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Background: TB is concentrated in populations with complex health and social issues, including alcohol use disorders (AUD). We describe treatment adherence and outcomes in a person-centred, multidisciplinary, psychosocial support and harm reduction intervention for people with multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) with harmful alcohol use., Methods: An observational cohort study, including multilevel mixed-effects logistic regression and survival analysis with people living in Minsk admitted with MDR/RR-TB and AUD during January 2019-November 2021 who received this person-centred, multidisciplinary, psychosocial support and harm reduction intervention, was conducted., Results: There were 89 participants enrolled in the intervention, with a median follow-up of 12.2 (IQR: 8.1-20.5) mo. The majority (n=80; 89.9%) of participants had AUD, 11 (12.4%) also had a dependence on other substances, six (6.7%) a dependence on opioids and three (3.4%) a personality disorder. Fifty-eight had a history of past incarceration (65.2%), homelessness (n=9; 10.1%) or unemployment (n=55; 61.8%). Median adherence was 95.4% (IQR: 90.4-99.6%) and outpatient adherence was 91.2% (IQR: 65.1-97.0%). Lower adherence was associated with hepatitis C, alcohol plus other substance use and outpatient facility-based treatment, rather than video-observed treatment, home-based or inpatient treatment support., Conclusions: This intervention led to good adherence to MDR/RR-TB treatment in people with harmful use of alcohol, a group usually at risk of poor outcomes. Poor outcomes were associated with hepatitis C, other substance misuse and outpatient facility-based treatment support., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

The academic literature concerning the tissue bridging the anterior vaginal wall and the posterior urethral wall, the urethrovaginal septum, is lacking and inconsistent, not only when compared to non-reproductive anatomy but also when compared to male reproductive anatomy. This knowledge gap must be addressed, given the implication of this tissue in numerous female reproductive pathologies and functions, including pelvic organ prolapse, intercourse and orgasm, urethral strictures, vaginal cancers, and stress urinary incontinence. This study seeks to characterize the histological composition of the urethrovaginal septum, including type I and III collagen proportions, elastin content, neurovascular distribution, and smooth muscle arrangement. Specimens were resected bilaterally from the bisected pelvic region of a postmenopausal female cadaver, spanning antero-posteriorly from the lumen of the urethra to the lumen of the vagina. The specimens were divided into medial and lateral portions, sectioned, and stained with hematoxylin and eosin, trichrome, reticulin, and elastin stains. Images were obtained through virtual microscopy. Type I collagen was confirmed as the major connective tissue component. Reticular fibers were mainly limited to blood and lymphatic vessel walls, as well as the perineurium and epineurium of nerve fibers. The elastic fiber content was minimal, appearing mainly in the lamina propria and vascular walls and interspersed with type I collagen in the connective tissue matrix of the septum. Smooth muscle bundles were mainly observed in the muscularis layers of both walls, but to a greater extent in the anterior vagina. These findings largely confirm those of the few published histological studies of this tissue while contributing to the current state of knowledge regarding the distribution of elastin and reticulin. Further research in premenopausal females and increased awareness of the microanatomy of the urethrovaginal septum is advised., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rieker et al.)

Femoro-femoral bypass grafts (FFBG) are performed to connect the major vessels of the lower extremities, such as the femoral arteries, to treat patients who have injured or occluded iliac arteries. Typically, patients with multiple comorbidities, such as heart failure, aneurysms, or diabetes, have a significantly higher risk of complications for open, invasive procedures to correct lower limb ischemia. This graft poses as an effective, less invasive option to treat lower-limb ischemia for higher-risk patients. This case study presents a finding of FFBG in an 82-year-old male cadaver during cadaveric dissection in the gross anatomy lab at Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania. Based on the initial findings of cardiomegaly with a triple coronary artery bypass graft (CABG) and pulmonary hypertension in the thoracic cavity and evidence of massive umbilical hernioplasty involving extensive mesh repair, our initial assumption of an FFBG placement in this cadaver was to increase perfusion to lower limbs, circumventing the need for surgical intervention due to the above-mentioned comorbidities, which act as risk factors. However, the discovery of a massive abdominal aortic aneurysm (AAA) measuring 26 cm in circumference with evidence of dissection of its wall and the presence of a stent within the aorta and common iliac arteries placed there as an endovascular aneurysm repair (EVAR) procedure came as a surprise. Publication of such findings provides awareness to curious individuals about the existence of multiple health concerns an individual suffers and how the medical as well as surgical teams work together to provide optimal treatment care to improve their standard of living and prolong their lifespan., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Geisinger Commonwealth School of Medicine issued approval (RAN- 20240203). Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Fung et al.)

This article discusses how inadequate anatomy education contributes to iatrogenic causes of human morbidity and mortality. Through a review of the relevant literature, high-yield clinical cases were identified in which a lack of sufficient anatomical knowledge contributed to patient morbidity, such as abscess formation and neuropathy as a result of improper intramuscular injections, superior gluteal nerve injuries due to surgical procedures, and misdiagnoses due to physicians' inability to examine and correlate clinical and radiological findings. The importance of a multimodal learning approach in anatomy education for medical students, which includes the utilization of the cadaveric dissection approach to emphasize spatial understanding, is crucial for the development of competent physicians with a deep-rooted foundational knowledge of anatomy and related concepts, such as physiology, pathology, and radiology. It cannot be understated that anatomy education and a lack of knowledge of anatomy and related concepts may influence iatrogenic causes of human morbidity and mortality. Therefore, all efforts should be made to ensure that students develop a strong foundational anatomy knowledge during their preclinical years., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Moglia et al.)

Background: Tuberculosis (TB) often concentrates in groups of people with complex health and social issues, including alcohol use disorders (AUD). Risk of TB, and poor TB treatment outcomes, are substantially elevated in people who have AUD. Médecins sans Frontières and the Belarus Ministry of Health have worked to improve treatment adherence in patients with multi-drug or rifampicin resistant (MDR/RR)-TB and harmful use of alcohol. In 2016, a person-centred, multidisciplinary, psychosocial support and harm reduction programme delivered by TB doctors, counsellors, psychiatrists, health-educators, and social workers was initiated. In 2020, we described patient and provider experiences within the programme as part of a wider evaluation., Methods: We recruited 12 patients and 20 health-care workers, using purposive sampling, for in-depth individual interviews and focus group discussions. We used a participant-led, flexible, exploratory approach, enabling participants and the interviewer to shape topics of conversation. Qualitative data were coded manually and analysed thematically. As part of the analysis process, identified themes were shared with health-care worker participants to enable their reflections to be incorporated into the findings., Results: Key themes related to the patients' and practitioners experience of having and treating MDRTB with associated complex health and social issues were: fragility and despair and guidance, trust and health. Prejudice and marginalisation were global to both themes. Counsellors and other health workers built a trusting relationship with patients, enabling guidance through a multi-disciplinary approach, which supported patients to achieve their vision of health. This guidance was achieved by a team of social workers, counsellors, doctors and health-educators who provided professional and individualised help for patients' illnesses, personal or interpersonal problems, administrative tasks, and job searches., Conclusions: Patients with MDR/RR-TB and harmful use of alcohol faced complex issues during treatment. Our findings describe how person-centred, multi-disciplinary, psychosocial support helped patients in this setting to cope with these challenges and complete the treatment programme. We recommend that these findings are used to: i) inform programmatic changes to further boost the person-centred care nature of this program; and ii) advocate for this type of person-centred care approach to be rolled out across Belarus, and in contexts that face similar challenges., (© 2022. The Author(s).)

Family-centered prevention is effective at reducing risk behavior throughout the life span and promoting healthy development. Despite research that suggests parents continue to play a significant role in the lives of their children during emerging adulthood, very few studies have examined effective family-centered strategies for preventing risk behavior in young adults. Typical prevention efforts for this age group have focused on college students and substance use prevention, with no integration of families or systems of support that may sustain the effects of the intervention. In this study, we evaluated a version of the Family Check-Up (FCU) that was adapted for young adults and their families, the Young Adult Family Check-Up (YA-FCU). Families were randomly assigned to receive the FCU or school as usual during the middle school years. Ten years later, they were offered the YA-FCU, which was adapted for families of emerging adult children. Intent-to-treat and complier average causal effect analyses were used to examine change in young adult risk behavior approximately 1 year after receiving the YA-FCU. Analyses indicated that random assignment alone or simple engagement was not associated with reductions in young adult risk behavior. However, dose-response analyses indicated that the more hours that youth and families were engaged in the YA-FCU, the greater the reductions in young adult risk behavior relative to those who did not engage or engaged very little in the intervention, resulting in a medium effect size of the YA-FCU on risk behavior.