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

Vírus entéricos na Lagoa Rodrigo de Freitas

Submitted by Sandra Infurna ([email protected]) on 2017-05-11T12:00:26Z No. of bitstreams: 1 carmen_baur_etal_IOC_2012.pdf: 1727779 bytes, checksum: 3b0b900ce7553c259745aec6cf98c33f (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2017-05-11T12:13:03Z (GMT) No. of bitstreams: 1 carmen_baur_etal_IOC_2012.pdf: 1727779 bytes, checksum: 3b0b900ce7553c259745aec6cf98c33f (MD5)Made available in DSpace on 2017-05-11T12:13:03Z (GMT). No. of bitstreams: 1 carmen_baur_etal_IOC_2012.pdf: 1727779 bytes, checksum: 3b0b900ce7553c259745aec6cf98c33f (MD5) Previous issue date: 2012Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Virologia Comparada e Ambiental. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Desenvolvimento Tecnológico em Virologia. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Desenvolvimento Tecnológico em Virologia. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Desenvolvimento Tecnológico em Virologia. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Virologia Comparada e Ambiental. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Virologia Comparada e Ambiental. Rio de Janeiro, RJ. Brasil.Os vírus são atualmente considerados importantes contaminantes de águas superficiais, embora ainda não estejam incluídos nos parâmetros de balneabilidade avaliados para exposição humana em águas. Este estudo tem como objetivo avaliar a contaminação pelos principais agentes etiológicos da gastrenterite viral aguda [rotavírus espécie A (RVA) e norovírus (NoV)], adenovírus humanos (HAdV) e vírus da hepatite A (HAV) em águas superficiais da Lagoa Rodrigo de Freitas, Rio de Janeiro, pela detecção, quantificação e caracterização molecular destes agentes, correlacionando-os com parâmetros microbiológicos de qualidade da água. Entre Agosto de 2007 e Julho de 2008, 2L de água superficial foram coletados mensalmente em 12 pontos, incluindo 10 pontos na Lagoa Rodrigo de Freitas, um no Rio dos Macacos e um na praia do Leblon, totalizando 144 amostras. As amostras foram concentradas 1000X pelo método de adsorção-eluição utilizando membrana carregada negativamente e reconcentradas a um volume final de 2mL em Centriprep®YM-50. RVA, NoV, HAdV e HAV foram detectados e quantificados pelas técnicas de reação em cadeia pela polimerase convencional e quantitativa (cPCR / qPCR) precedidas por transcrição reversa (RT). Pela análise conjunta destas metodologias, RVA, NoV, HAdV e HAV foram detectados em 24,3% (35/144), 18,8% (27/144), 16,7% (24/144) e 21,5% (31/144) das amostras estudadas, respectivamente. E.coli foi quantificada por Kit Colilert®-18 Quanti-Tray®/2000 em cada ponto de coleta como um indicador microbiológico de contaminação fecal e 87,5% (126/144) das amostras foram caracterizadas como próprias a balneabilidade conforme estabelecido pela legislação vigente. RVA, NoV, HAdV e HAV foram detectados em 23,8% (30/126), 16,7% (21/126), 15,1% (19/126) e 23,0% (29/126), respectivamente, das amostras consideradas próprias, evidenciando a presença de vírus em águas que estão dentro dos padrões aceitáveis para E.coli. Os dados obtidos neste estudo enfatizam a necessidade do estabelecimento de parâmetros virais para a avaliação da qualidade da água e a necessidade de se disponibilizar protocolos de detecção viral que auxiliem para a adoção de medidas de controle de contaminação ambiental.Viruses are now considered important contaminants of surface water, although not yet included in the parameters evaluated for human exposure in bathing waters. This study aims to assess contamination of surface waters of Rodrigo de Freitas Lagoon, Rio de Janeiro, by its major etiologic agents of acute viral gastroenteritis [species A rotavirus (RVA) and norovirus (NoV)], human adenoviruses (HAdV) and hepatitis A virus (HAV) by detection, quantification and molecular characterization of these agents establishing a correlation with microbiological parameters of water quality. From August 2007 to July 2008, 2L of surface water were monthly collected at 12 points, including 10 points in Rodrigo de Freitas Lagoon, one in Macacos River and one in Leblon Beach, with a total of 144 samples.The samples were concentrated 1000X by an adsorption-elution method using a negatively charged membrane and reconcentrated to a final volume of 2mL in Centriprep® YM-50. RVA, NoV, HAdV and HAV were detected and quantified by conventional and quantitative polymerase chain reaction (cPCR / qPCR) preceded by reverse transcription (RT). Overall, RVA, NoV, HAdV and HAV were detected in 24.3% (35/144), 18.8% (27/144), 16.7% (24/144) and 21.5% (31/144) of the samples studied, respectively. E. coli was quantified by Kit Colilert®-18 Quanti-Tray®/2000 in each sample as an indicator of fecal contamination and 87.5% (126/144) of the samples were characterized as suitable for bathing as established by current regulation. RVA, NoV, HAdV and HAV were detected in 23.8% (30/126), 16.7% (21/126), 15.1% (19/126) and 23.0% (29/126) of the samples, respectively, showing the presence of viruses in waters that are within the acceptable standards for E.coli. The data obtained in this study emphasizes the need to establish parameters for the evaluation of viral quality of water and the need to develop viral detection protocols that can assist measures to control the environmental contamination

Detection of enteric viruses in recreational waters of an urban lagoon in the city of Rio de Janeiro, Brazil

The aim of this study was to determine the occurrences of the group A rotavirus (RVA), norovirus (NoV) and human adenovirus (HAdV) in the surface waters of an urban lagoon (Rodrigo de Freitas Lagoon) in the city of Rio de Janeiro, Brazil. During one year of surveillance, water samples were obtained from the lagoon and other interconnected ecosystems (river and beach). The samples were concentrated using an adsorption-elution method with a negatively charged membrane and tested by qualitative and quantitative polymerase chain reaction assays. RVA was the most prevalent virus detected (24.3%) with a viral load ranging from 3.0 x 10¹-5.6 x 10(4) genome copies/L, followed by NoV (18.8%) and HAdV (16.7%). Considering water samples suitable for bathing, according to Escherichia coli criterion (< 2,000 most probable number/100 mL), viruses were detected in 50% (57/114) of them. Physicochemical parameters were also measured and showed possible correlations between turbidity and RVA presence and between pH and NoV presence. These data demonstrate the importance of considering viral parameters to ensure water quality and the utilisation of these parameters as additional tools for the characterisation of environmental contamination

Assessment of Water Quality in a Border Region Between the Atlantic Forest and an Urbanised Area in Rio de Janeiro, Brazil

Made available in DSpace on 2015-06-12T13:57:52Z (GMT). No. of bitstreams: 2 license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) np_gamaetal_IOC_2014.pdf: 703840 bytes, checksum: 00786e91ea43f78a233e8663681bd35f (MD5) Previous issue date: 2014Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Virologia Comparada e Ambiental. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Virologia Comparada e Ambiental. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Virologia Comparada e Ambiental. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Virologia Comparada e Ambiental. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Virologia Comparada e Ambiental. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Virologia Comparada e Ambiental. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Virologia Comparada e Ambiental. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Desenvolvimento Tecnológico em Virologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Desenvolvimento Tecnológico em Virologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Virologia Comparada e Ambiental. Rio de Janeiro, RJ, Brasil.The preservation of water resources is one of the goals of the designation of parks that act as natural reservoirs. In order to assess the impact of the presence of humans in an environmental preservation area bordering urban areas, the presence of four pathogenic enteric viruses [group A rotavirus (RV-A), norovirus (NoV), human adenoviruses (HAdV), and hepatitis A virus (HAV)], as well as the physico-chemical parameters, and Escherichia coli levels were assessed in riverine water samples. From June 2008 to May 2009, monthly monitoring was performed along the Engenho Novo River. RV-A, NoV, and HAdV were observed in 29% (31/108) of the water samples, with concentrations of up to 10(3) genome copies/liter. The natural occurrence of infectious HAdV was demonstrated by Integrated Cell Culture-PCR (ICC-PCR). This study confirms the suitability of using the detection of fecal-oral transmitted viruses as a marker of human fecal contamination in water matrices and indicates the spread of pathogenic viruses occurring in an alleged area of environmental protection

Relative expression of a subset of genes as determined by RNASeq and qPCR assays.

<p>Bar plots of Log2ChangeFold of the subset of genes chosen to validate the RNASeq (red) pattern of expression by using qPCR (blue). The Pearson’s coefficient, at a 95% confidence level is shown on the graph and illustrates the gene expression assessed by both methods. The scatter plot shows the strong correlation of gene expression calculated by the two methods (Pearson’s correlation = 0.86, p-value < 0.001). The solid line is the linear regression adjusted to the points of correlation; the dashed line represents a correlation where x = y.</p

Summary of filtering of RNASeq reads.

<p>Summary of filtering of RNASeq reads.</p