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

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 > 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

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

Effect of ethylcellulose on the structure and stability of non-aqueous oil based propylene glycol emulsions

The hydrophobic polymer ethylcellulose (EC) has been used to structure vegetable oils and as a stabilizer of oil/water (o/w) emulsions, among other non food uses. in this work we show that EC dissolved in medium chain triglycerides (MCT) or soybean oil (SO) is able to stabilize non-aqueous emulsions of propylene glycol (PG) as a dispersed phase. Cream-like emulsions can be obtained at both low and high homogenization speeds which show a very good stability for at least one month without the requirement of co-surfactants. PG-in-oil emulsions at concentrations of EC below 5% (w/w) display pseudoplastic behavior and greater viscosity than the respective solutions of the polymer in MCT or SO. However, at concentrations of EC above 5% (w/w) firm gels are formed in MCI' or SO and after the addition of PG, the emulsions formed have lower viscosity than the original solutions of the polymer in MCI' or SO. Such effects were independent of the mean molecular weight (MMW) of the EC at high shear stress and inversely proportional at low shear stress. These results indicate that the stabilizing effect of EC in PG-in-oil emulsions might not be caused mainly by an increase in the viscosity of the continuous phase. Comparing all the results obtained, we can infer that EC, despite being insoluble in PG, is promoting interactions which are responsible for the observed effects.These PG-in-oil emulsions have interesting structural and flow properties which make them attractive to be used in food formulations, either as emulsions themselves or as potential vehicles for active ingredients. (C) 2014 Elsevier B.V. All rights reserved.CONICETCtr Excelenda Prod & Proc CEPROCOR, Buenos Aires, DF, ArgentinaConsejo Nacl Invest Cient & Tecn CONICET, Buenos Aires, DF, ArgentinaUniversidade Federal de São Paulo, Inst Ciencia & Tecnol, São Paulo, BrazilUniv Catalica Cordoba, Fac Ciencias Quim, Lab Biotecnol, Cordoba, ArgentinaUniv Nacl La Rioja, Dept Ciencias Exactas Fis & Natr, La Rioja, ArgentinaUniversidade Federal de São Paulo, Inst Ciencia & Tecnol, São Paulo, BrazilCONICET: PIP 11220100100502CONICET: PIP 11220090100732Web of Scienc

Chitosan and cloxacillin combination improve antibiotic efficacy against different lifestyle of coagulase-negative Staphylococcus isolates from chronic bovine mastitis

Abstract Bovine mastitis affects the health of dairy cows and the profitability of herds worldwide. Coagulase-negative staphylococci (CNS) are the most frequently isolated pathogens in bovine intramammary infection. Based on the wide range of antimicrobial, mucoadhesive and immunostimulant properties demonstrated by chitosan, we have evaluated therapy efficiency of chitosan incorporation to cloxacillin antibiotic as well as its effect against different bacterial lifestyles of seven CNS isolates from chronic intramammary infections. The therapeutic effects of combinations were evaluated on planktonic cultures, bacterial biofilms and intracellular growth in mammary epithelial cells. We found that biofilms and intracellular growth forms offered a strong protection against antibiotic therapy. On the other hand, we found that chitosan addition to cloxacillin efficiently reduced the antibiotic concentration necessary for bacterial killing in different lifestyle. Remarkably, the combined treatment was not only able to inhibit bacterial biofilm establishment and increase preformed biofilm eradication, but it also reduced intracellular bacterial viability while it increased IL-6 secretion by infected epithelial cells. These findings provide a new approach to prophylactic drying therapy that could help to improve conventional antimicrobial treatment against different forms of bacterial growth in an efficient, safer and greener manner reducing multiresistant bacteria generation and spread

Nanotecnología y Sociedad en Argentina : para una agenda inter y transdisciplinaria

El presente libro reúne una serie de trabajos en torno al desarrollo nanotecnológico en Argentina, organizados en tres secciones sub- temáticas: “Políticas Públicas, Regulación y Gobernanza”; “Innovación Nanotecnológica, Ciencia y Regulación. Una Mirada al Desarrollo de la Nanomedicina / Farmaceútica”; e “Innovación Responsable, Desarrollo Sustentable y Principio Precautorio”. Las y los autores provienen de la academia y sectores tecnológicos, del sector público y de organismos elaboradores de normas nanoespecíficas. El conjunto de los trabajos aporta un marco inter y transdisciplinario para el abordaje de los distintos aspectos vinculados a la nanotecnología así como a ampliar el acceso y discusión de la información disponible en lo concerniente a la promoción, evaluación de riesgos y regulación de productos y procesos productivos a escala nanométrica.This book gathers a series of papers on nanotechnological development in Argentina, organized in three sub-thematic sections: "Public Policies, Regulation and Governance"; "Nanotechnological Innovation, Science and Regulation. A Look at the Development of Nanomedicine / Pharmaceutics"; and "Responsible Innovation, Sustainable Development and the Precautionary Principle". The authors come from academia and technological sectors, from the public sector and from organizations that develop nano-specific standards. The works as a whole provide an inter- and transdisciplinary framework for addressing the different aspects related to nanotechnology, as well as broadening access to and discussion of the information available concerning the promotion, risk assessment and regulation of products and production processes at the nanometric scale.Fil: Berger, Mauricio. Universidad Nacional de Córdoba. Facultad de Ciencias Sociales. Instituto de Investigación y Formación en Administración Pública; ArgentinaFil: Carroza Tomás. Universidad Nacional de Mar del Plata. Facultad de Ciencias Agrarias. Departamento de Ciencias Sociales; Argentina.Fil: Bailo, Gonzalo. Universidad Nacional del Litoral. Facultad de Ciencias Jurídicas y Sociales; Argentina.Fil: Surtayeva, Sofya. Universidad Nacional de San Martín. Centro Babini; Argentina.Fil: Fiorani,Viviana. Instituto Argentino de Normalización y Certificación; Argentina.Fil: Talbot Wright, María Lorena. Universidad Nacional de Córdoba. Oficina de Propiedad Intelectual; ArgentinaFil: Gaggiotti, María Cecilia. Universidad Nacional de Córdoba. Programa de Valorización del Conocimiento; Argentina.Fil: Palma, Santiago Daniel. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Ciencias Farmacéuticas; ArgentinaFil:Formica, María Lina. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Ciencias Farmacéuticas; Argentina.Fil: Bianco, Ismael D. Córdoba. Gobierno de la Provincia de Córdoba. Ministerio de Ciencia y Tecnología. Centro de Excelencia en Productos y Procesos de Córdoba; Argentina.Fil: Salinas, Silvina R. Córdoba. Gobierno de la Provincia de Córdoba. Ministerio de Ciencia y Tecnología. Centro de Excelencia en Productos y Procesos de Córdoba; Argentina.Fil: Ridano, Magalí E. Córdoba. Gobierno de la Provincia de Córdoba. Ministerio de Ciencia y Tecnología. Centro de Excelencia en Productos y Procesos de Córdoba; Argentina.Fil: Salinas, Silvina R. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Kiyomi Mizutamari, R. Córdoba. Gobierno de la Provincia de Córdoba. Ministerio de Ciencia y Tecnología. Centro de Excelencia en Productos y Procesos de Córdoba; Argentina.Fil: Saborido, Mariano. Administración Nacional de Medicamentos Alimentos y Tecnología Médica; Argentina.Fil: Pesce, Guido. Administración Nacional de Medicamentos Alimentos y Tecnología Médica; Argentina.Fil: Herrera, Pablo Matías. Universidad de Buenos Aires. Facultad de Ciencias Económicas. Instituto de Investigaciones en Administración, Contabilidad y Métodos Cuantitativos para la Gestión; Argentina.Fil: García Fronti, Javier. Universidad de Buenos Aires. Faculta de Ciencias Económicas. Centro de Investigación en Metodologías Básicas y Aplicadas a la Gestión; Argentina.Fil: Ballestero, Gonzalo. Universidad de San Andrés; Argentina.Fil: Chavera Bianchi, Carlos. Universidad de Buenos Aires; Argentina.Fil: Bianco, Ismael D. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Formica, María Lina. Consejo Nacional de Investigaciones Científicas y Técnicas. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica; Argentina.Fil: Palma, Santiago Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica; Argentina.Fil: Kiyomi Mizutamari, R. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina