Clinical, epidemiological and laboratory characteristics of cases of Covid-19-related maternal near miss and death at referral units in northeastern Brazil: a cohort study.

Objective: Covid-19 poses a major risk during pregnancy and postpartum, resulting in an increase in maternal mortality worldwide, including in Brazil; however, little research has been conducted into cases of a near miss. This study aimed to describe the frequency of COVID-19-related near miss and deaths during pregnancy or in the postpartum in referral centers in northeastern Brazil, as well as the clinical, epidemiological, and laboratory characteristics of the women who experienced a severe maternal outcome.Methods: A retrospective and prospective cohort study was performed between April 2020 and June 2021 with hospitalized pregnant and postpartum women with a diagnosis of COVID-19 confirmed by real-time polymerase chain reaction (RT-PCR). Data from five tertiary hospitals in northeastern Brazil were evaluated. Descriptive statistical analysis was performed using Epi Info, version 7.2.5.0.Results: A total of 463 patients were included. Of these, 64 (14% of the sample) had a severe maternal outcome, with 42 cases of near miss (9%) and 22 maternal deaths (5%). Patients who had a severe maternal outcome were predominantly young (median age 30 years) and 65.6% were black or brown-skinned. The women had between 6 and 16 years of schooling; 45.3% had a stable partner; 81.3% were pregnant at the time of admission to the study; and 76.6% required a Cesarean section. The great majority (82.8%) had severe acute respiratory syndrome (SARS). Other complications included hypertensive syndromes (40.6%), pneumonia (37.5%), urinary tract infections (29.7%), acute renal failure (25.0%) and postpartum hemorrhage (21.9%). Sepsis developed in 18.8% of cases, neurological dysfunction in 15.6%, and hepatic dysfunction and septic shock in 14.1% of cases each. The relative frequency of admission to an intensive care unit was 87.5%, while 67.2% of the patients required assisted mechanical ventilation, and 54.7% required noninvasive ventilation. Antibiotics were prescribed in 93.8% of cases and corticosteroids in 71.9%, while blood transfusion was required in 25.0% of cases and renal replacement therapy in 15.6%. Therapeutic anticoagulants were administered to 12.5% of the patients. Of the patients who had a severe maternal outcome, the frequency of respiratory dysfunction was 93.8%, with 50.0% developing neurological dysfunction and 37.5% cardiovascular dysfunction. Hematological dysfunction was found in 29.7%, renal dysfunction in 18.8%, and uterine dysfunction in 14.1%. Hepatic dysfunction occurred in 7.8% of the sample. The near-miss ratio for Covid-19 was 1.6/1000 live births and the maternal mortality ratio for Covid-19 was 84.8/100,000 live births, with a mortality index of 34.4% in the sample.Conclusion: This study revealed a low Covid-19-related maternal near miss (MNM) ratio of 1.6/1000 live births and a high Covid-19-related maternal mortality ratio (MMR) of 84.81/100,000 live births. The mortality index was also high. Most of the patients were admitted while pregnant, were young, married and black or brown-skinned, and none had completed university education. The majority had SARS and required admission to an intensive care unit and mechanical ventilation. Most were submitted to a Cesarean section.

Validation and use of a serum bactericidal antibody assay for Neisseria meningitidis serogroup X in a seroprevalence study in Niger, West Africa.

Invasive meningococcal disease (IMD) affects approximately 1.2 million people worldwide annually. Prevention of IMD is mostly provided through vaccination; however, no licensed vaccine is currently available to protect against meningococcal serogroup X associated infection. Limited data are available on the natural immunity to Neisseria meningitidis serogroup X within the African sub-Saharan meningitis belt. The objective of the study was to provide an overview of natural immunity to serogroup X within a community in the African meningitis belt prior to the introduction of a pentavalent conjugate vaccine (NmCV-5). Prior to its introduction, a validated assay to assess vaccine efficacy was also required. This study therefore incorporated two objectives: a seroprevalence study to assess natural immunity in serum samples (n = 377) collected from Niger, West Africa in 2012, and the validation of a serogroup X serum bactericidal antibody (SBA) assay. Seroprevalence data obtained found that natural immunity to N. meningitidis serogroup X were present in 52.3% of study participants. The highest putative protective titres (≥8) to serogroup X were seen in age group 5-14 years-old (73.9%) and lowest in ages < 1 year old (0%). The SBA assay was successfully validated for selectivity/specificity, precision/reproducibility, linearity, and stability. This study demonstrated the suitability of the serogroup X SBA assay in clinical trials for future meningococcal conjugate vaccines containing serogroup X polysaccharides.

Sound mind vs sound heart.

Depressive and anxiety disorders have both have been associated with an increased risk of cardiovascular disease. This article highlights the multifactorial and bidirectional interaction between cardiovascular diseases, depression and anxiety, and the need for early assessment, diagnosis and intervention.

New non-cognitive procedures for medical applicant selection: a qualitative analysis in one school.

BACKGROUND: Recent data have called into question the reliability and predictive validity of standard admission procedures to medical schools. Eliciting non-cognitive attributes of medical school applicants using qualitative tools and methods has thus become a major challenge. METHODS: 299 applicants aged 18-25 formed the research group. A set of six research tools was developed in addition to the two existing ones. These included: a portfolio task, an intuitive task, a cognitive task, a personal task, an open self-efficacy questionnaire and field-notes. The criteria-based methodology design used constant comparative analysis and grounded theory techniques to produce a personal attributes profile per participant, scored on a 5-point scale holistic rubric. Qualitative validity of data gathering was checked by comparing the profiles elicited from the existing interview against the profiles elicited from the other tools, and by comparing two profiles of each of the applicants who handed in two portfolio tasks. Qualitative validity of data analysis was checked by comparing researcher results with those of an external rater (n =10). Differences between aggregated profile groups were checked by the Npar Wilcoxon Signed Ranks Test and by Spearman Rank Order Correlation Test. All subjects gave written informed consent to their participation. Privacy was protected by using code numbers. RESULTS: A concept map of 12 personal attributes emerged, the core constructs of which were motivation, sociability and cognition. A personal profile was elicited. Inter-rater agreement was 83.3%. Differences between groups by aggregated profiles were found significant (p < .05, p < .01, p < .001).A random sample of sixth year students (n = 12) underwent the same admission procedure as the research group. Rank order was different; and arrogance was a new construct elicited in the sixth year group. CONCLUSIONS: This study suggests a broadening of the methodology for selecting medical school applicants. This methodology differentiates between both individuals and groups, providing a personal attribute profile of applicants, useful for admission procedures. The qualitative procedures are cost-effective, can easily be taught and used by faculty members. The predictive validity of the presented model requires a longitudinal trial.

Faculty development in end-of-life care: evaluation of a national train-the-trainer program.

To address serious deficiencies in physician training in end-of-life care, the authors developed and disseminated a faculty development curriculum. The overall goals of this curriculum were to enhance physician competence in end-of-life care, foster a commitment to improving care for the dying, and improve teaching related to end-of-life care. The authors provide descriptions of the curriculum and the train-the-trainer programs (2000-2002) that successfully prepared 17 medical faculty as in-house end-of-life care faculty developers at institutions nationwide. They also report on a study of the effects of the 16-hour, end-of-life care curriculum delivered by trained facilitators to 62 faculty and residents at their home sites. Program evaluation showed that the home-site seminars enhanced the knowledge, skills, and attitudes of participating faculty and residents. When project evaluation concluded in 2003, trained facilitators had disseminated the 16-hour curriculum as well as modified versions of the curriculum to approximately 3,400 medical teachers. An adapted version of the curriculum is available on the Internet for use in health professions education. The importance of this type of faculty development effort was confirmed by the positive impact of the 16-hour curriculum on participants' knowledge, skills, and attitudes related to end-of-life care, the high ratings of the program's educational and clinical relevance, and the finding that, on average, more than 50% of the material was new to them.

An interactive course to enhance self-efficacy of family practitioners to treat obesity.

BACKGROUND: Physicians' awareness of their important role in defusing the obesity epidemic has increased. However, the number of family practitioners who treat obesity problems continues to be low. Self-efficacy refers to the belief in one's ability to organize and execute the courses of action required to produce given attainments. Thus, practitioners who judge themselves incapable of managing obesity do not even try. We hypothesized that practitioners' self-efficacy and motivation would be enhanced as a result of participating in an interactive course designed to enrich their knowledge of obesity management. METHODS: Twenty-nine family practitioners participated in the course, which was accompanied by qualitative interviews. The difference between the physicians' pre-course and post-course appraisals was tested by paired t-test. The interviews were analyzed by qualitative methods. RESULTS: Post-course efficacy appraisals were significantly higher than pre-course appraisals (p < 0.0005). A deeper insight on the practitioners' self-efficacy processes was gained through reflection of the practitioners on their self-efficacy during the interviews. CONCLUSIONS: Up-to-date information and workshops where skills, attitudes and social support were addressed were important in making the program effective.