Cocirculation and Coinfection Associated to Zika Virus in the Americas

Zika virus, a flavivirus, has arrived to Latin America in 2013. It became evident causing epidemics since 2015, first in Brazil and later in other countries in the region, such as Colombia, with a higher peak in 2016. The World Health Organization (WHO), based on cumulated evidence on its association with Guillain-Barre syndrome (GBS) and microcephaly and other birth defects (also the congenital Zika syndrome, CZS), declared for a period of almost a year, an international public health emergency. Epidemics in the region caused around 1 million cases with also additional complications beyond GBS and the CZS, which in patients with comorbidities lead to deaths. Among the events studied in the region, a number of cases with arboviral coinfections/codetection (dengue and chikungunya) were described and published beginning in Colombia and later in Brazil. In addition to that, cocirculation and still ongoing research on antibody-dependent enhancement (ADE) are challenges for physicians and public health authorities, given the implications for clinical manifestations and serological diagnosis in patients with previous exposition to other flaviviruses. We reviewed such aspects in this chapter

Rayleigh wave dispersion measurements reveal low-velocity zones beneath the new crust in the Gulf of California

Rayleigh wave tomography provides images of the shallow mantle shear wave velocity structure beneath the Gulf of California. Low-velocity zones (LVZs) are found on axis between 26 and 50 km depth beneath the Guaymas Basin but mostly off axis under the other rift basins, with the largest feature underlying the Ballenas Transform Fault. We interpret the broadly distributed LVZs as regions of partial melting in a solid mantle matrix. The pathway for melt migration and focusing is more complex than an axis-centered source aligned above a deeper region of mantle melt and likely reflects the magmatic evolution of rift segments. We also consider the existence of solid lower continental crust in the Gulf north of the Guaymas Basin, where the association of the LVZs with asthenospheric upwelling suggests lateral flow assisted by a heat source. These results provide key constraints for numerical models of mantle upwelling and melt focusing in this young oblique rift

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

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

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

The role of subducted sediments in the formation of intermediate mantle-derived magmas from the Northern Colombian Andes

Unraveling the sources and processes that produce intermediate continental arc volcanoes is still a challenge for geoscientists. To address this problem, here we use comprehensive geochemical and isotopic data from Nevado del Santa Isabel and Cerro Machín volcanoes in the North Volcanic Province of Colombia, and from oceanic sediments sampled outboard the Colombian continental margin. Volcanoes along this province have been influenced by the subduction of a compositionally contrasting sedimentary column constituted by a carbonate-rich pelagic layer overlain by a clay-and-apatite-rich hemipelagic unit. The studied volcanoes exhibit the high Mg# (~60) and calc-alkaline affinities that are typical of continental arcs but display unusually high and contrasting Th(U)/La, Nb/Ta and Dy/Yb ratios and isotopic compositions. We argue that the geochemical variations within and among these volcanoes are not controlled by differentiation or crustal contamination of a parental basaltic magma but formed by melting of different kinds of subducted sedimentary materials detached from the slab as buoyantly rising diapirs at various depths. This model accounts for the reworking of refractory carbonates into arc magmatism and suggests that the geochemical diversity of the North Volcanic Province is mainly controlled by the nature of the subduction inputs and their exhumation pathways within the mantle wedge. © 201