A study protocol for a double-blind randomised placebo-controlled trial evaluating the efficacy of carrageenan nasal and throat spray for COVID-19 prophylaxis—ICE-COVID

Introduction: At present, vaccines form the only mode of prophylaxis against COVID-19. The time needed to achieve mass global vaccination and the emergence of new variants warrants continued research into other COVID-19 prevention strategies. The severity of COVID-19 infection is thought to be associated with the initial viral load, and for infection to occur, viruses including SARS-CoV-2 must first penetrate the respiratory mucus and attach to the host cell surface receptors. Carrageenan, a sulphated polysaccharide extracted from red edible seaweed, has shown efficacy against a wide range of viruses in clinical trials through the prevention of viral entry into respiratory host cells. Carrageenan has also demonstrated in vitro activity against SARS-CoV-2. Methods and analysis: A single-centre, randomised, double-blinded, placebo-controlled phase III trial was designed. Participants randomised in a 1:1 allocation to either the treatment arm, verum Coldamaris plus (1.2 mg iota-carrageenan (Carragelose®), 0.4 mg kappa-carrageenan, 0.5% sodium chloride and purified water), or placebo arm, Coldamaris sine (0.5% sodium chloride) spray applied daily to their nose and throat for 8 weeks, while completing a daily symptom tracker questionnaire for a total of 10 weeks. Primary outcome: Acquisition of COVID-19 infection as confirmed by a positive PCR swab taken at symptom onset or seroconversion during the study. Secondary outcomes include symptom type, severity and duration, subsequent familial/household COVID-19 infection and infection with non-COVID-19 upper respiratory tract infections. A within-trial economic evaluation will be undertaken, with effects expressed as quality-adjusted life years. Discussion: This is a single-centre, phase III, double-blind, randomised placebo-controlled clinical trial to assess whether carrageenan nasal and throat spray reduces the risk of development and severity of COVID-19. If proven effective, the self-administered prophylactic spray would have wider utility for key workers and the general population. Trial registration: NCT04590365; ClinicalTrials.gov NCT04590365. Registered on 19 October 2020

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Estabelecimento de condições operacionais para o bico rotativo micromax na aplicação do herbicida glyphosate

Alguns parâmetros operaciona is do bico rotativo Micromax para apli cação do herbi cida glypho sate foram estudados em condições de laboratório. O bico Micromax a 1.600 rpm e vazão de 0,96 //min forneceu gotas com vmd de 280 μm e à vazão de 0,43 i/min , de 232 μm, sendo que em ambas as condições o coeficient e de dispersão (r = vmd/nmd) foi inferior a 1,4, atendendo, portanto, às especificações para o processo CDA. A distância entre bicos a serem montadas numa barra foi determinada em mesa de estudo do padrão de deposição foi de 1,80 m para a vazão de 0,96 Z/min e concentração da formulação comercial do glyphosate entre 4% e 6%. Essa distancia foi de 1,40 m para vazão de 0,43 1/min e concentração de glyphosate entre 9% e 13%. Distancias fora dessas especificações produziram deposições bastante irregulares sob a barra de pulverização.Some operation al parameters of Micromax rotary atomizers in the application of glyphosate were studied under laboratory conditions. Micromax nozzle at 1.600 rpm and 0,96 1/min feed rate produced 280m vmd droplets and 0,43 1/min feed rate, produ ced 232 m vmd droplets. In both conditions the dispersion coefficien t (r = vmd/nmd) was bellow 1,4, attending to the spedfication for CDA. Nozzl espacement between Micromax heads in a spray boom was estab lished as 1,80 m for 0,96 1/min feed rate using 4% to 6% glyphosate (commercia l) solution and 1,40 m for 0,43 Z/min feed rate using 9% to 13% solution. Nozzle spacement out of these specifications produces very irregular deposition patterns

Personal protective equipment for surgeons during COVID-19 pandemic: systematic review of availability, usage and rationing

Abstract Background Surgeons need guidance regarding appropriate personal protective equipment (PPE) during the COVID-19 pandemic based on scientific evidence rather than availability. The aim of this article is to inform surgeons of appropriate PPE requirements, and to discuss usage, availability, rationing and future solutions. Methods A systematic review was undertaken in accordance with PRISMA guidelines using MEDLINE, Embase and WHO COVID-19 databases. Newspaper and internet article sources were identified using Nexis. The search was complemented by bibliographic secondary linkage. The findings were analysed alongside guidelines from the WHO, Public Health England, the Royal College of Surgeons and specialty associations. Results Of a total 1329 articles identified, 95 studies met the inclusion criteria. Recommendations made by the WHO regarding the use of PPE in the COVID-19 pandemic have evolved alongside emerging evidence. Medical resources including PPE have been rapidly overwhelmed. There has been a global effort to overcome this by combining the most effective use of existing PPE with innovative strategies to produce more. Practical advice on all aspects of PPE is detailed in this systematic review. Conclusion Although there is a need to balance limited supplies with staff and patient safety, this should not leave surgeons treating patients with inadequate PPE. </jats:sec

Additional file 1 of A study protocol for a double-blind randomised placebo-controlled trial evaluating the efficacy of carrageenan nasal and throat spray for COVID-19 prophylaxis—ICE-COVID

Additional file 1

Efeito da intensidade do vento, da pressão e de pontas de pulverização na deriva de aplicações de herbicidas em pré-emergência Effect of wind intensity, pressure and nozzles on spray drift from preemergence herbicide applications

Objetivou-se com este trabalho avaliar o efeito de pontas de pulverização, pressão e intensidade do vento na deriva gerada em aplicações simuladas de herbicidas aplicados em pré-emergência. Os modelos de pontas de pulverização e as respectivas pressões testadas foram: SF 11002 (207 e 310 kPa), JA-2 (345 e 655 kPa) e AVI 11002 (207 e 414 kPa). As aplicações foram realizadas em dois períodos, em dias com condições de velocidade de vento distintas, em uma área de 1.200 m², localizada na Fazenda Experimental da FCA/UNESP. Um pulverizador com barra de 12 m, 24 bicos e tanque de 600 L foi utilizado nas aplicações. A calda de aplicação foi composta por água e o corante alimentício FDC-1 foi usado como traçador. A deriva foi amostrada por coletores ativos fixados sobre a barra de pulverização. As velocidades mínimas, médias e máximas de vento registradas no primeiro e segundo períodos das aplicações foram de 7, 14 e 23 km h-1 e 1, 5 e 18 km h-1, respectivamente. Nas duas ocasiões de aplicação, as pontas de pulverização com indução de ar AVI 11002 e de jato cônico vazio JA-2 a 655 kPa resultaram nas menores e maiores quantidades de depósito de líquido detectadas, respectivamente. A maior intensidade do vento incrementou a deriva. A redução na pressão pode ser utilizada para controle de deriva, mas a seleção adequada de uma ponta mostrou ser mais eficiente para esse propósito.<br>The aim of this work was to evaluate the effect of nozzles, spray pressure and wind intensity on spray drift generated in simulated preemergence herbicide applications. The nozzle designs and respective pressures tested were: SF 11002 (207 and 310 kPa), JA-2 (345 and 655 kPa) and AVI 11002 (207and 414 kPa). The applications were performed during two periods, on days with different wind conditions, in an area with 1,200 m², in the Experimental Farm of the FCA/UNESP. A sprayer with a 12 m boom, 24 nozzles and tank with 600 L was used for the applications. The spray liquid was composed by water and the food dye FDC-1 as a tracer. The spray drift was sampled by active collectors fixed on the spray boom. The minimum, mean and maximum wind velocity values registered in the first and second spraying period were 7, 14 and 23 km h-1 and 1, 5 and 18 km h-1, respectively. The air induction flat fan nozzle AVI 11002 and the hollow cone JA-2 at 655 kPa resulted in the lowest and highest amounts of deposit detected, respectively, for both applications. The higher wind intensity increased the drift. Reductions on the spray pressure can be used to control the drift, but adequate nozzle selection was found to be more important for this purpose