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

Physiological responses of the red rocky crab Cancer antennarius exposed to different concentrations of copper sulfate

In this study we evaluated physiological, metabolic and hematological responses for the crab Cancer antennarius to different copper sulfate concentrations (0.5, 1.0, 1.5, 2.0 mg L-1). The evaluated responses were: the median lethal dose, osmoregulatory capacity, oxygen consumption, ammonium excretion, atomic relation O:N, glucose, THC and hemocyanin concentration. The median lethal dose (LD50) we found was 1.6 mg L-1 of copper sulfate. The pattern followed on most of the observed responses was an increase directly proportional to the amount of copper sulfate concentration, except for osmoregulatory capacity where the osmoregulation pattern, usually isosmotic in normal conditions, was modified to hyposmotic. In the atomic relation O:N we observed a decrease in values due to changes in metabolic substrate as a result of stress caused by exposure to copper sulfate.Se evaluaron en el cangrejo de roca Cancer antennarius las respuestas fisiológicas, metabólicas y hematológicas a diferentes concentraciones de sulfato de cobre (0,5, 1,0, 1,5, 2,0 mg L-1). Las respuestas a determinar fueron: dosis letal media, capacidad osmorreguladora, consumo de oxígeno, excreción de amonio, relación atómica O:N, glucosa, el CTH y la concentración de hemocianina. En cuanto a la dosis letal media (LD50) se determinó que la concentración fue de 1,6 mg L-1 de sulfato de cobre. El patrón observado en la mayoría de las respuestas medidas fue un aumento directamente proporcional a la concentración de sulfato de cobre; a excepción de la capacidad osmorreguladora, en la que el patrón de osmorregulación, de ser típicamente isosmótico en condiciones normales, se modificó a hiposmótico. En la relación atómica O:N se observó una disminución en los valores debido a cambios en sustrato metabólico como un resultado del estrés causado por la exposición al sulfato de cobre

Sex-Specific Regulation of AMP-Activated Protein Kinase (AMPK) in the Pacific Oyster Crassostrea gigas

The hermaphrodite Pacific oyster Crassostrea gigas displays a high energy allocation to reproduction. We studied the expression of AMP-activated protein kinase (AMPK) during gametogenesis in the gonad and characterized the mRNA sequences of the AMPK subunits: the AMPK alpha mRNA sequence was previously characterized; we identified AMPK beta, AMPK gamma, and mRNAs of putative AMPK-related targets following bioinformatics mining on existing genomic resources. We analyzed the mRNA expression of the AMPK alpha, beta, and gamma subunits in the gonads of male and female oysters through a reproductive cycle, and we quantified the mRNA expression of genes belonging to fatty acid and glucose metabolism. AMPK alpha mRNA levels were more abundant in males at the first stage of gametogenesis, when mitotic activity and the differentiation of germinal cells occur, and were always more abundant in males than in females. Some targets of fatty acid and glucose metabolism appeared to be correlated with the expression of AMPK subunits at the mRNA level. We then analyzed the sex-specific AMPK activity by measuring the phosphorylation of the catalytic AMPK alpha protein and its expression at the protein level. Both the amount of AMPK alpha protein and threonine 172 phosphorylation appeared to be almost totally inhibited in mature female gonads at stage 3, at the time when accumulation of reserves in oocytes was promoted, while it remained at a high level in mature spermatozoa. Its activation might play a sex-dependent role in the management of energy during gametogenesis in oyster

Biología de los anfibios y reptiles en el bosque seco tropical del norte de Colombia.

Los anfibios y reptiles son animales asombrosos y su biología es mucho más Fascinante y variada de lo que originalmente se consideraba. Esta afirmación se soporta fácilmente en múltiples aspectos, entre los cuales sobresale, su reproducción (Duellman & Trueb 1994; Wells 2007; Balshine 2012; Gómez-Mestre et al. 2012; Vitt & Caldwell 2014; Pough et al. 2016). En los anfibios, por ejemplo, muchas especies no dejan sus huevos en charcas y lagunas, como tradicionalmente ha creído el común de las personas, sino que las hembras los depositan en ambientes terrestres, tales como la superficie de hojas o en ambientes húmedos que se dan a nivel del suelo entre hojarasca y bajo troncos caídos, piedras o raíces de árboles (Duellman & Trueb 1994; Crump 2015). Más aún, hay especies cuya reproducción es tan especializada que los padres o madres transportan a los renacuajos en diferentes partes de su cuerpo , ya sea, por pocas horas o días, mientras los depositan en ambientes específicos, o hasta que las crías terminan su ciclo de metamorfosis y se desarrollen como un adulto, pero en miniatura  (Noble 1927; Mendelson et al. 2000; Castroviejo-Fisher et al. 2015). Con respecto a los reptiles, hay ejemplos de especies, donde, - las hembras no requieren que un gameto masculino fertilice sus óvulos para producir crías, o especies, donde el sexo de la progenie no está determinado genéticamente, sino por la temperatura ambiental, lo cual, permiten la incubación de huevos (Tinkle & Gibbons 1977; Shine 1995; Vitt & Caldwell 2014). Los factores o procesos asociados a la evolución de este último aspecto en la reproducción de reptiles, es todo un enigma para los científicos (BlacNburn 2006; Shine 2015). Estos y muchos más ejemplos, que se encuentran a lo largo de este libro, contradicen la imagen que durante décadas se tuvo de los anfibios y reptiles, incluso, por científicos y naturalistas tan prestigiosos como, Carlos Linneo, quien afirmó que estos vertebrados eran animales repulsivos, en los cuales el creador no había ejercido toda su sabiduría y poder (Halliday & Adler 1986)

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN