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BackgroundInformation on tuberculosis (TB) and coronavirus disease 2019 (COVID-19) is still limited. The aim of this study was to describe the features of the TB/COVID-19 co-infected individuals from a prospective, anonymised, multicountry register-based cohort with special focus on the determinants of mortality and other outcomes.MethodsWe enrolled all patients of any age with either active TB or previous TB and COVID-19. 172 centres from 34 countries provided individual data on 767 TB-COVID-19 co-infected patients, (>50% population-based).ResultsOf 767 patients, 553 (74.0%) out of 747 had TB before COVID-19 (including 234 out of 747 with previous TB), 71 (9.5%) out of 747 had COVID-19 first and 123 (16.5%) out of 747 had both diseases diagnosed within the same week (n=35 (4.6%) on the same day). 85 (11.08%) out of 767 patients died (41 (14.2%) out of 289 in Europe and 44 (9.2%) out of 478 outside Europe; p=0.03): 42 (49.4%) from COVID-19, 31 (36.5%) from COVID-19 and TB, one (1.2%) from TB and 11 from other causes. In the univariate analysis on mortality the following variables reached statistical significance: age, male gender, having more than one comorbidity, diabetes mellitus, cardiovascular disease, chronic respiratory disease, chronic renal disease, presence of key symptoms, invasive ventilation and hospitalisation due to COVID-19. The final multivariable logistic regression model included age, male gender and invasive ventilation as independent contributors to mortality.ConclusionThe data suggest that TB and COVID-19 are a “cursed duet” and need immediate attention. TB should be considered a risk factor for severe COVID disease and patients with TB should be prioritised for COVID-19 preventative efforts, including vaccination.

International audience

Introducción: Los defectos congénitos son anomalías morfológicas o funcionales, de causa genética y/o ambiental, pre o post concepcional, que afectan entre el 2 - 5 % de los nacimientos; constituyen la segunda causa de mortalidad infantil en América del Sur. En nuestro país ocupa el cuarto lugar en menores de un año. El 15% de las gestaciones concluyen como abortos espontáneos; de estas, el 80% presenta un embrión con defectos. La mitad de los casos pueden prevenirse, ello implica un principio de responsabilidad moral para la sociedad, agravado en la clase médica. La mayoría de los centros públicos carecen de la colaboración de un especialista en genética, recayendo en el pediatra la responsabilidad de las primeras e importantes orientaciones sobre el defecto congénito constatado en el paciente. Objetivos: Determinar el grado de conocimiento de los pediatras en relación a la etiología, factores de riesgo y formas de prevención de los defectos congénitos. Material y Métodos: Estudio de diseño prospectivo observacional descriptivo, con muestreo no probabilístico de casos consecutivos. Se interrogo a 117 médicos de 3 centros públicos con programa de formación de especialistas en pediatría, con un cuestionario voluntario, individual y anónimo constituido por 54 preguntas, de las cuales 51 evaluaban el nivel de conocimiento sobre el tema. Resultados: De los 117 médicos encuestados: 47% (n: 55) eran residentes, 48% (n: 56) pediatras, 4.2% neonatólogos (n:5), 0,8% médicos de familia (n:1). La proporción de respuestas correctas fue de 35/51 (68,6%). El 28,2% (n: 33) conoce la influencia de los defectos congénitos en la mortalidad infantil, el 44,4%(n: 52) la desconoce. La talidomida y las tetraciclinas fueron reconocidas como agentes teratogénicos por más del 80% de los encuestados, menos del 50% reconoció la acción teratogénica de la vitamina A, del acido valproico y del enalapril. Más del 80% reconoció como agente no teratogénico al acido fólico, al paracetamol y a la amoxicilina. El 80% indicó que no hay una dosis segura de ingesta alcohólica. Más del 80% identificó como factores de riesgo la consanguinidad, hijo previo malformado y la edad materna. El 56% y el 83% reconocieron inequívocamente la edad paterna y el tabaquismo materno como factores de riesgo respectivamente. El 95,7% reconoció la aparición del Síndrome de Down como relacionado a la edad materna, pero menos del 50% identifico a las Trisomías 13 y 18 asociadas a este mismo factor. El 21,4% indico correctamente la incidencia de Síndrome de Down en niño de mujeres mayores de 35 años. Más del 80% indico correctamente la determinación del Sx. De Down y el Sx. De Turner por cariotipo fetal. El 94,8% determino correctamente que las malformaciones de tubo neural pueden prevenirse con la ingesta de ácido fólico y el 75,2% respondió correctamente el momento de administración del mismo. El 9,4% indico que se realiza la orientación genética previa al alta del paciente. Conclusión: Existe desconocimiento sobre la influencia de los defectos congénitos en la mortalidad infantil en nuestro país, así como la incidencia de Síndrome de Down en mujeres mayores de 35 años. El conocimiento de los encuestados resulto aceptable en relación a la etiología y los factores de riesgo y satisfactorio en relación a la prevención de defectos congénitos. Introduction: Congenital disorders are morphological or functional anomalies of genetic or environmental origin and which may pre- or post-date conception. They affect from 2% to 5% of births, and are the second most common cause of infant mortality in South America. In Paraguay they are the fourth leading cause of death for infants of less than 1 year of age. Spontaneous abortion occurs in 15% of pregnancies; of these 80% are of embryos with abnormalities. Since half of these cases could be prevented, society, and the medical community especially, bear moral responsibility in the matter. Most public facilities lack the assistance of a genetic specialist, and therefore responsibility for the important initial guidance concerning any congenital disorder detected falls on the pediatrician. Objectives: To determine the state of knowledge of pediatricians concerning causes, risk factors, and preventative measures for congenital disorders. Material and Methods: A prospective observational and descriptive study with a non-probabilistic sample of consecutive cases. We used a form with 54 questions, 51 of them on congenital disorders, to voluntarily and anonymously survey 117 physicians in 3 public facilities that train pediatric specialists. Results: Of the 117 physicians surveyed, 47% (n: 55) were residents, 48% (n: 56) pediatricians, 4.2% (n: 5) neonatologists, and 0.8% (n: 1) family practitioners. An average of 35/51 (68.6%) of answers were correct. A total of 28.2% (n: 33) knew the effect of congenital disorders on the infant mortality rate, while 44.4% (n: 52) did not. More than 80% of those surveyed recognized thalidomide and the tetracyclines as teratogenic agents, but less than 50% knew of the teratogenic action of vitamin A, valproic acid, or enalapril. More than 80% correctly identified folic acid, paracetamol (acetaminophen), and amoxicillin as non-teratogenic. That no safe amount of alcohol consumption exists was sustained by 80%. More than 80% identified consanguinity, maternal age, and a previous malformed child as risk factors. Paternal age and tobacco use by the mother were also unequivocally recognized as risk factors. Down's syndrome was recognized as related to maternal age by 95.7%, but less than 50% identified trisomy 13 or 18 as being associated with it. The incidence of Down's syndrome in women over age 35 was correctly identified by 21.4%. More than 80% correctly identified how to determine Down’s and Turner's syndrome by fetal karyotyping That malformation of the neural tube can be prevented by intake of folic acid was correctly supported by 94.8%, while 75.2% correctly identified when it should be administered. Only 9.4% reported providing genetic counseling to patients before discharge. Conclusion: A lack of knowledge exists concerning the influence of congenital disorders on infant mortality in Paraguay and of the incidence of Down's syndrome in children of women over age 35. Those surveyed showed acceptable levels of knowledge concerning the causes and risk factors for congenital disorders, and satisfactory knowledge concerning their prevention.