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

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Thermochronological, petrographic and geochemical characteristics of the Combia Formation, Amagá basin, Colombia

The Amagá basin between the Western and Central Cordilleras of the Northern Andes of Colombia hosts the Neogene volcanic and volcaniclastic Combia Formation. Deposition of the Combia Formation in relation to Nazca plate subduction and arc volcanism is still a matter of debate. Therefore, the timing, petrography and geochemical characteristics of Combia Formation rocks were studied in the western and eastern parts of the Amagá basin, in order to gain more information on the type of magma generation and volcanic activity that led to the deposition of the Combia Formation. Apatite and zircon fission-track dating largely confirm a 12-6 Ma age for the deposition of the Combia Formation. Petrographic and major element analyses show that mainly trachy-andesite ignimbrites with a calc-alkaline composition were deposited in the western Amagá basin, whereas the volcanic rocks of the eastern Amagá basin are lavas flow and fall-out deposits of basaltic andesites of tholeiitic affinity. Trace element and isotopic analyses show that slab dehydration and sediment melting/decarbonation were important in primary magma generation in the mantle wedge, but the primary magma was mixed with lower continental crustal melts (e.g. High-Pb radiogenic), resulting in characteristic isotope signatures in the western and eastern Amagá basin. Then, the hot-zone developed a high Pb-radiogenic, garnet-bearing lower continental crustal (LCC) level as a consequence of the quantity of dehydration of the subducting slab and of changes in the tectonic regime. An extensional pull-apart event (12- 9 Ma), likely facilitated rapid magma ascend to the uppermost crust along a subvertical magma plumbing system throughout the Romeral Fault zone in the eastern Amagá basin, and calc-alkaline magmas with adakite-like signature, which may indicate contractile tectonics that allow the formation of middle-to upper-crustal magma chambers with a garnet fractionation at depth and the evolution of silicate melts into the hot zone mainly related to the amount of water (>4 wt %) present. © 2020 Elsevier Lt

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study (vol 46, pg 2021, 2022)

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Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2