Wses Guidelines For Management Of Clostridium Difficile Infection In Surgical Patients

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.1

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

Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections : a prospective multicentre study (WISS Study)

Background: To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. Methods: The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. Results: Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p <0.0001). The multivariate logistic regression model was highly significant (p <0.0001, R-2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4. Conclusions: WSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.Peer reviewe

In Pursuit of Fish-Free Feeds: A Multi-Species Evaluation

The future growth and sustainability of fed aquaculture, and especially that for carnivorous species, will be highly dependent upon the industry stepping away from its reliance upon forage fishes as major feed ingredients. With this goal in mind, the F3 Feed Innovation Network&mdash;a consortium of researchers; businesses, including feed manufacturers and ingredient providers; NGOs; and others&mdash;energizes industry to adopt novel and promising aquafeed ingredients and formulations. All evaluated formulae are open-source and freely available on the F3 website. Moreover, the F3 diets can be readily retailored to suit user demands and/or local conditions (i.e., ingredient availability/restrictions). This presentation summarizes completed F3 trials undertaken with five species of cultured and candidate fishes. With reference to eight studies, findings are compared against conventional fishmeal (FM)/fish oil (FO)-based feeds. The described research documents the response of test animals to aquafeeds containing traditional FM/FO alternatives (e.g., soybean meal and poultry by-product meal) as well as innovative ingredients (e.g., microalgae and single-cell proteins). Depending on the species examined, account is given to the overall growth performance, health aspects, and product quality. The F3 trials demonstrate the feasibility of the complete removal of FM/FO from the diets of the tested animals

In Pursuit of Fish-Free Feeds: A Multi-Species Evaluation

The future growth and sustainability of fed aquaculture, and especially that for carnivorous species, will be highly dependent upon the industry stepping away from its reliance upon forage fishes as major feed ingredients. With this goal in mind, the F3 Feed Innovation Network—a consortium of researchers; businesses, including feed manufacturers and ingredient providers; NGOs; and others—energizes industry to adopt novel and promising aquafeed ingredients and formulations. All evaluated formulae are open-source and freely available on the F3 website. Moreover, the F3 diets can be readily retailored to suit user demands and/or local conditions (i.e., ingredient availability/restrictions). This presentation summarizes completed F3 trials undertaken with five species of cultured and candidate fishes. With reference to eight studies, findings are compared against conventional fishmeal (FM)/fish oil (FO)-based feeds. The described research documents the response of test animals to aquafeeds containing traditional FM/FO alternatives (e.g., soybean meal and poultry by-product meal) as well as innovative ingredients (e.g., microalgae and single-cell proteins). Depending on the species examined, account is given to the overall growth performance, health aspects, and product quality. The F3 trials demonstrate the feasibility of the complete removal of FM/FO from the diets of the tested animals