Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

CONOSCENZE, ATTITUDINI E PRATICHE SULLA TUBERCOLOSI TRA GLI STUDENTI ITALIANI: RISULTATI PRELIMINARI

La tubercolosi (tbc) rappresenta un problema di Sanità Pubblica riemergente a livello globale, come indicato dall'Organizzazione Mondiale della Sanità (OMS) a partire dal 1993. In Italia, il tasso di notifica di TB negli ultimi anni è risultato inferiore a 10 casi per 100.000 abitanti, soglia entro la quale un Paese è definito dall'OMS "a bassa incidenza". Tra i soggetti più a rischio di contrarre l'infezione figurano gli operatori sanitari e gli studenti dei Corsi di Laurea dell'area medica. La corretta conoscenza della malattia rappresenta il presupposto per le attività di prevenzione e controllo. La presente indagine ha lo scopo di valutare le conoscenze sulla tbc degli studenti dei Corsi di Laurea dell'area sanitaria in Italia. Metodi L'indagine è stata svolta in 14 Università Italiane attraverso un questionario predisposto dal GISIO (Gruppo Italiano Studio Igiene Ospedaliera) e somministrato al termine delle lezioni dei corsi di Igiene e Medicina Preventiva. Il questionario raccoglieva diversi item: corso di laurea, eziologia della tbc, prognosi, trattamento e prevenzione dell'infezione. Risultati Sono stati reclutati 1.855 studenti (66,5% di sesso femminile), di cui 520 iscritti al corso di laurea in Medicina e Chirurgia e 1.335 ai corsi di laurea delle professioni sanitarie. Il 95% degli intervistati conosce l'eziologia della tbc, ed il 77% afferma l'esistenza di potenziali forme di malattia extra-polmonari; il 67% riporta che la tbc non trattata ha una letalità superiore al 50%, mentre il 76% evidenzia la necessità di una assunzione prolungata di antibiotici, con probabilità di sviluppare una farmaco-resistenza (79%). Il 28% sottolinea come la maggior parte delle infezioni decorrono in maniera asintomatica. L'87% degli intervistati conosce l'esistenza di un vaccino anti-tbc, mentre il 69% ritiene che non sia completamente efficace ed il 42% che sia costituito dal bacillo di Calmette-Guerin. L'88% degli studenti identifica la prova tubercolinica quale test di screening dell'infezione latente, il restante 12% la indica come test di laboratorio, vaccino o terapia. Conclusioni: Anche se la maggior parte degli studenti conosce la tbc, una parte (rilevante per alcuni quesiti) evidenzia importanti carenze conoscitive, ad esempio quelle concernenti la frequenza di forme latenti o la composizione del vaccino. I dati ottenuti indicano un basso livello di attenzione nei confronti della malattia, probabilmente legato ad una scarsa percezione del rischio. Risulta necessario, pertanto, potenziare le strategie formative nei Corsi di Laurea, con particolare attenzione alla prevenzione del rischio biologico in ambito assistenziale

SIMILAR BUT NOT THE SAME: CHROMOSOMAL ABNORMALITIES T(8;21)(Q22;Q22) AND INV(16)(P13;Q22)/T(16;16)(P13;Q22) IDENTIFY SUBTYPES OF CORE BINDING FACTOR ACUTE MYELOID LEUKEMIA CHARACTERIZED BY DIFFERENT SURVIVAL AND PROGNOS- TIC FACTORS

Aim. To address the heterogeneity of CBF AML patients- t(8;21)(q22;q22)/RUNX1-RUNX1T1 and inv(16)(p13q22)/t(16;16)(p13q22)/CBFB-MYH11- by assessing their char- acteristics at diagnosis and their response to therapy. Methods. we ret- rospectively studied 132 patients (t(8;21) n=58; inv(16)/t(16;16) n=74) treated with curative intent in 9 Hematology Centers between 1987 and 2012. Median follow-up was 66 months(10-294). Cytogenetic data at diagnosis were available for all patients, while only 39 had KIT(29.5%), 63 FLT3(47.7%) and 54 NPM1 assessment(40.9%). Patients were treat- ed with regimens either based on DA37 and similar (n=102) or first-line Fludarabine-containing regimens (n=30). All patients achieving complete remission (CR) after induction were consolidated with 1 (n=18), 2 (n=49) or >3 (n=50) cycles with HiDAC. 29 patients underwent ASCT, and 15 first-line allogeneic HSCT. Results. median age was 44 yrs (15-79). 5-year OS, DFS and EFS of the whole series was 62%, 58.9% and 53.5%, respectively. While achieving high CR rates after induction (86.2% vs 90.5%, P=NS), patients with t(8;21) experienced worse 5-yr OS (57.3% vs 67.7%, P=0.09), DFS (47.0 vs 67.5, P=0.015) and EFS (43.6% vs 60.8%, P=0.045) than patients with inv16/t(16;16), due to a trend to higher relapse (48% vs 32.8%, P=NS) and poorer response to salvage treament. Considering all patients, age >61 yrs, grade-4 thrombocytopenia, ele- vated LDH and D816 KIT mutation were predictive for poorer OS, while the presence of extramedullary disease/granulocytic sarchoma, and D816 KIT mutation were prognostically relevant only for t(8;21) patients; con- versely, age>61, leukocytosis and grade-4 thrombocytopenia were pre- dictive only for inv16/t(16:16) patients. Noteworthy, D816 KIT mutation did not predict prognosis in inv(16)/t(16;16) patients. Additional trisomy 22 (n=7), trisomy 8 (n=5) and chromosome 7 alterations (n=6) were asso- ciated with a trend to better survival. Neither the presence of FLT3 muta- tions (ITD/TKD) nor the presence of NPM1 mutations affected progno- sis. The use of first-line Fludarabine did not yield clear advantages, while the achievement of complete remission after induction had maximal impact on OS (HR 4.82; 95%CI: 2.29-10.16, p<0.001). We observed a clear survival benefit in a small selected series consolidated by first-line autologous (n=29) or allogenic HSCT (n=15, P=0.022) after HiDAC. Con- clusions:t(8;21) and inv(16)/t(16;16) CBF AML should be considered as two distinct entities

Evidence for the decay X(3872) -> psi(2S)gamma

Evidence for the decay mode X(3872) -> psi(2S)gamma in B+ -> X(3872)K+ decays is found with a significance of 4.4 standard deviations. The analysis is based on a data sample of proton proton collisions, corresponding to an integrated luminosity of 3 fb(-1), collected with the LHCb detector, at centre-of-mass energies of 7 and 8 TeV. The ratio of the branching fraction of the X(3872) -> psi(2S)gamma decay to that of the X(3872) -> J/psi gamma decay is measured to be B(X(3872) -> psi(2S)gamma)/B(X(3872) -> J/psi gamma) = 2.46 +/- 0.64 +/- 0.29, where the first uncertainty is statistical and the second is systematic. The measured value does not support a pure D (D) over bar* molecular interpretation of the X(3872) state. (C) 2014 CERN for the benefit of the LHCb Collaboration. Published by Elsevier B.V

Measurement of the charge asymmetry in B-+/- -> phi K +/- and search for B-+/- -> phi pi(+/-) decays

The CP-violating charge asymmetry in B-+/- -> phi K-+/- decays is measured in a sample of pp collisions at 7 TeV centre-of-mass energy, corresponding to an integrated luminosity of 1.0 fb-1 collected by the LHCb experiment. The result is A(CP)(B-+/- -> phi K-+/-) = 0.022 +/- 0.021 +/- 0.009, where the first uncertainty is statistical and the second systematic. In addition, a search for the B-+/- -> phi pi(+/-) decay mode is performed, using the B-+/- -> phi K-+/- decay rate for normalization. An upper limit on the branching fraction B(B-+/- -> phi pi(+/-)) < 1.5 x 10(-7) is set at 90% confidence level. (C) 2013 The Authors. Published by Elsevier B.V. All rights reserved

B flavour tagging using charm decays at the LHCb experiment

An algorithm is described for tagging the flavour content at production of neutral B mesons in the LHCb experiment. The algorithm exploits the correlation of the flavour of a B meson with the charge of a reconstructed secondary charm hadron from the decay of the other b hadron produced in the proton-proton collision. Charm hadron candidates are identified in a number of fully or partially reconstructed Cabibbo-favoured decay modes. The algorithm is calibrated on the self-tagged decay modes B+ -> J/psi K+ and B-0 -> J/psi K*(0) using 3.0fb(-1) of data collected by the LHCb experiment at pp centre-of-mass energies of 7TeV and 8TeV. Its tagging power on these samples of B -> J/psi X decays is (0.30 +/- 0.01 +/- 0.01) %