pp. 213-269. , Palm Springs, CA, pBarbanti, S.H. Dissertação de Mestrado, FEM/UNICAMP, Campinas (2001

Evaluation Of Degradation Of Bioabsorbable Polycaprolactone Used In Rapid Prototyping For Medical Application

Tissue engineering is an emerging field on regenerative medicine to try to solve the end-stage of organ and tissue failure. This kind of method was developed as an alternative therapy for the treatment of tissue loss or organ failure resolving the shortage on transplantation therapy. Bone and cartilage tissue are under extensive investigation in tissue engineering research. A significant progress has been done on the recent years, although one major obstacle is to maintain the constructed tissue alive in vitro as well as in vivo. For this kind of problem a large number of bioresorbable materials and scaffolds design have been developed. They must have some especial characteristics such as three-dimensional features and highly porous structure with interconnection, biocompatibility and degradation control. Additionally, they shall present suitable surface for attachment of cells, growth and differentiation. Trying to enhance these properties it was used a bioabsorbable polymer approved by the FDA, polycaprolactone. Selective Laser Sintering (SLS) was used with a deflected laser beam selectively to scan over the powder surface following the cross-sequential profiles carried by the slice data. The interaction of the laser beam with the powder elevates the powder temperature to reach the glass-transition temperature, causing surfaces in contact to deform and fuse together. CAD models of different scaffolds were made to evaluate the most commons problems such shrinkage and distortion. In this case we observed oversize of the scaffold walls, reducing the pores size. To evaluate the material degradation rate it was used the SBF solution on 37°C on different times of immersion. After that the samples were weighted and observed on the SEM. We could see a reduction of mass percentage and it was visible bulk degradation of the material on the microscope observation. This study allows some properties of bioabsorbable polymer used in rapid prototyping (SLS), but it must be done citotoxicity tests to evaluate the biocompatibility. © 2008 Taylor & Francis Group.101105Berry, E., Preliminary experience with medical applications of rapid prototyping by selective laser sintering (1997) Med Eng Phys, 19 (1), pp. 90-96Bezwada, R.S., Monocryl suture, a new ultrapliable absorbable monofilament suture (1995) Biomaterials, 16, pp. 1141-1148(2007) InVesalius software, , http://www.cenpra.gov.br, CenPRA , Available atChen, D.R., Polycaprolactone microparticles and their biodegradation (2000) Polymer Degradation and Stability, 67, pp. 455-459Chen, J.H., (1995) Polym Mater Sci Eng, 11, p. 79Darney, P.D., Clinical evaluation of the Capronor contraceptive implant: Preliminary report (1989) Am J Obstet Gynecol, 160, pp. 1292-1295Das, S., Freeform fabrication of nylon-6 tissue engineering scaffolds (2003) Rapid Prototyping J, 9 (1), pp. 43-49Deckard, C.R., (1986) Generation by Layerwise Selective Sintering, , MS thesis, Department of Mechanical Engineering, University of Texas at AustinDeckard, C.R., (1988) Selective Laser Sintering, , PhD dissertation, Department of Mechanical Engineering, University of Texas at AustinDeshpande, A.A., Bioerodible polymers for ocular drug delivery (1998) Crit Rev Therapeutic Drug Carrier Systems, 15 (4), pp. 381-420Engelberg, I., Kohn, J., Physicomechanical properties of degradable polymers used in medical applications:a comparative study (1991) Biomaterials, 12 (3), pp. 292-304Li, Y., Effects of filtration seeding on cell density, spatial distribution and proliferation in nonwoven fibrous matrices (2001) Biotechnol. 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Injectable Biodegradable Polycaprolactone-sebacic Acid Gels For Bone Tissue Engineering

Tissue engineering constitutes a promising alternative technology to transplantation medicine by creating viable substitutes for failing tissues or organs. The ability to manipulate and reconstitute tissue function has tremendous clinical implications and will most likely play a key role in cell and gene therapies in the coming years. In the present work, a novel injectable and biodegradable biomaterial is reported that could be injected on the human body with a surgical syringe. The material prepared is a blend of polycaprolactone (PCL), a biodegradable and elastic biomedical polymer, and sebacic acid, a natural polymer part of castor oil with low molecular weight to accelerate the slow degradation rate of PCL. The biocompatibility of the blend was evaluated in vitro and its in vivo behavior was also assessed through subcutaneous and bone implantation in rats to evaluate its tissue-forming ability and degradation rate. The results allowed the conclusion that the gel is biocompatible, promotes the differentiation of mesenchymal stem cells, and presents an adequate degradation rate for use in bone tissue engineering. In vivo the gel blends promoted tissue regeneration and adverse reactions were not observed on subcutaneous and bone implants. © 2012 Mary Ann Liebert, Inc.181-2137146Payne, R.G., Yaszemski, M.J., Yasko, A.W., Mikos, A.G., Development of an injectable, in situ crosslinkable, degradable polymeric carrier for osteogenic cell populations. Part 1. Encapsulation of marrow stromal osteoblasts in surface crosslinked gelatin microparticles (2002) Biomaterials, 23, p. 4359Bidarra, S.J., Barrias, C.C., Barbosa, M.A., Soares, R., Granja, P.L., Immobilization of human mesenchymal stem cells within RGD-grafted alginate microspheres and assessment of their angiogenic potential (2010) Biomacromolecules, 11, p. 1956Evangelista, M.B., Hsiong, S.X., Fernandes, R., Sampaio, P., Kong, H.J., Barrias, C.C., Upregulation of bone cell differentiation through immobilization within a synthetic extracellular matrix (2007) Biomaterials, 28, p. 3644Kretlow, J.D., Klouda, L., Mikos, A.G., Injectable matrices and scaffolds for drug delivery in tissue engineering (2007) Adv Drug Delivery Rev, 59, p. 263Evangelista, M.B., Hsiong, S.X., Fernandes, R., Sampaio, P., Kong, H.J., Barrias, C.C., Salema, R., Granja, P.L., Preosteoblasts growth and differentiation into injectable peptide-functionalized pectin (2011) Biomacromolecules, , dx.doi.org/10.1021/bm101110XUludag, H., Horvath, V., Black, J.P., Sefton, M.V., Viability and protein secretion from human hepatoma (Hepg2) cells encapsulated in 400-Mu-M polyacrylate microcapsules by submerged nozzle liquid jet extrusion (1994) Biotechnol Bioeng, 10, p. 1199Kweon, H., Yoo, M.K., Park, I.K., Kim, T.H., Lee, H.C., Lee, H.S., A novel degradable polycaprolactone networks for tissue engineering (2003) Biomaterials, 24, p. 801Fonseca, K.B., Bidarra, S.J., Oliveira, M.J., Granja, P.L., Barrias, C.C., Molecularly designed alginate hydrogels susceptible to local proteolysis as three-dimensional cellular microenvironments (2011) Acta Biomaterialia, 7, p. 1674Grellier, M., Granja, P.L., Fricain, J.C., Bidarra, S.J., Renard, M., Bareille, R., The effect of the co-immobilization of human osteoprogenitors and endothelial cells within alginate microspheres on mineralization in a bone defect (2009) Biomaterials, 30, p. 3271Hench, L.L., Polak, J.M., Xynos, I.D., Buttery, L.D.K., Bioactive materials to control cell cycle (2000) Mater Res Innov, 3, p. 313Chu, C.C., Biodegradable polymeric biomaterials: An updated overview (2000) Biomedical Engineering Handbook, pp. 1-22. , Bronzino, J.D., ed 2nd edition. Boca Raton, FL: CRC PressRatner, B.D., New ideas in biomaterials science-a path to engineered biomaterials (1993) J Biomed Mater Res, 27, p. 837Luciano, R.M., Zavaglia, C.A.C., Duek, E.A.R., Alberto-Rincon, M.C., Synthesis and characterization of poly(L-lactic acid) membranes: Studies in vivo and in vitro (2003) J Mater Sci Mater Med, 14, p. 87Williams, J.M., Adewunmi, A., Schek, R.M., Flanagan, C.L., Krebsbach, P.H., Feinberg, S.E., Hollister, S.J., Das, S., Bone tissue engineering using polycaprolactone scaffolds fabricated via selective laser sintering (2005) Biomaterials, 23, p. 4817Mano, J.F., Sousa, R.A., Boesel, L.F., Neves, N.M., Reis, R.L., Bloinert, biodegradable and injectable polymeric matrix composites for hard tissue replacement: State of the art and recent developments (2004) Compos Sci Technol, 64, p. 789Barbanti, S.H., Santos, A.R., Zavaglia, C.A.C., Duek, E.A.R., Porous and dense poly(L-lactic acid) and poly(D,Llactic acid co-glycolic acid) scaffolds: In vitro degradation in culture medium and osteoblasts culture (2004) J Mater Sci Mater Med, 15, p. 1315Li, S.M., Chen, X.H., Gross, R.A., McCarthy, S.P., Hydrolytic degradation of PCL/PEO copolymers in alkaline media (2000) J Mater Sci Mater Med, 11, p. 227Vert, M., Li, S.M., Spenlehauer, G., Guerin, P., Bioresorbability and biocompatibility of aliphatic polyesters (1992) J Mater Sci Mater Med, 3, p. 432Lam, C.X.F., Hutmacher, D.W., Schantz, J.T., Woodruff, M.A., Teoh, S.H., Evaluation of polycaprolactone scaffold degradation for 6 months in vitro and in vivo (2009) J Biomed Mater Res Part A, 90 A, p. 906Salgado, C.L., Sanchez, E.S., Zavaglia, C.A.C., Granja, P.L., (2009) Método de Confecção de Polímero Biodegradável Injeta ́vel Brazil, , Brazilian submitted patent: PI 018080059526(1999) Standardization of Biological Evaluation of Medical Devices. Part 5: Tests for Cytotoxicity: In Vitro Methods, Volume 10993-5, , ISO, ed. Geneva, SwitzerlandAshton, B.A., Abdullah, F., Cave, J., Williamson, M., Sykes, B.C., Couch, M., Characterization of cells with high alkaline-phosphatase activity derived from human-bone and marrow-preliminary assessment of their osteogenicity (1985) Bone, 6, p. 313Barrias, C.C., Lamghari, M., Granja, P.L., Sa Miranda, M.C., Barbosa, M.A., Biological evaluation of calcium alginate microspheres as a vehicle for the localized delivery of a therapeutic enzyme (2005) J Biomed Mater Res, 72, p. 57Ciapetti, G., Ambrosio, L., Marletta, G., Baldini, N., Giunti, A., Human bone marrow stromal cells: In vitro expansion and differentiation for bone engineering (2006) Biomaterials, 27, p. 6150Vitte, J., Benoliel, A.M., Pierres, A., Bongrand, P., Is there a predictable relationship between surface physical-chemical properties and cell behaviour at the interface? (2004) Eur Cell Mater, 7, p. 52Luttikhuizen, D.T., Harmsen, M.C., Van Luyn, M.J.A., Cellular and molecular dynamics in the foreign body reaction (2006) Tissue Eng, 12, p. 1955Chang, D.T., Jones, J.A., Meyerson, H., Colton, E., Kwon, I.K., Matsuda, T., Lymphocyte/macrophage interactions: Biomaterial surface-dependent cytokine, chemokine, and matrix protein production (2008) J Biomed Mater Res Part A, 87 A, p. 676Rodriguez, A., Meyerson, H., Anderson, J.M., Quantitative in vivo cytokine analysis at synthetic biomaterial implant sites (2009) J Biomed Mater Res Part A, 89 A, p. 152Ratner, B.D., Hoffman, A.S., Schoen, F.J., Lemons, J.E., (1995) Biomaterials Science: An Introduction to Materials in Medicine, , London: Academic PressWoodruff, M.A., Hutmacher, D.W., The return of a forgotten polymer-polycaprolactone in the 21st century (2010) Progr Polym Sci, 35, p. 1217Woodward, S.C., Brewer, P.S., Moatamed, F., Schindler, A., Pitt, C.G., The intracellular degradation of poly(epsiloncaprolactone) (1985) J Biomed Mater Res, 19, p. 437Albertson, A.C., Controlled degradation by artificial and biological processes (1997) Macromolecular Design of Polymeric Materials, pp. 739-780. , Hatada. K., Kitayama, T., and Vogl, O., eds New York, Basel, Hong Kong: Marcel Dekker IncJabbari, E., Wang, S.F., Lu, L.C., Gruetzmacher, J.A., Ameenuddin, S., Hefferan, T.E., Synthesis, material properties, and biocompatibility of a novel self-crosslinkable poly(caprolactone fumarate) as an injectable tissue engineering scaffold (2005) Biomacromolecules, 6, p. 2503Martina, M., Hutmacher, D.W., Biodegradable polymers applied in tissue engineering research: A review (2007) Polym Int, 56, p. 145Shikanov, A., Vaisman, B., Krasko, M.Y., Nyska, A., Domb, A.J., Poly(sebacic acid-co-ricinoleic acid) biodegradable carrier for paclitaxel: In vitro release and in vivo toxicity (2004) J Biomed Mater Res Part A, 69 A, p. 47Shikanov, A., Domb, A.J., Poly(sebacic acid-co-ricinoleic acid) biodegradable injectable in situ gelling polymer (2006) Biomacromolecules, 7, p. 288Modi, S., Jain, J.P., Domb, A.J., Kumar, N., Copolymers of pharmaceutical grade lactic acid and sebacic acid: Drug release behavior and-biocompatibility (2006) Eur J Pharm Biopharm, 64, p. 277Clark, R.A.F., Ghosh, K., Tonnesen, M.G., Tissue engineering for cutaneous wounds (2007) J Invest Dermatol, 127, p. 1018Salgado, A.J., Coutinho, O.P., Reis, R.L., Bone tissue engineering: State of the art and future trends (2004) Macromol Biosci, 4, p. 743Sawyer, A.A., Song, S.J., Susanto, E., Chuan, P., Lam, C.X.F., Woodruff, M.A., The stimulation of healing within a rat calvarial defect by mPCL-TCP/collagen scaffolds loaded with rhBMP-2 (2009) Biomaterials, 30, p. 247

Opportunistic infections and AIDS malignancies early after initiating combination antiretroviral therapy in high-income countries

Background: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis. Methods: We identified individuals in the HIV-CAUSAL Collaboration, which includes data from six European countries and the US, who were HIV-positive between 1996 and 2013, antiretroviral therapy naive, aged at least 18 years, hadCD4+ cell count and HIV-RNA measurements and had been AIDS-free for at least 1 month between those measurements and the start of follow-up. For each AIDS-defining event, we estimated the hazard ratio for no cART versus less than 3 and at least 3 months since cART initiation, adjusting for time-varying CD4+ cell count and HIV-RNA via inverse probability weighting. Results: Out of 96 562 eligible individuals (78% men) with median (interquantile range) follow-up of 31 [13,65] months, 55 144 initiated cART. The number of cases varied between 898 for tuberculosis and 113 for PML. Compared with non-cART initiation, the hazard ratio (95% confidence intervals) up to 3 months after cART initiation were 1.21 (0.90-1.63) for tuberculosis, 2.61 (1.05-6.49) for MAC, 1.17 (0.34-4.08) for CMV retinitis, 1.18 (0.62-2.26) for PML, 1.21 (0.83-1.75) for HSV, 1.18 (0.87-1.58) for Kaposi sarcoma, 1.56 (0.82-2.95) for NHL, 1.11 (0.56-2.18) for cryptococcosis and 0.77 (0.40-1.49) for candidiasis. Conclusion: With the potential exception of mycobacterial infections, unmasking IRIS does not appear to be a common complication of cART initiation in high-income countries. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Opportunistic infections and AIDS malignancies early after initiating combination antiretroviral therapy in high-income countries

Background: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis. Methods: We identified individuals in the HIV-CAUSAL Collaboration, which includes data from six European countries and the US, who were HIV-positive between 1996 and 2013, antiretroviral therapy naive, aged at least 18 years, hadCD4+ cell count and HIV-RNA measurements and had been AIDS-free for at least 1 month between those measurements and the start of follow-up. For each AIDS-defining event, we estimated the hazard ratio for no cART versus less than 3 and at least 3 months since cART initiation, adjusting for time-varying CD4+ cell count and HIV-RNA via inverse probability weighting. Results: Out of 96 562 eligible individuals (78% men) with median (interquantile range) follow-up of 31 [13,65] months, 55 144 initiated cART. The number of cases varied between 898 for tuberculosis and 113 for PML. Compared with non-cART initiation, the hazard ratio (95% confidence intervals) up to 3 months after cART initiation were 1.21 (0.90-1.63) for tuberculosis, 2.61 (1.05-6.49) for MAC, 1.17 (0.34-4.08) for CMV retinitis, 1.18 (0.62-2.26) for PML, 1.21 (0.83-1.75) for HSV, 1.18 (0.87-1.58) for Kaposi sarcoma, 1.56 (0.82-2.95) for NHL, 1.11 (0.56-2.18) for cryptococcosis and 0.77 (0.40-1.49) for candidiasis. Conclusion: With the potential exception of mycobacterial infections, unmasking IRIS does not appear to be a common complication of cART initiation in high-income countries

Human immunodeficiency virus continuum of care in 11 european union countries at the end of 2016 overall and by key population: Have we made progress?

Background. High uptake of antiretroviral treatment (ART) is essential to reduce human immunodeficiency virus (HIV) transmission and related mortality; however, gaps in care exist. We aimed to construct the continuum of HIV care (CoC) in 2016 in 11 European Union (EU) countries, overall and by key population and sex. To estimate progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, we compared 2016 to 2013 estimates for the same countries, representing 73% of the population in the region. Methods. A CoC with the following 4 stages was constructed: number of people living with HIV (PLHIV); proportion of PLHIV diagnosed; proportion of those diagnosed who ever initiated ART; and proportion of those ever treated who achieved viral suppression at their last visit. Results. We estimated that 87% of PLHIV were diagnosed; 92% of those diagnosed had ever initiated ART; and 91% of those ever on ART, or 73% of all PLHIV, were virally suppressed. Corresponding figures for men having sex with men were: 86%, 93%, 93%, 74%; for people who inject drugs: 94%, 88%, 85%, 70%; and for heterosexuals: 86%, 92%, 91%, 72%. The proportion suppressed of all PLHIV ranged from 59% to 86% across countries. Conclusions. The EU is close to the 90-90-90 target and achieved the UNAIDS target of 73% of all PLHIV virally suppressed, significant progress since 2013 when 60% of all PLHIV were virally suppressed. Strengthening of testing programs and treatment support, along with prevention interventions, are needed to achieve HIV epidemic control

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P < 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P < 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -9·4 (95 per cent c.i. -11·9 to -6·9) per cent; P < 0·001), but the relationship was reversed in low-HDI countries (+12·1 (+7·0 to +17·3) per cent; P < 0·001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0·60, 0·50 to 0·73; P < 0·001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone