Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Uso del láser en urgencias por periodontitis apical post tratamiento endodóntico

Introduction: Laser therapy and stimulation of the acupuncture points are anti-inflammatory and analgesic alternative treatments in dentistry.Objective: to describe the use of low power laser therapy in the emergency treatment of apical periodontitis after endodontic treatment during 2018.Methods: observational, descriptive, longitudinal, and prospective study of patients who attended emergency department at Guama Dentistry Clinic during 2018, Pinar del Río, presenting apical periodontitis after endodontic treatment; 86 patients participated in the study. Descriptive statistics was applied, respecting the bioethical principles.Results: female gender predominated (53,49 %), apical periodontitis after endodontic treatment was more prevalent in the age group 20-24 (30,23 %); 65,5 % of the patients presented remission and relief after the third treatment session. Only 2,33 % needed more than six treatment sessions.Conclusions: apical periodontitis after endodontic treatment is more common in women during the first half of the second decade of life. The treatment showed effectiveness from the first treatment sessions.Introducción: la terapia y estimulación con láser en puntos acupunturales constituyen alternativas de tratamiento antiinflamatorio y analgésico en estomatología.Objetivo: describir el uso de la terapia láser de baja potencia en el tratamiento de urgencias por periodontitis apical post tratamiento endodóntico durante el 2018.Método: estudio observacional, descriptivo, longitudinal y prospectivo en pacientes que acudieron a la consulta de urgencias de la Clínica Estomatológica “Guamá’’, municipio Pinar del Río, en el período durante el año 2018, por presentar periodontitis apical post tratamiento endodóntico. El universo estuvo constituido por 86 pacientes trabajándose con la totalidad. Se empleó estadística descriptiva y se siguieron los principios bioéticos.Resultados: predominó el sexo femenino (53,49 %), donde la periodontitis apical post tratamiento endodóntico se presentó en mayor cuantía en el grupo etario de 20 a 24 años de edad (30,23 %). El 65,5 % de los pacientes presentaron remisión y alivio tras la tercera sesión de tratamiento. Solo el 2,33 % necesitó más de seis sesiones de tratamiento.Conclusiones: la periodontitis apical post tratamiento endodóntico se presentan en mayor cuantía en las féminas, durante la primera mitad de la segunda década de vida. El tratamiento con terapia laser de baja frecuencia mostró efectividad desde las primeras sesiones de tratamiento

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

What can crop stable isotopes ever do for us? An experimental perspective on using cereal carbon stable isotope values for reconstructing water availability in semi-arid and arid environments

This study re-assesses and refines the use of crop carbon stable isotope values (Δ13C) to reconstruct past water availability. Triticum turgidum ssp. durum (durum wheat), Hordeum vulgare (six-row barley) and Sorghum bicolor (sorghum) were experimentally grown at three crop research stations in Jordan for up to three years under five different irrigation regimes: 0% (rainfall only), 40%, 80%, 100% and 120% of the crops’ optimum water requirements. The results show a large variation in carbon stable isotope values of crops that received similar amounts of water, either as absolute water input or as percentage of crop requirements. We conclude that C3 crop carbon stable isotope composition should be assessed using a climate zone specific framework. In addition, we argue that interpretation should be done in terms of extremely high values showing an abundance of water versus low values indicating water stress, with values in between these extremes best interpreted in conjunction with other proxy evidence. Carbon stable isotope values of the C4 crop Sorghum were not found to be useful for the reconstruction of water availability

Experimental crop growing in Jordan to develop methodology for the identification of ancient crop irrigation

Crop irrigation has long been recognized as having been important for the evolution of social complexity in several parts of the world. Structural evidence for water management, as in the form of wells, ditches and dams, is often difficult to interpret and may be a poor indicator of past irrigation that may have had no need for such constructions. It would be of considerable value, therefore, to be able to infer past irrigation directly from archaeo-botanical remains, and especially the type of archaeo-botanical remains that are relatively abundant in the archaeological record, such as phytoliths. Building on the pioneering work of Rosen and Wiener (1994), this paper describes a crop-growing experiment designed to explore the impact of irrigation on the formation of phytoliths within cereals. If it can be shown that a systemic and consistent relationship exists between phytolith size, structure and the intensity of irrigation, and if various taphonomic and palaeoenvironmental processes can be controlled for, then the presence of past irrigation can feasibly be inferred from the phytoliths recovered from the archaeological record