Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

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

Public awareness of beach litter and alien invasions: Implications for early detection and management

Coastal areas are environments of high diversity and severely threatened by hazards as marine litter and biological invasions. Citizens’ knowledge and awareness are drivers of changes needed to improve environment conservation. Density both of litter and IAS Cortaderia selloana were measured from six beaches in southwest Bay of Biscay along with awareness of inhabitants of the zone using a social survey. Relationship between beach littering, alien invasion and perception and awareness of adults and students were assessed. Litter levels were associated with port presence and showed relationship between environmental degradation, IAS and litter accumulation. Adults were more aware about both issues and their perception of litter and plant invasion were positively correlated. Results suggest enhancing marine awareness, with more effort addressed specifically to students. There is a misperception of the real magnitude of IAS and litter impacts that should be approached improving awareness about this topics in the younger generations.En prens

Flotsam, an overlooked vector of alien dispersal from ports

Anthropogenic litter is considered a potential vector for the dispersal of non-indigenous species (NIS) in marine ecosystems. Using the bay of Gijon (Southwestern Bay of Biscay) as a case study, we studied the composition and potential transfer of the communities inhabiting three different environment components: 1) natural and artificial substrates from the international port of Gijon, 2) six proximate rocky beaches and 3) floating litter collected in the adjacent coast. A total of 717 organisms were morphologically identified and DNA barcoded using COI and 18S genes. In total 23 NIS were detected, six of them considered invasive in the area. The taxonomic profiles of the three environment components were significantly different, flotsam containing higher proportions of Hexanauplia and less mollusks, echinoderms and polychaetes than ports and beaches. Contrary to expectations, floating litter showed higher densities of native and exotic species than beaches or port surfaces. This and shared haplotypes between port, flotsam and beaches in some invasive species may indicate that marine litter could represent a new habitat for species to disperse into new areas.En prens