Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: A nationwide study in Spain

Objective To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain. Settings The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied. Participants This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020. Interventions An exploratory factorial analysis was performed to select the most relevant variables of the sample. Primary and secondary outcome measures Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection. Results Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/10 5 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade =3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/10 5 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated. Conclusions Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/10 5 people/week) was a statistically independent predictor of mortality. Trial registration number CEIM 20/217

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

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

Distribución, tallas y proporción sexual del calamar Lolliguncula panamensis del Golfo de Tehuantepec, México

ABSTRACT: An intense fishing activity focused to the capture of shrimp and demersal fishes is developed in the Gulf of Tehuantepec (Mexico). As part of the shrimp trawl fishing the capture of the Lolliguncula panamensis is very abundant. Assess the distribution, abundance, size structure and sexual proportion of the Panama brief squid, in the gulf of Tehuantepec, México. The squids specimens were collected through bycatch shrimp trawlers during November and December 2017, and February (fishing season), May, July and August 2018 (closed fishing season); from five fishing open ocean trips (156 fishing sets). A total of 746 females (21 to 110 mm Mantle length, LM) and 76 males (21 to 93 mm LM) were caught, with the highest abundance (94.5%) between 20 and 30 m deep. Sexual proportion was predominated by females (1M:7H χ2 = 248.81, p < 0.05), whereas size-weight relationship differences were significant (K-S, p < 0.05). The abundant capture of L. panamensis in the Gulf of Tehuantepec, mainly during the fishing shrimp season (rainy season), suggests the importance of the Pacific brief squid as a potential exploitable resource as well as an alternative for fishermen during the fishing closure of resources like shrimp and sharks. Likewise, represents a complementary source of proteins for local populations.RESUMEN: En el Golfo de Tehuantepec se desarrolla una intensa actividad pesquera centrada en la captura de camarones y peces demersales. Como parte de la pesca de arrastre de camarones, la captura de Lolliguncala panamensis es abundante. El objetivo fue evaluar la distribución, abundancia, estructura de tallas y proporción sexual del calamar dedal L. panamensis, en la zona de pesca del camarón en el Golfo de Tehuantepec. Los calamares se recolectaron de la fauna de acompañamiento del camarón, durante noviembre y diciembre de 2017 y febrero (temporada de pesca), mayo, julio y agosto de 2018 (temporada de veda); a partir de cinco viajes y 156 lances de pesca de altamar, realizados a bordo de embarcaciones camaroneras comerciales. Se recolectaron 746 hembras (21 a 110 mm Longitud del manto, LM) y 76 machos (21 a 93 mm LM), con la mayor abundancia (94.5%), entre los 20 y 30 m de profundidad. Las hembras dominaron la proporción sexual (1M:7H χ2 = 248.81, p < 0.05), mientras que las diferencias en talla y peso entre ambos sexos, fueron significativas (K-S, p < 0.05). La abundante captura de esta especie en el Golfo de Tehuantepec, principalmente durante la veda del camarón (temporada de lluvias), sugiere la importancia de este calamar como un recurso potencial explotable y una alternativa para los pescadores durante la veda de otros recursos como el camarón y tiburón; así como una fuente de proteínas complementarias para las poblaciones locales

Phosphorus-induced zinc deficiency in wheat pot-grown on noncalcareous and calcareous soils of different properties

<p>High levels of phosphorus (P) often induce zinc (Zn) deficiency in plants grown on Zn-poor soils. We investigated P-induced Zn deficiency in durum wheat (<i>Triticum durum</i> L. ‘Carpio’) grown on 16 noncalcareous and 31 calcareous soils differing in levels of available (Olsen) P and available (diethylenetriaminepentaacetic acid (DTPA)-extractable) Zn using micropots. A completely randomized factorial design with two levels of P (0 and 40 mg P kg⁻¹ soil) and Zn (0 and 3 mg Zn kg⁻¹ soil), i.e. four treatments (‘control’, + P, + Zn, and + PZn), were used. Grain yield of control plants depended mainly on the Olsen P level. Phosphorus had a negative effect on yield in 6 soils with Olsen P/Zn_DTPA > 25, and Zn a positive one in 5 soils with Olsen P/Zn_DTPA > 50; and the + PZn treatment generally resulted in the highest yield. Grain Zn concentration of control plants was negatively correlated with growth and Olsen P. Calcareous soils were less sensitive to P-induced Zn deficiency than noncalcareous soils because phosphate is sorbed by calcite rather than being co-adsorbed with Zn on the Fe oxides. Co-application of P and Zn to soil at low and application of Zn at high Olsen P ensured both maximum yield and grain Zn bioavailability.</p

Scaling up the production of electrodeposited nanowires: a roadmap towards applications

The use of metallic nanowires is mostly reduced to scientific areas where a small quantity of nanostructures are needed. In order to broaden the applicability of these nanomaterials, it is necessary to establish novel synthesis protocols that provide a larger amount of nanowires than the conventional laboratory fabrication processes at a more competitive cost. In this work, we propose several modifications to the conventional electrochemical synthesis of nanowires in order to increase the production with considerably reduced production time and cost. To that end, we use a soft anodization procedure of recycled aluminum at room temperature to produce the alumina templates, followed by galvanostatic growth of CoFe nanowires. We studied their morphology, composition and magnetic configuration, and found that their properties are very similar to those obtained by conventional methods