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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Genetic Dissection of the Planarian Reproductive System Through Characterization of Schmidtea Mediterranea Cpeb Homologs

Cytoplasmic polyadenylation is a mechanism of mRNA regulation prevalent in metazoan germ cells; it is largely dependent on Cytoplasmic Polyadenylation Element Binding proteins (CPEBs). Two CPEB homologs were identified in the planarian Schmidtea mediterranea. Smed-CPEB1 is expressed in ovaries and yolk glands of sexually mature planarians, and required for oocyte and yolk gland development. In contrast, Smed-CPEB2 is expressed in the testes and the central nervous system; its function is required for spermatogenesis as well as non-autonomously for development of ovaries and accessory reproductive organs. Transcriptome analysis of CPEB knockdown animals uncovered a comprehensive collection of molecular markers for reproductive structures in S. mediterranea, including ovaries, testes, yolk glands, and the copulatory apparatus. Analysis by RNA interference revealed contributions for a dozen of these genes during oogenesis, spermatogenesis, or capsule formation. We also present evidence suggesting that Smed-CPEB2 promotes translation of Neuropeptide Y-8, a prohormone required for planarian sexual maturation. These findings provide mechanistic insight into potentially conserved processes of germ cell development, as well as events involved in capsule deposition by flatworms

Moderating effects on residents’ willingness in waste sorting to improve waste handling in Dammam City, Saudi Arabia

While the total amount of municipal solid waste (MSW) in Dammam city was about 13 million tons in 2013, it is expected to reach about 18.4 million tons in 2025. Although the main problem in Dammam city is an increase in solid waste production without any formal treatment except landfilling, the lack of waste segregation greatly affects the residents’ handling practices of solid waste due to incorrect disposing practices. The objective of this study explored the possibility of Dammam residents’ participation in sorting and recycling to improve MSW handling and to measure the influence of psychological factors which affecting residents’ willingness to participate in waste handling regarding socioeconomic levels and moderating effects. This study also examined various respondents’ perspectives on sorting and recycling sustainable waste and the handling of waste generation. This study covered most Dammam communities, with a gender distribution of 56% males and 44% females and the monthly income ranging from SR700 to SR12,000. The descriptive analysis showed that of the 450 participants, 170 (37.8%) were in the middle-income levels, 199 (44.2%) were in the high-income levels and 81 (18%) were in the low-income levels. The moderating effect of income was observed between attitude and willingness to sort and recycle waste in the low-income levels and high-income levels groups. Additionally, an association was found between market incentives and willingness to sort and recycle waste in the low-income levels and high-income levels groups. The gender status of the participants had a moderating effect on the relationship between market incentives and willingness to sort and recycle waste in males and females. Additionally, the moderating effect of social influence on households’ willingness to sort and recycle waste was moderated by gender in males and females

Comparative study between early active and passive rehabilitation protocols following two-strand flexor tendon repair: can two-strand flexor tendon repair withstands early active rehabilitation?

Background Restoration of full range of motion of digits as well as prevention of joint contracture following flexor tendon repair is a challenge. There is lack of solid evidence regarding the most suitable rehabilitation protocol following flexor tendon repair. This is owing to the limited number of studies comparing different rehabilitation protocols. Moreover, the present studies advocate a specific technique with no comparative group. Even the few controlled studies conducted vary in methods of repair and rehabilitation, and outcome assessment. To our knowledge, the only randomized controlled trial comparing early passive rehabilitation with early active rehabilitation is the one done by Trumble and colleagues in 2010, which was done on four-strand repaired tendon. These authors concluded that active rehabilitation program had better range of motion with less flexion contractures and greater satisfaction scores than those subjected to passive rehabilitation protocol. Aim This conclusion stimulated us to study the effect of early active mobilization versus early passive mobilization following two-strand repair. Patient and methods We conducted our study for 12 weeks comparing early active mobilization protocol ‘place and hold’ with early passive mobilization ‘modified Kleinert’ after standard two-strand modified Kessler repair in different hand zones. Results and conclusion We concluded that early active mobilization had better tendon gliding and excursion even with the two-strand repair as active motion will decrease adhesion formation, with significant difference compared with the passive group. Moreover, there was no significant difference in the rupture rate and significant difference for combined tendon lag and flexion deformity owing to the tenodesis mobilization between both the groups

Understanding the effect of internal and external factors on households’ willingness to sort waste in Dammam City, Saudi Arabia

The acceleration of growth in the population in Saudi Arabia and the increase in municipal solid waste generation have caused a problem in Dammam city: an increase in solid waste production. Therefore, solid waste sorting is an important practice of municipal solid waste management. The main objectives in this research are understanding the effect of internal and external factors on household willingness in sorting waste in Dammam city and studying the attempts to construct a theoretical research model by adding market incentives, government facilitators, and awareness into the popular planned behaviour theory to explain residents’ waste sorting intentions. The data collection and analysis are based on the questionnaire study, which is based on the questionnaire survey data from 450 households in Dammam. This study revealed that social influence significantly predicts households’ willingness to sort and recycle, that is, to promote recycling. Additionally, the variable social influence has a significant but low influence on households’ willingness to sort and recycle. The result of the structural equation model shows that perceived behavioural control significantly predicts households’ willingness to sort and recycle waste. This finding is consistent with the theoretical expectation. Therefore, this research shows that attitude, social influence, perceived behavioural control, market incentives, government facilitators and awareness positively and significantly affect residents’ waste sorting intentions. Additionally, this research corroborates the discrepancy between internal and external variables

The influence of Socio-Psychological Factors on Residents’ Willingness to Practice Sustainable Waste Handling in Dammam City, Saudi Arabia

An increase in solid waste production may affect sustainable solid waste handling practices such as indirect disposal and sanitary landfilling. The objective of this study was to explore the possibility of Dammam residents’ participation in sorting and recycling by comparing sustainable waste handling practices from different income level groups according to family income levels to determine the impacts of independent variables on the willingness of residents to participate in sustainable waste handling practices. There was a statistically significant difference between low and high levels of awareness and perceived behavior control in Dammam City households’ willingness to sort waste and recycle; however, at the middle level, there was only a significant difference in perceived behavior control. Moreover, there was a statistically significant difference between high and middle levels in government facilitators regarding sorting and recycling willingness in Dammam City. The descriptive analysis comprised 450 participants (37.8%) in middle levels, (44.2%), high levels, and (18%) low levels. The results of the participants’ attitudes consisted of sorting (57.1%) and recycling (55.1%), as well as awareness (46.9%) and sorting and recycling (47.1%) in high-income levels. In perceived behavior control, the participants’ results were 47.7% for sorting and 49.6% for recycling in the middle level. Regarding, MI, SI, and GF, the participants’ results in the high-income levels were greater than the others (44.2%, 51.1%, and 57.1%, respectively) toward sorting and recycling. Only awareness between low-income and high-income groups and between the middle-income and high-income groups was significant; therefore, it was supported in some instances and not in others