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

Anxiety, depression symptoms, and physical activity levels of eutrophic and excess-weight Brazilian elite police officers: a preliminary study

Rodrigo L Vancini,1 Claudio AB de Lira,2 Sarah A Anceschi,1 André V Rosa,1 Ana P Lima-Leopoldo,1 André S Leopoldo,1 Weverton Rufo-Tavares,1 Marilia S Andrade,3 Pantelis T Nikolaidis,4 Thomas Rosemann,5 Beat Knechtle5 1Departamento de Desportos, Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória, Brazil; 2Setor de Fisiologia Humana e do Exercício, Faculdade de Educação Física e Dança, Universidade Federal de Goiás, Goiânia, Goiás, Brazil; 3Departamento de Fisiologia, Universidade Federal de São Paulo, São Paulo, Brazil; 4Exercise Physiology Laboratory, Nikaia, Greece; 5Institute of Primary Care, University of Zurich, Zurich, Switzerland Background: Police officers are subjected to high work-related stress. This scenario of irregular and insalubrious working conditions may be related to an increase in psychiatric disorders and overweight. In particular, low levels of physical activity and high work stress levels may predispose police officers to obesity, poor lifestyles, and, consequently, major risk of psychological disorders. Thus, our aim was to profile the anxiety/depression symptoms and habitual physical activity (HPA) levels of Brazilian elite police officers classified by body mass index (BMI). Patients and methods: Eighty-seven male police officers classified as normal-weight (NG, BMI =18.5–24.9 kg/m2, n=34) and excess-weight (EG, BMI ≥25 kg/m2, n=53) completed (before work routine time) the questionnaires: Baecke (HPA levels), State-Trait Anxiety Inventory (anxiety), and Beck Depression Inventory (depression). Results: There was a slight trend (despite did not reach statistical significance) of the EG group (which have a significantly [P=0.0369] higher mean [8.8±7.6] of military service time [in years] when compared to NG group [5.8±6.0]) presenting higher values of anxiety-trait (+5.0%) and depression (+16.0%) and lower levels of leisure time HPA (–3.7%) than NG group. Conclusion: Although our hypothesis was not ratified, our findings have clinical relevance because we profiled the anxiety and depression symptoms and HPA levels of elite police officers. Moreover, it is possible to suppose that the military service time (years) is a relevant factor, that it needs to be studied in depth, and that it may impact the predisposition for mood disorders and low levels of physical activity of police officers. Keywords: depression, mood state, physical activity, physical exercise, physical fitness, police officer

Alta parasitemia pelo Trypanosoma cruzi em paciente com lupus eritematoso sistêmico Trypanosoma cruzi high parasitemia in patient with systemic lupus erythematosus

É descrito um caso de doença de Chagas com alta parasitemia pelo Trypanosoma cruzi em paciente com lupus eritematoso sistêmico. O xenodiagnóstico foi útil na identificação da parasitemia e o benznidazol foi capaz de reduzir a alta e incomum parasitemia. Em indivíduos com doenças auto-imunes e immunossuprimidos, o benznidazol pode ser uma alternativa no controle da alta parasitemia por Trypanosoma cruzi.<br>A case of Trypanosoma cruzi high parasitemia in patient with systemic lupus erythematosus is reported. A xenodiagnostic test was useful in the identification of high and uncommon parasitemia, and Benznidazole was able to reduce the parasitemia. Benznidazole can be an alternative to control the Trypanosoma cruzi high parasitemia in people with autoimmune disease and immunosuppression

Genome-wide linkage and peak-wide association study of obesity-related quantitative traits in Caribbean Hispanics

Although obesity is more prevalent in Hispanics than non-Hispanic whites in the United States, little is known about the genetic etiology of the related traits in this population. To identify genetic loci influencing obesity in non-Mexican Hispanics, we performed a genome-wide linkage scan in 1,390 subjects from 100 Caribbean Hispanic families on six obesity-related quantitative traits: body mass index (BMI), body weight, waist circumference, waist-to-hip ratio, abdominal and average triceps skinfold thickness after adjusting for significant demographic and lifestyle factors. We then carried out an association analysis of the linkage peaks and the FTO gene in an independent community-based Hispanic subcohort (N = 652, 64% Caribbean Hispanics) from the Northern Manhattan Study. Evidence of linkage was strongest on 1q43 with multipoint LOD score of 2.45 (p = 0.0004) for body weight. Suggestive linkage evidence of LOD > 2.0 was also identified on 1q43 for BMI (LOD = 2.03), 14q32 for abdominal skinfold thickness (LOD = 2.17), 16p12 for BMI (LOD = 2.27) and weight (LOD = 2.26), and 16q23–24 for average triceps skinfold thickness (LOD = 2.32). In the association analysis of 6,440 single nucleotide polymorphisms (SNPs) under 1-LOD unit down regions of our linkage peaks on chromosome 1q43 and 16p12 as well as in the FTO gene, we found that two SNPs (rs6665519 and rs669231) on 1q43 and one FTO SNP (rs12447427) were significantly associated with BMI or body weight after adjustment for multiple testing. Our results suggest that in addition to FTO, multiple genetic loci, particularly those on 1q43 region, may contribute to the variations in obesity-related quantitative traits in Caribbean Hispanics

Tabagismo e câncer no Brasil: evidências e perspectivas Tobacco smoking and cancer in Brazil: evidence and prospects

Neste artigo analisa-se a tendência temporal da prevalência do tabagismo no Brasil, bem como as assimetrias da prevalência de acordo com as regiões do país, a idade, o gênero e o nível socioeconômico da população. Desde o estabelecimento da relação entre tabagismo e câncer de pulmão há 60 anos, o número de tumores malignos com evidências de associação causal com o tabagismo ascendeu a vinte. O declínio da prevalência do tabagismo na população brasileira tem sido constante desde o final da década de 80. Até 2003, foi mais intenso entre os homens. A partir daquele ano, a queda tornou-se mais pronunciada entre as mulheres. As mais altas prevalências de tabagismo encontram-se no Sudeste e Sul, as duas regiões com maiores incidências de neoplasias estritamente relacionadas ao tabaco (cavidade oral, esôfago e pulmão). A exposição ambiental à fumaça do tabaco também foi examinada considerando-se os efeitos para os adultos não fumantes, que apresentam maior risco de tumores de pulmão, laringe e faringe, e entre crianças de pais fumantes, suscetíveis ao risco de hepatoblastoma e leucemia linfocítica aguda. Apesar do incontestável sucesso da política de controle do tabagismo no país, as ações de prevenção devem considerar que as parcelas da população com piores condições socioeconômicas e com baixo nível educacional são as que apresentam taxas mais altas de prevalência de tabagismo. Dentro destes segmentos populacionais os adolescentes representam uma prioridade.<br>In this paper, the prevalence of smoking in Brazil is examined according to time trend and regions of the country, as well as considering the asymmetries of the prevalence of tobacco smoking by age, sex and socio-economic level of the population. Since the establishment of the relationship between smoking and lung cancer 60 years ago, the number of malignant tumors with evidence of a causal association with tobacco smoking has amounted to twenty. From the late 80's, the decline of the prevalence of smoking in the Brazilian population has been continuous. Until 2003, the decrease was more significant among men, when an inversion occurred and the decline became more pronounced in women. The highest prevalence of smoking is detected in the Southeast and South, and these two regions present the highest incidence of tumors closely related to tobacco (oral cavity, esophagus and lung). Environmental exposure to tobacco smoke was also examined considering the effect in nonsmoking adults, with a higher risk of lung, larynx and pharynx tumors, as well as among children of smoking parents more susceptible to the risk of hepatoblastoma and acute lymphocytic leukemia. Despite the undeniable success of the policy to control tobacco smoking in the country, health professionals should be attentive to populations with low socioeconomic status and lower educational levels who show the highest prevalence rates of smoking. Adolescents represent a priority in these populations