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

Compostos orgânicos como substratos na formação de mudas de ipê-amarelo (Tabebuia Chrysotricha (Mart. Ex. Dc.) Standl) irrigadas com água residuária

A necessidade de estudar a utilização dos resíduos de podas de árvores é de grande importância ambiental para solucionar os problemas de resíduos sólidos existentes nas áreas urbanas junto com os resíduos de lixos domésticos. O estudo destes materiais foi avaliado com o desenvolvimento de mudas de ipê-amarelo (Tabebuia Chrysotricha (Mart. Ex. Dc.) sandl) em diferentes misturas de substratos e tipos de água para irrigação. O experimento foi instalado no Departamento de Engenharia Rural da Faculdade de Ciências Agrárias e Veterinárias - UNESP, Câmpus de Jaboticabal. Foram realizados dois experimentos, avaliados juntamente com delineamento experimental em blocos casualizados, de oito substratos, duas qualidades de águas e quatro repetições, totalizando 64 parcelas. Cada parcela foi composta por 30 plantas (cinco linhas de seis plantas), sendo consideradas como úteis as três linhas de quatro plantas centrais da parcela. Foram testados oito substratos, resultantes da combinação de substrato comercial, composto de lixo e composto de poda de árvores com dois tipos de água de irrigação (água potável e residuária) e quatro repetições. Para acompanhar o desenvolvimento das mudas de ipê-amarelo, foram avaliados a altura da parte aérea das plantas (H) e o diâmetro do colmo (D). As características foram avaliadas aos 21; 42; 63 e 84 dias após a emergência. da análise dos resultados, possibilitou-se concluir que os substratos estudados promoveram diferenças significativas para a altura média das plantas e o diâmetro de colmo, em todos os períodos de avaliação. Os substratos 4 e 5 e a água residuária apresentaram os melhores resultados no desenvolvimento das mudas de ipê-amarelo.The need to study the use of waste of tree pruning is of great importance to solve the environmental problems of solid waste in the urban areas along with the household waste. The study of these materials was evaluated with the development of seedlings of yellow- ipe (Tabebuia Chrysotricha (Mart. Ex DC.) Sandl) in different types of substrate mixtures and water for irrigation. The experiment was installed at the Department of Rural Engineering in the Faculty of Agricultural Sciences and Veterinary - UNESP, Jaboticabal Campus, in a randomized block design, with 8 substrates, 2 qualities of water and 4 repetitions, totaling 64 plots. Each plot was composed of 30 plants (5 lines of 6 plants), being regarded as useful, the 3 lines of 4 plants of the central plot. Eight substrates were tested, resulting from the combination of commercial substrate, composed of garbage and of trees pruning with 2 types of irrigation water (clean water and residuary) with 4 repetitions. To track the development of the yellow- ipe seedlings, were evaluated the height of the shoots (H) and the diameter of the stem (D). The characteristics were evaluated at 21, 42, 63 and 84 days after the emergency. The analysis of the results allowed to conclude that the substrates studied promoted significant difference in average height and diameter of the stems in all periods of assessment. The substrate 4, 5 and the residuary water showed the best results in the development of the yellow-ipe seedlings

Variáveis biométricas da cana-de-açúcar fertilizada com resíduos orgânico e industrial e irrigada com água servida e potável

O uso agrícola de resíduos orgânicos e industriais é uma alternativa de aproveitamento como fertilizante e fonte de matéria orgânica ao solo. Neste sentido, o objetivo deste trabalho foi avaliar o uso do composto de lixo e biofertilizante como fonte de nutrientes, e o resíduo do processamento da bauxita como corretivo da acidez do solo, para a cultura da cana-de-açúcar (cana-planta), irrigada com água potável e servida. Para tanto foi conduzido experimento em vaso, utilizando-se de solo Argissolo Vermelho-Amarelo distrófico, cultivado com a variedade RB855536. Foram avaliadas variáveis biométricas da planta, tais como: altura de plantas, diâmetro do colmo, perfilhamento, número de folhas, matéria seca de raiz e parte aérea. Os dados obtidos evidenciaram que a qualidade da água de irrigação, potável ou servida, não influenciou as variáveis avaliadas. A aplicação de composto de lixo e de biofertilizante constituiu-se numa fonte eficiente de nutrientes para as plantas de cana-de-açúcar, mas é necessária a aplicação adicional de fertilizantes para a obtenção de produção de colmos, similar ao do tratamento com adubação mineral convencional. Já o resíduo do processamento da bauxita mostrou-se eficiente na correção da acidez, apresentando as variáveis físicas semelhantes ao tratamento com adubação mineral, com exceção da matéria seca de raiz.The agricultural use of organic and industrial residues is an alternative of exploitation with fertilization and source of organic matter to the soil. In this direction, the objective of this research was to evaluate the use of the urban solid waste and biofertilizer as nutrient source, and residue of the bauxite processing as agricultural liming materials of the soil for sugar cane (cane plant) and culture yields, irrigated with potable water and wastewater. For in such an experiment in vase was lead, under Alfisol soil, cultivated with the variety RB855536. It had been evaluated biometric variable of the plant such as: plant height, diameter of stem, tillering, leaf number, dry matter of the root and dry matter of the aerial part. The data showed that the quality of the irrigation water, potable and wastewater, did not influence the evaluated parameters. The application of urban solid waste and biofertilizer had consisted in an efficient source of nutrients for sugar cane plants, but is necessary to apply additional fertilizer for the attainment of stem production similar to the treatment with conventional mineral fertilization. Now the residue of the bauxite processing revealed efficient in the correction of the acidity presenting similar physical parameters to the treatment with mineral fertilization and lime, with exception of the dry matter of the root.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Acúmulo de metais pesados em cana-de-açúcar mediante a aplicação de lodo de esgoto e vinhaça

O uso de resíduos agroindustriais pode acumular metais pesados no solo e na planta. O objetivo deste trabalho foi avaliar os efeitos do lodo de esgoto e/ou vinhaça, aplicados no solo, disponibilizando Cd, Cr, Ni e Pb ao solo e quantificar as respectivas concentrações em plantas de cana-de-açúcar, após três aplicações anuais sucessivas. O experimento foi conduzido em condições de campo, com parcelas experimentais de cinco linhas espaçadas de 1,5 m e 10 m de comprimento. O delineamento experimental adotado foi o de blocos casualizados, com três repetições. Os tratamentos avaliados foram: 1. Lodo de esgoto com 100% de N; 2. Lodo de esgoto com 200% de N; 3. Vinhaça com 100% de K; 4. Vinhaça com 200% de K; 5. Lodo de esgoto+vinhaça com 100% de N e K; 6. Lodo de esgoto+vinhaça com 200% de N e K; 7. Testemunha (fertilização mineral). Os baixos teores de metais pesados (Cd, Cr, Ni e Pb) disponíveis no solo e nas partes das plantas de cana-de-açúcar indicam que o lodo de esgoto e a vinhaça, empregados nas doses mencionadas, não apresentaram, após três aplicações anuais sucessivas, potencial de contaminação do sistema solo-planta.The organic residues are able to change heavy metals in soil and plant. The objective of this work was to evaluate the sewage sludge and/or vinasse effects in Cd, Cr, Ni and Pb soil valuable contents and sugarcane accumulated amounts after three successive annual applications. The experiment was conducted in field conditions. The experimental plots were made of five plant lines spaced of 1.5 m, with 10 m of length. The experimental design was a randomized blocks with three replications. The treatments were: 1. Sewage sludge (100% of N); 2. Sewage sludge (200% of N); 3. Vinasse (100% of K); 4. Vinasse (200% of K); 5. Sewage sludge plus vinasse (100% of N and K); 6. Sewage sludge plus vinasse (200% of N and K); 7. Control (mineral fertilization to sugarcane plants). The small soil heavy metal contents and small sugarcane heavy metal accumulated amounts it can be draw that the used residues, at these doses, do not present, until this moment, soil-plant system contamination potential

Quantificação de macronutrientes no solo e em folhas de cana-de-açúcar em função de doses de resíduo da mineração de bauxita

The experiment was carried out in green house with the objective of evaluating the effect of the bauxite mining residue in the rates of macronutrients in sugarcane and soil. Containers of 10 L were used. They received the following rates of bauxite residue: 0; 28; 56; 84; 112 and 140 t ha(-1). The used culture was the sugarcane (SP92 4221). The incorporation of the bauxite residue in the soil provided an increase in the levels of the soil macronutrients, and only for sulphur levels above 83 t ha(-1), it was possible to provide reductions of this nutrient. For rates of determined macronutrients in the leaf, levels above 70, 5; 125; 101; 56 t ha (-1) diminished the rates of nitrogen, phosphorum, potassium and sulphur, respectively. However, for calcium and magnesium the use of the residue provided the reduction of leaf rates. The level of the bauxite residue which had the largest production of dry mass was 64 t ha(-1)

Physical atributes of oxisol cultivated with sugar cane after applications of sewage sludge and vinasse

O objetivo deste trabalho foi avaliar se a aplicação anual de lodo de esgoto e vinhaça, resíduos empregados com a finalidade exclusiva de fornecer a quantidade necessária de N e K para cana-de-açúcar, causaria alteração em alguns atributos físicos de um Latossolo Vermelho distroférrico argiloso, após as colheitas do 3º e 4º cortes da cultura. O experimento foi conduzido em blocos ao acaso, com três repetições. Os tratamentos foram: (i) dose de lodo de esgoto para suprir 100% do N exigido pela cultura; (ii) dose de lodo de esgoto para suprir 200% do N exigido; (iii) dose de vinhaça para suprir 100% do K exigido; (iv) dose de vinhaça para suprir 200% do K exigido; (v) combinação dos tratamentos (i) e (iii); (vi) combinação dos tratamentos (ii) e (iv); (vii) testemunha (adubação mineral recomendada). Os somatórios das doses dos resíduos foram de 39 e 51 t ha-1 de lodo de esgoto e de 870 e 1.174 m³ ha-1 de vinhaça até o 3º e 4º cortes, respectivamente. Nas camadas de 0-10; 10-20; 20-30; 30-40 e 40-50 cm de profundidade, após as colheitas do 3º e 4º cortes da cultura, foram determinados: teor de matéria orgânica, porosidade total, macroporosidade, microporosidade, densidade do solo, densidade de partícula, resistência do solo à penetração e teor de água gravimétrico. Aplicações de lodo de esgoto e vinhaça não causaram modificação nos atributos físicos, resultado associado à falta de efeito dos resíduos na matéria orgânica do solo.The objective of this work was to evaluate if annual application of sewage sludge and vinasse, residues employed with exclusive purpose of supply N and K to sugar cane, would cause alteration on some physical attributes of clayey Haplustox after the harvests of the 3rd and 4th cuts of the crop. The experiment was carried out in a complete randomized block design with three repetitions. The treatments were: (i) rate of sewage sludge to supply 100% of the required N by the crop; (ii) dose rate of sewage sludge to supply 200% of the required N; (iii) rate of vinasse to supply 100% of the required K; (iv) rate of vinasse to supply 200% of the required K; (v) combination of the treatments (i) and (iii); (vi) combination of the treatments (ii) e (iv); (vii) control (mineral fertilization recommended). Sums rates of the residues were of 39 and 51 t ha-1 of sewage sludge and 870 and 1,174 m³ ha-1 of vinasse until the 3rd and 4th cuts, respectively. Soil samples were taken in the layers of 0-10, 10-20, 20-30, 30-40 e 40-50 cm of depth, after the harvests of the 3rd and 4th cuts of the crop. In these samples were determined the organic matter content, total porosity, macroporosity, microporosity, soil bulk density, particle density, soil resistance to penetration and gravimetric water content. Sewage sludge and vinasse applications did not cause any alteration on the physical attributes, result associated to lack of effect of the residues in the soil organic matter