Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Reproducibilidad del examen directo de heces y de la concentración formoléter y validez del examen directo de heces para el diagnóstico de parásitos intestinales

Introduction: Despite the clinical, epidemiological and public health importance of intestinal parasites, research on its diagnostic methods in Colombia is meager. Objective: To evaluate the reproducibility direct stool examination and formalin-ether concentration and determine validity, performance and accuracy of direct examination of stool for the diagnosis of intestinal parasites. Methods: Concordance study and evaluation of diagnostic tests. A demographic survey, direct examination of faeces and method Telleman concentration in samples of 51 individuals from Medellin, Colombia applied. The concordance test was evaluated with Kappa and Phi Gamma coefficients; the validity estimates of sensitivity, specificity, and likelihood ratios J Youden index; performance with predictive values and accuracy with the proportion of correctly diagnosed patients. Results: Nine species of intestinal parasites were identified, higher proportion: Blastocystis spp, Endolimax nana and Entamoeba coli. For species of protozoa, diners, pathogens and parasites overall, the kappa indexes were higher than 0.70, the direct method presented higher positive likelihood ratios 15, negative likelihood ratios of 0.03; predictive values greater than 93%, J Youden indices greater than 0.9 and proportions of correctly diagnosed patients greater than 96%. Conclusion: Excellent agreement and correlation between the evaluated methods was obtained; direct examination showed excellent validity, performance and accuracy for the diagnosis of intestinal parasitic protozoa, but not for helminths.Introducción: A pesar de la importancia clínica, epidemiológica y de salud pública del parasitismo intestinal, la investigación sobre sus métodos diagnósticos en Colombia es exigua. Objetivo: Evaluar la reproducibilidad entre el examen directo de heces y la concentración formol-éter y determinar validez, desempeño y exactitud del examen directo de heces para el diagnóstico de parásitos intestinales. Métodos: Estudio de concordancia y evaluación de pruebas diagnósticas. Se aplicó una encuesta sociodemográfica, examen directo de heces y método de concentración formol-éter en muestras de 51 individuos de Medellín, Colombia. La concordancia de las pruebas se evaluó con Índice Kappa y coeficientes Phi y Gamma; la validez con la estimación de sensibilidad, especificidad, cocientes de probabilidad e Índice J de Youden; el desempeño con valores predictivos y exactitud con la proporción de pacientes correctamente diagnosticados. Resultados: Se identificaron nueve especies de parásitos intestinales, mayor proporción: Blastocystis spp, Endolimax nana y Entamoeba coli. Para las especies de protozoos, comensales, patógenos y parasitismo global, los índices kappa fueron mayores a 0,70, el método directo presentó cocientes de probabilidad positivos mayores a 15, cocientes de probabilidad negativos de 0,03; valores predictivos mayores al 93%, Índices J de Youden mayores a 0,9 y proporciones de pacientes correctamente diagnosticados mayores a 96%. Conclusión: Se obtuvo excelente concordancia y correlación entre los métodos evaluados; el examen directo presentó excelente validez, desempeño y exactitud para el diagnóstico de parasitismo intestinal por protozoos, pero no para helmintos

Revista Temas Agrarios Volumen 26; Suplemento 1 de 2021

1st International and 2nd National Symposium of Agronomic Sciences: The rebirth of the scientific discussion space for the Colombian Agro.1 Simposio Intenacional y 2 Nacional de Ciencias Agronómicas: El renacer del espacio de discusión científica para el Agro colombiano

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic