A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Paracoccidioidomicose aguda/subaguda disseminada. Primeiro caso no Rio Grande do Sul Acute/subacute disseminated paracoccidioidomycosis. First case in Rio Grande do Sul State, Brazil

É relatado o primeiro caso autóctone de paracoccidioidomicose disseminada aguda/subaguda ocorrido em criança no Rio Grande do Sul. A doença iniciou com adenomegalias superficiais generalizadas, seis meses antes da internação hospitalar. O diagnóstico foi feito através de biópsia de gânglio cervical. É comentado o espectro de formas clínicas da micose observado nesse Estado.<br>The first autochthonous case of acute/subacute disseminated paracoccidioidomycosis observed in a child in Rio Grande do Sul (Brazil) is reported. The disease started with widespread superficial lymphadenopathy six months before the patient was admitted to the hospital. The diagnosis was made through a cervical lymph node biopsy. The spectrum of the clinical forms of the mycosis observed in this State is commented upon

Saúde do trabalhador e o desafio ambiental: contribuições do enfoque ecossocial, da ecologia política e do movimento pela justiça ambiental Workers’ health and the environmental challenge: contributions from the ecosocial approach, the political ecology and the moviment for environmental justice

Este artigo relaciona o campo da saúde do trabalhador à temática ambiental, tendo por referências o enfoque ecossocial, a ecologia política e o movimento pela justiça ambiental, cada qual destacando uma dimensão específica: (1) no enfoque ecossocial destacamos a dimensão do conhecimento, com ênfase no desenvolvimento de análises integradas e na análise do papel da ciência e sua necessária renovação, sem a qual a luta política pode recair em ideologias simplistas baseadas em ciências positivistas e fragmentadas, as quais ignoram a complexidade dos problemas socioambientais e suas incertezas; (2) na abordagem da ecologia política e no conceito de justiça ambiental enfatizamos a dimensão do poder a partir da (re)produção das relações de dominação centro-periferias marcadas pelo desprezo sobre as pessoas e a natureza; e finalmente (3) no movimento pela justiça ambiental realçamos a dimensão da ação gerada pela consciência que inúmeros problemas ambientais possuem sua origem em um modelo de desenvolvimento injusto, particularmente para com as populações mais pobres e discriminadas. Nesse tópico destacamos a experiência da Rede Brasileira de Justiça Ambiental como um exemplo estratégico para o enfrentamento de problemas socioambiental em países latino-americanos como o Brasil.<br>This article links the workers’ health and the environmental issue, using as references the ecosocial approach, the political ecology and the movement for environmental justice. Each reference detaches a specific dimension: (1) the ecosocial approach emphasizes the dimension of knowledge through the development of integrated assessment and the new role of science in order to surpass simplistic ideologies based on positivism and fragmentation, which ignore the complexity of socio-environmental problems and their uncertainties; (2) the political ecology and the concept of environmental justice discuss the dimension of power, in which socio-environmental problems are understood as consequences of center-peripheries relationships of domination that despair the need of human beings and nature; and finally (3) the movement for environmental justice presents the dimension of action, which is propitiated the consciousness that many socio-environmental problems have their origin in an unfair development model, specially for the most discriminated and poor population. Here we discuss the role developed by the Brazilian Network of Environmental Justice, which can be seen as a strategic example how to face environmental challenges in Latin-American countries as Brazil