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

Le livre d’Esther : réflexions sur une littérature de diaspora dans le judaïsme de l’époque du deuxième Temple

Le livre d’Esther constitue une fascinante pièce de littérature émanant de communautés juives de l’Antiquité. Il raconte l’histoire, largement fictive, d’une jeune juive vivant à la cour du roi perse Xerxès et parvenant à sauver son peuple d’un pogrom. L’analyse de ce texte biblique permet de mieux comprendre les problématiques et les défis auxquels furent confrontés les groupes qui, dans un monde largement dominé par la culture hellénistique, le produisirent. Introduction générale au livre d..

Ancient Israel : what do we know and how do we know it ?, L. L. Grabbe, London : T & T Clark International, 2007

Macchi Jean-daniel. Ancient Israel : what do we know and how do we know it ?, L. L. Grabbe, London : T & T Clark International, 2007. In: ASDIWAL. Revue genevoise d'anthropologie et d'histoire des religions, n°3, 2008. pp. 138-144

The environment, technology, and wisdom according to the Book of Job

This paper shows that, according to ancient Near Eastern worldview, the purpose of the action of the Creator God and of the humans is to control natural environment. In the Book of Job, Job's character is suffering. He puts in question the justice of the Creator God because it seems to him that the order of the world is not right regarding the wisdom's principle of retribution of humans' acts. Responding to that, God's speeches in Job 38 to 41 show that the order of the world as well as action of the Creator God is much more complex than what the human wisdom is able to understand. The hymn of Job 28 adds that even if technologies and capacities developed by human wisdom are impressive, that is not the true wisdom

The Book of Esther: A Persian story in Greek style

This study has shown the striking similarities between the representation of the Persian world and its practices in the Greek literature and in the Book of Esther. Furthermore, it has also shown that most episodes described in Esther's story look like episodes concerning characters that Greek literature situates in the Persian world. The college of lawyers consulted by Ahashwerosh to decide on the future of his wife Vashti looks like the college that legislated on the marriage of Cambyses with his sister (Herodotus). The story of the Esther's ascending to the kingship makes her an other Aspasia (Aelian). Mordecai's refusal to bow down to Haman can be compared with the attitude of the two Spartans in front of Xerxes (Herodotus – Plutarch). The risk that Esther accepts to run in order to go to the King makes her one other Phaedyme (Herodotus); furthermore, she acts in the very same way as Parysatis when she manipulates the King and Haman (Ctesias). Haman's hanging can be compared with the torturing to death of many enemies of the Queens Amestris and Parysatis (Ctesias); and Pourim is not without similarities with the Persian Magophonia (Herodotus). In addition to these numerous similarities, we can add that the book of Esther uses several historiographical techniques, which are distinctive of Hellenistic literature. For example, like Herodotus and others, the authors of Esther were concerned with explaining exotic customs (2,12-14 and 4,11); they also mentioned or quoted alleged archives (Est. 9,11-13 ), and used terms and names with Persian consonance (in particular Est. 1,11.14). The large number of parallels that can be drawn between the book of Esther and the Hellenistic literature has no equivalence elsewhere in the Hebrew Bible. To be sure, as regards general conceptions of history and geography as well as historiographical literary techniques, some connections do exist with Hellenistic historiographical literature elsewhere in the biblical literature. However, those connections are nowhere as significant as in Esther. Furthermore, within the biblical literature, very few stories can be found, which are really similar to the stories found in Greek literature. Thus, as regards connections with Hellenistic literature, Esther comprises a distinct book in the Hebrew Bible. In order to explain the parallels between Esther and the Greek texts and to preserve a dating for the redaction of Esther as ancient as possible, scholars argued that the same literary conventions about Persian world existed in the Greek world and in the Near East. However, considering the large number of parallels identified above, this solution seems less likely than the assumption of a direct influence of Greek writings on the authors of Esther. Literary conventions about Persia similar to those of the book of Esther are not attested in any writings that were composed outside the Hellenistic cultural influence. Furthermore, the dating of the book of Esther does not contradict a priori the possibility that the Greek literature influenced the authors of Esther, quite to the contrary. In fact, most scholars argue for a dating of Esther between the last part of the Persian period (4th century BCE) and the Hasmonean period (2nd - 1st century BCE). In my opinion, all the parallels between the Hellenistic literature and the book of Esther highlighted above are best accounted for if the authors of Esther were familiar with the Greek culture and literature. Even if they wrote in Hebrew, the Hellenistic literature was clearly the intellectual background of such authors. They knew the Greek way of life, and had probably read the Greek writings or at least had heard about the Greek stories. Thus, the authors of Esther were able to write a text like the book of Esther, which is very much in agreement with the Greek way of writing a Persian story. In order to create a story involving Judeans living in the Persian Empire, they resorted to major aspects of the Hellenistic culture in which they lived. Furthermore, they did not hesitate to write most episodes of Esther's story on the base of well known Persian stories composed by the Greek writers. In a way, the book of Esther can be viewed as a Hebrew equivalent of the «persicae» of Greek literature: a Persian story in Greek style. If the results of our analysis are correct, the following conclusions should be drawn. Regarding the meaning of the text and its underlying problematics, the fundamental questions already identified concerning Judean identity should be situated in the context of the dialogue and of the confrontation between Judean identity and the Hellenistic culture. By writing a novel about Persia in a way very similar to what a Greek would have been able to write (and read), the authors of the book establish two things. On one hand, that Judeans living in the Persian Empire did not act differently than well-educated Greek men or women (refusal to act as a Persian concubine, refusal to bow down in front of Persian King, acceptance of risking one's life to save one's own people etc.). Thus, the text shows that the Judeans had many values in common with the Hellenistic world where they lived. On the other hand, however, the book of Esther shows that when Jews live in an oppressive foreign empire they have to resist strongly to their enemies and have to defend their own values. This part of the argumentation can probably be understood as a warning against the possible abuses of power of the Hellenistic dominators, particularly when they became tyrannical. Regarding the dating and the historical context of production, the book of Esther was certainly written within a Judean circle significantly influenced by the Hellenistic culture. This kind of circles, which had access to some of the masterpieces of Greek historical literature, and were able to produce a book at the frontier between Greek and Judean way of thinking, never existed before the middle of the 3rd century BCE. They probably first appeared in the Judean diaspora living in the great cities of Egypt and of Syria. Later, during the Seleucid period, such circles gradually developed in the city of Jerusalem, as the latter became more and more Hellenize