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

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

The night and day of dung beetles (Coleoptera, Scarabaeidae) in the Serra do Japi, Brazil: elytra colour related to daily activity

In the present study 387 dung beetles (Coleoptera: Scarabaeidae) were surveyed at the Serra do Japi, in the Atlantic Forest in São Paulo State, with four baited pitfall traps during the months of December, 1998, and January, 1999 during eight 24 hour cycles. A total of 30 species were identified and temporal variation in activity patterns among the species shows a specialization in the use of food resources: 9 species were classified as nocturnal and 13 as diurnal. The daily activity pattern of dung beetles does not necessarily correspond to the taxonomic classification, but is strongly related to the colouring of species, determined by predominant elytra colour: nocturnal species have 89 % more chances of being black as opposed to colourful. Black nocturnal species might have evolved as an interspecific adaptation to avoid predation (cryptic colouring). Among the colourful diurnal dung beetles, measure of body length of each species shows that development of bright colouring was more often found in medium to large species, which suggests that colouring evolved as a response to intraspecific pressures, important in agonistic encounters among males

The Savior de Carlos Morton y sus adaptaciones al espa\uf1ol

In this article we analyze the two Spanish versions of the play The Savior (Morton, 1992), an earlier one adapted by Morton himself and Honduran Teatro La Fragua (Romero de las Am\ue9ricas, unpublished) and a later one by I. C. Flores Hern\ue1ndez and Teatro Universitario de la Benem\ue9rita Universidad Aut\uf3noma de Puebla (Romero, el Salvador, unpublished). The play, set in El Salvador in the Seventies, features the last years of life and the killing of archbishop 3scar Arnulfo Romero. Drawing on the theoretical framework of the School of Manipulation and Lefevere's construct of rewriting (Lefevere, 1982; 1992) we argue that the different approaches adopted for the two translations (the former relatively more target-oriented and the latter relatively more source-oriented) are largely motivated by the extra-textual constraints in which they were produced, namely the socio-historical setting and purpose of the translation (i.e., stage performance).En el presente trabajo analizamos las dos versiones en espa\uf1ol de la obra teatral The Savior (Morton, 1992), la m\ue1s antigua a cargo del propio dramaturgo en colaboraci\uf3n con el teatro hondure\uf1o La Fragua (Romero de las Am\ue9ricas, in\ue9dita) y la m\ue1s reciente a cargo de I. C. Flores Hern\ue1ndez y del grupo del Teatro Universitario de la Benem\ue9rita Universidad Aut\uf3noma de Puebla (Romero, el Salvador, in\ue9dita). La obra, ambientada en El Salvador a finales de los setenta, trata de la figura, de la obra y del asesinato de monse\uf1or 3scar Arnulfo Romero. A la luz de las problem\ue1ticas te\uf3ricas puestas de manifiesto por la Escuela de la Manipulaci\uf3n y del concepto de reescritura (Lefevere, 1982; 1992), intentaremos mostrar c\uf3mo los dos productos textuales (la versi\uf3n hondure\uf1a, relativamente m\ue1s target-oriented y la poblana, m\ue1s source-oriented) est\ue1n moldeados conforme los v\uednculos extratextuales y gen\ue9ricos de fondo que marcaron las circunstancias concretas de su elaboraci\uf3n, atendiendo tambi\ue9n a su funci\uf3n primordial, la interpretaci\uf3n en las tablas

Spatial variation of dung beetle assemblages associated with forest structure in remnants of southern Brazilian Atlantic Forest

AbstractThe Brazilian Atlantic Forest is one of the world's biodiversity hotspots, and is currently highly fragmented and disturbed due to human activities. Variation in environmental conditions in the Atlantic Forest can influence the distribution of species, which may show associations with some environmental features. Dung beetles (Coleoptera: Scarabaeinae) are insects that act in nutrient cycling via organic matter decomposition and have been used for monitoring environmental changes. The aim of this study is to identify associations between the spatial distribution of dung beetle species and Atlantic Forest structure. The spatial distribution of some dung beetle species was associated with structural forest features. The number of species among the sampling sites ranged widely, and few species were found in all remnant areas. Principal coordinates analysis indicated that species composition, abundance and biomass showed a spatially structured distribution, and these results were corroborated by permutational multivariate analysis of variance. The indicator value index and redundancy analysis showed an association of several dung beetle species with some explanatory environmental variables related to Atlantic Forest structure. This work demonstrated the existence of a spatially structured distribution of dung beetles, with significant associations between several species and forest structure in Atlantic Forest remnants from Southern Brazil

Development of conceptacles in Amphiroa (Corallinales, Rhodophyta)

Here, we describe the development of sporangial and gametangial conceptacles for Amphiroa beauvoisii and A. vanbosseae; sporangial conceptacles only for A. misakiensis; and gametangial conceptacles only for A. cryptarthrodia and A. rigida. The descriptions are based on the observation of histological preparations obtained from 112 specimens collected from the Gulf of California, in Mexico, and the Azores archipelago of Portugal. Information on the development of the sporangial conceptacle pore and conceptacle senescence is here described and illustrated for the first time. Four development patterns were observed: two for sporangial conceptacles; one for spermatangial conceptacles; and one for carposporangial conceptacles. The phases of development of the sporangial conceptacle were found to be useful in delimiting species within the genus. Based on the sporangium location on the cavity floor and the pore canal anatomy, the species A. beauvoisii, A. misakiensis and A. vanbosseae can be distinguished from each other