Multicentre observational study on multisystem inflammatory syndrome related to COVID-19 in Argentina

Background: The impact of the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in low- and middle-income countries remains poorly understood. Our aim was to understand the characteristics and outcomes of PIMS-TS in Argentina. Methods: This observational, prospective, and retrospective multicenter study enrolled patients younger than 18 years-old manifesting PIMS-TS, Kawasaki disease (KD) or Kawasaki shock syndrome (KSS) between March 2020 and May 2021. Patients were followed-up until hospital discharge or death (one case). The primary outcome was pediatric intensive care unit (PICU) admission. Multiple logistic regression was used to identify variables predicting PICU admission. Results: Eighty-one percent, 82%, and 14% of the 176 enrolled patients fulfilled the suspect case criteria for PIMS-TS, KD, and KSS, respectively. Temporal association with SARS-CoV-2 was confirmed in 85% of the patients and 38% were admitted to the PICU. The more common clinical manifestations were fever, abdominal pain, rash, and conjunctival injection. Lymphopenia was more common among PICU-admitted patients (87% vs. 51%, p < 0.0001), who also showed a lower platelet count and higher plasmatic levels of inflammatory and cardiac markers. Mitral valve insufficiency, left ventricular wall motion alterations, pericardial effusion, and coronary artery alterations were observed in 30%, 30%, 19.8%, and 18.6% of the patients, respectively. Days to initiation of treatment, rash, lymphopenia, and low platelet count were significant independent contributions to PICU admission. Conclusion: Rates of severe outcomes of PIMS-TS in the present study agreed with those observed in high-income countries. Together with other published studies, this work helps clinicians to better understand this novel clinical entity.Fil: Vainstein, Eduardo. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Baleani, Silvia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Urrutia, Luis. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Affranchino, Nicolás. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Ackerman, Judith. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Cazalas, Mariana. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Goldsman, Alejandro. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Sardella, Angela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Tolin, Ana Laura. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaFil: Goldaracena, Pablo. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; ArgentinaFil: Fabi, Mariana. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; ArgentinaFil: Cosentino, Mariana. Hospital Británico de Buenos Aires; ArgentinaFil: Magliola, Ricardo. Hospital Británico de Buenos Aires; ArgentinaFil: Roggiero, Gustavo. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Manso, Paula. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Triguy, Jésica. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaFil: Ballester, Celeste. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaFil: Cervetto, Vanesa. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Vaccarello, María. Sanatorio de la Trinidad; ArgentinaFil: De Carli, Domingo Norberto. Clínica del Niño de Quilmes; ArgentinaFil: De Carli, Maria Estela. Clínica del Niño de Quilmes; ArgentinaFil: Ciotti, Ana Laura. Hospital Nacional Profesor Alejandro Posadas; ArgentinaFil: Sicurello, María Irene. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Rios Leiva, Cecilia. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Villalba, Claudia. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Hortas, María. Sanatorio de la Trinidad; ArgentinaFil: Peña, Sonia. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaFil: González, Gabriela. Gobierno de la Provincia de Mendoza. Hospital Pediátrico Humberto Notti; ArgentinaFil: Zold, Camila Lidia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Fisiología y Biofísica Bernardo Houssay. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiología y Biofísica Bernardo Houssay; ArgentinaFil: Murer, Mario Gustavo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Fisiología y Biofísica Bernardo Houssay. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Fisiología y Biofísica Bernardo Houssay; ArgentinaFil: Grippo, M.. No especifíca;Fil: Vázquez, H.. No especifíca;Fil: Morós, C.. No especifíca;Fil: Di Santo, M.. No especifíca;Fil: Villa, A.. No especifíca;Fil: Lazota, P.. No especifíca;Fil: Foti, M.. No especifíca;Fil: Napoli, N.. No especifíca;Fil: Katsikas, M. M.. No especifíca;Fil: Tonello, L.. No especifíca;Fil: Peña, J.. No especifíca;Fil: Etcheverry, M.. No especifíca;Fil: Iglesias, D.. No especifíca;Fil: Alcalde, A. L.. No especifíca;Fil: Bruera, M.J.. No especifíca;Fil: Bruzzo, V.. No especifíca;Fil: Giordano, P.. No especifíca;Fil: Pena Acero, F.. No especifíca;Fil: Netri Pelandi, G.. No especifíca;Fil: Pastaro, D.. No especifíca;Fil: Bleiz, J.. No especifíca;Fil: Rodríguez, M. F.. No especifíca;Fil: Laghezza, L.. No especifíca;Fil: Molina, M. B.. No especifíca;Fil: Patynok, N.. No especifíca;Fil: Chatelain, M. S.. No especifíca;Fil: Aguilar, M. J.. No especifíca;Fil: Gamboa, J.. No especifíca;Fil: Cervan, M.. No especifíca;Fil: Ruggeri, A.. No especifíca;Fil: Marinelli, I.. No especifíca;Fil: Checcacci, E.. No especifíca;Fil: Meregalli, C.. No especifíca;Fil: Damksy Barbosa, J.. No especifíca;Fil: Fernie, L.. No especifíca;Fil: Fernández, M. J.. No especifíca;Fil: Saenz Tejeira, M.M.. No especifíca;Fil: Cereigido, C.. No especifíca;Fil: Nunell, A.. No especifíca;Fil: Villar, D.. No especifíca;Fil: Mansilla, A. D.. No especifíca;Fil: Darduin, M. D.. No especifíca

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Transferencia de investigaciones virológicas a sectores educativos y generales de la comunidad

La educación es la única y verdadera herramienta válida, por excelencia, para lograr cambios positivos en la historia, en la política, en la salud o en cualquiera otro aspecto importante de la vida de los hombres. Entonces, deberíamos insistir en mejorar la calidad educativa de los ciudadanos y alumnos de todos los niveles, mejorando necesariamente la actualización de los saberes de los funcionarios, profesionales y docentes para que se inscriba en el discurso cotidiano. El desconocer, no prepararse, nos lleva a crisis sociales que inevitablemente incrementan flagelos como la pobreza, la pérdida de biodiversidad, las guerras, las epidemias, entre otros. Así, desde donde se produce y construye el conocimiento científico, la Universidad Nacional de Córdoba, Facultad de Ciencias Médicas y específicamente el Instituto de Virología "Dr. José María Vanella" también se promueve el objetivo de extensión comunitaria, brindando este proyecto a docentes, alumnos y comunidad en general de la provincia de Córdoba como servicio educativo y actualización. Las temáticas son variadas, los talleres convocan a la Divulgación científica y tecnológica de infecciones virales de importancia sanitaria su conocimiento, prevención y difusión, no solo para el sector educativo sino también para la comunidad en general. Las actividades son talleres, conferencias, laboratorios, jornadas de un día hasta dos semanas. Las metodologías aplicadas son charlas dialogadas, vídeos, dinámica de grupos, Hay evaluaciones de seguimiento a través de comentarios, relatos, encuestas. Todas las actividades de extensión del InViV cuentan con la aprobación de la Facultad Ciencias Médicas a través de las Res. Decanales anuales.Fil: Balangero, Marcos. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Gil, Pedro Ignacio: Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Gil, Pedro Ignacio: Universidad Nacional de Córdoba. Secretaría de Ciencia y Tecnología; ArgentinaFil: Frutos: María Cecilia: Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Frutos: María Cecilia: Universidad Nacional de Córdoba. Secretaría de Ciencia y Tecnología; ArgentinaFil: Díaz, Luis Adrián. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Ré, Viviana. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Farias, Adrián Alejandro. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Spinsanti, Lorena. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Venezuela, Raúl Fernando. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Kiguen, Ana Ximena. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Konigheim, Brenda. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Pisano, María Belén. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil:Masachessi, Gisela. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Barril, Patricia Angélica. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Varella"; Argentina.Fil: Barril, Patricia Angelica. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Estudios en Comunicación, Expresión y Tecnologías; Argentina.Fil: Castro, Gonzalo. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Batallán, Pedro Gonzalo. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Batallán, Pedro Gonzalo. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Estudios en Comunicación, Expresión y Tecnologías; Argentina.Fil: Quaglia, Agustín.Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Tauro, Laura Beatriz. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Tauro, Laura Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Estudios en Comunicación, Expresión y Tecnologías; Argentina.Fil: Flores, Fernando Sebastián. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Flores, Fernando Sebastián. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Estudios en Comunicación, Expresión y Tecnologías; Argentina.Fil: Beranek, Mauricio. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Beranek, Mauricio. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Estudios en Comunicación, Expresión y Tecnologías; Argentina.Fil: Maturano, Eduardo. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Rodríguez, Pamela Elizabeth. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Cámara, Jorge Augusto. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil, Albrieu Llinás, Guillermo. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil, Albrieu Llinás, Guillermo. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Estudios en Comunicación, Expresión y Tecnologías; Argentina.Fil: Adamo, María Pilar. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Ghietto, Lucía María. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Ghietto, Lucía María. Universidad Nacional de Córdoba. Secretaría de Ciencia y Tecnología; ArgentinaFil: Pedranti, Mauro Sebastián. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Giordano, Miguel Oscar. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Martínez, Laura Cecilia.Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Isa, Maria Beatriz. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Ascheri, Stella Maris. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Paredes, Norma Gladys. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Contigiani, Marta Silvia. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Benítez, Marta. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Theiler, Gerardo. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Augello, Marysol. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Fosatti, L. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; ArgentinaFil:Moreno, F. Colegio San Martín; Argentina.Fil:Marín, M. Colegio Nuestra Señora del Sagrado Corazón; Argentina.Fil: Carreras, G. Provincia de Córdoba. Ipem 323 de Villa Angelelli; Argentina.Fil: Navarro, A. Provincia de Córdoba. Ipem 323 de Villa Angelelli; Argentina.Fil: Fuentes, M. Provincia de Córdoba. Ipem 323 de Villa Angelelli; Argentina.Fil: Santiago, T. Provincia de Córdoba. Ipem 323 de Villa Angelelli; Argentina.Fil: Cámara, Alicia. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Paglini, María Gabriela. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Cuffini, Cecilia. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Gallego, Sandra Verónica.Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Aguilar, Javier. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Paván, Jorge. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Fil: Nates, Silvia Viviana. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Instituto de Virología "Dr. José María Vanella"; Argentina.Enfermedades Infecciosa

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. METHODS: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. FINDINGS: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2-11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75-1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58-1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91-1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70-1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11-0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50-0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38-0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45-0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. INTERPRETATION: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. FUNDING: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Microemulsification-based method: analysis of ethanol in fermentation broth of sugar cane

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)This article addresses important results for the consolidation of the microemulsification-based method (MEC), an approach recently proposed by these authors, which represents a powerful output for the deployment of point-of-use technologies. In MEC, the detection is conducted in a solution with the naked eyes. It relies on the effect of the analyte on the formation of microemulsions (MEs). The minimum volume fraction of amphiphile needed to obtain ME (Phi(ME)) is the analytical response whose measurement is based on binary chemical information: the cloudy-to-transparent transition that occurs with microemulsification. Accordingly, this signal can be precisely detected with the naked eye, thus enabling precise determinations. The experiments that were accomplished are as follows: robustness investigation and the direct determination of ethanol in fermentation broths of sugar cane. Dispersions were composed of water, oleic acid, and ethanol as hydrophilic (W), hydrophobic (O), and amphiphilic (AP) phases, respectively. Standards of analyte were added to the W phase before the addition of AP in the W-O mixture to attain the analytical curves. For application, the samples were directly used as the W phase. Our approach was somewhat robust with regard to deviations in volumetric preparation of the dispersions and changes in temperature and conductivity. Lastly, the reliability of the MEC was evaluated in the determination of ethanol in fermentation broths of sugar cane. The results were astoundingly accurate after direct analyses with the naked-eye detection. Usually, for these samples the dilution and separation steps require tools such as chromatography and electrophoresis. Limit of linearity, analytical sensitivity, and limit of detection were 70.00% v/v ethanol to water, -0.39, and 1.34% v/v, respectively. MEC stands out in relation to the other methods reported in literature for the determination of ethanol in alcoholic beverages and fermentation broths when considering parameters of wide linearity and low-cost. Indeed, our method is unique in ensuring precise determinations without instrumental detection, requiring only the naked eye. It represents a remarkable aspect for point-of-use measurements. In contrast, MEC is not applicable for trace chemical analyses because of its poor limit of detection.This article addresses important results for the consolidation of the microemulsification-based method (MEC), an approach recently proposed by these authors, which represents a powerful output for the deployment of point-of-use technologies. In MEC, the d7231006110066FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP [2014/24126-6]2014/24126-6Financial support from Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, Grant No. 2014/24126-6) is gratefully acknowledged. CTBE is recognized for providing and charactering the samples of fermentation brot

Point-of-use Electroanalytical Platform Based On Homemade Potentiostat And Smartphone For Multivariate Data Processing

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)We herein report a potential point-of-use platform for multivariate analyses by presenting homemade potentiostat and smartphone. This system combined high-performance detection (linear sweep, cyclic, and square wave voltammetry) with great simplicity, low-cost, portability, autonomy (6 h), and cable-free (wireless communication) device. In addition, the smartphone showed ability for processing complex and multivariate data. To the best of our knowledge, this paper is the first reporting about the development of a totally integrated point-of-use system with chemometric data processing on smartphone. This feature is essential for in-situ assays by allowing the real-time accomplishment of the entire analytical measurement at remote places. Such ability further reduces the occurrence of model overfitting by non-expert users. As proof-of-concept, our system was successfully applied to fingerprint Brazilian honey samples according to their botanical and geographic origins. The method relied on the unsupervised technique of principal component analysis (PCA) and the assays were performed by cyclic voltammetry using a single and non-modified working electrode of gold. (C) 2016 Elsevier Ltd. All rights reserved.219170177Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [2014/24126-6]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Intervening factors in the performance of a naked-eye microemulsification-based method and improvements in analytical frequency

FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOAn investigation into the use of different amphiphiles and improvements in the analytical frequency of the microemulsification-based method (MEC) are described. The results are important for improving the understanding of the method (recently proposed by92233473355FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO2014/24126-6Financial support for this project was provided by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, Grant 2014/24126-6