Pliocene Ostracoda of the Saline Basin, Veracruz, Mexico (Paleoecology, Tertiary, Gulf).

A detailed systematic study of samples from the Pliocene of the Saline Basin, Veracruz, Mexico, shows characteristic ostracode assemblages fro the Encanto, Lower and Upper Concepcion, and Agueguexquite strata. The remaining units, Filisola, Paraje Solo and Cedral, did not contain ostracodes. Ninety species belonging to 53 genera are determined and described. The ostracode assemblages of the studied units indicate a general upward shallowing trend during the Pliocene. The Encanto strata, constituting the oldest unit (N 19 or upper N 18), are characterized by Ambocythere spp., Argilloecia posterotruncata Bold, Bradleya normani (Brady), Krithe trinidadensis Bold, and Parakrithe spp. indicating a middle to upper bathyal environment. The Lower and Upper Concepcion beds (N 20) can be recognized by the presence of Actinocythereis vineyardensis (Cushman), Touroconcha lapidiscola Hartmann and the abundance of Hulingsina sp. 1, Henryhowella ex. gr. asperrima (Reuss) and Puriana spp. Encanto species persisting in the Lower Concepcion beds indicate an upper bathyal to outer neritic environment. The Upper Concepcion beds lack these species but instead possess abundant Cyprideis and Perissocytheridea spp., Basslerites? sp., Cytherura wardensis Howe and Brown and Loxoconcha sp. A Hazel. This assemblage indicates an outer to middle shelf environment. The Filisola and Paraje Solo samples were barren of ostracodes. Their foraminiferal and molluscan fauna indicates nearshore and brackish environments. The Paraje Solo may be in part contemporaneous to the Agueguexquite. The Agueguexquite strata contain the youngest (middle N 20), most abundant, and diverse fauna, indicating an inner neritic environment of deposition. They represent a local marine transgression of short duration in the northern part of the basin. By upper Agueguexquite time brackish and continental conditions had returned. A Q-mode cluster analysis utilizing Ward\u27s method on species proportions divided the Agueguexquite and Upper Concepcion samples in two main clusters, each one subdivided into two groups representing slightly different environments. Because of their low abundance only one Encanto and 3 Lower Concepcion samples were used in the clustering. They form generally independent groups. No apparent diversity trends were found

Distribución de pigmentos fotosintéticos del fitoplancton del Golfo de Tehuantepec en verano (junio, 2003): importancia del picofitoplancton*

Existen estudios previos sobre fitoplancton y sus grupos taxonómicos y especies, así como de su biomasa y productividad primaria, principalmente en invierno y primavera, pero se conoce poco la estructura del fitoplancton del Golfo de Tehuantepec en verano. Aquí se dan a conocer la composición y distribución de pigmentos fotosintéticos fitoplanctónicos en condiciones de verano. Se obtuvieron datos hidrográficos en nueve estaciones durante un crucero oceanográfico en junio, 2003, y se analizaron cinco pigmentos, Fucoxantina, Prasinoxantina, Violaxantina, Zeaxantina (indicador de Synechococcus, procarionte del picoplancton) y Divinil-clorofila a (diagnóstico de Prochlorococcus, otro procarionte del picoplancton). La columna de agua se encontró estratificada: la capa superficial, definida por la profundidad del tope de la termoclina, varió entre 20 y 35 m de espesor. Los valores de todos los pigmentos fueron bajos, pero mostraron patrones similares de distribución vertical, con un pico de concentración subsuperficial (entre 30 y 40 m), destacando Divinil-clorofila a en la mayoría de las estaciones, excepto en la 3 y 4, donde la Fucoxantina fue el principal pigmento. Estos picos no siempre coincidieron con la profundidad de la termoclina en cada estación, generalmente éstos se encontraron por debajo de ella. Este escenario muestra al picoplancton como una fracción importante en verano (al menos en junio), contrastando notablemente con la condición de invierno-primavera, de intensa mezcla turbulenta y surgencias, donde el microplancton y las diatomeas predominan

Application of multiple proxies in Mexican tropical coasts to prove evidence of tsunami deposits

"The study of tsunami deposits has significantly advanced since the Chilean 2010 and Tohoku 2011 tsunamis providing opportunities to analyze tsunami deposits and their characteristics (Rubin et al., 2017)." (fragm.

Sand deposits reveal great earthquakes and tsunamis at Mexican Pacific Coast

Globally, instrumentally based assessments of tsunamigenic potential of subduction zones have underestimated the magnitude and frequency of great events because of their short time record. Historical and sediment records of large earthquakes and tsunamis have expanded the temporal data and estimated size of these events. Instrumental records suggests that the Mexican Subduction earthquakes produce relatively small tsunamis, however historical records and now geologic evidence suggest that great earthquakes and tsunamis have whipped the Pacific coast of Mexico in the past. The sediment marks of centuries old-tsunamis validate historical records and indicate that large tsunamigenic earthquakes have shaken the Guerrero-Oaxaca region in southern Mexico and had an impact on a bigger stretch of the coast than previously suspected. We present the first geologic evidence of great tsunamis near the trench of a subduction zone previously underestimated as potential source for great earthquakes and tsunamis. Two sandy tsunami deposits extend over 1.5 km inland of the coast. The youngest tsunami deposit is associated with the 1787 great earthquake, M 8.6, producing a giant tsunami that poured over the coast flooding 500 km alongshore the Mexican Pacific coast and up to 6 km inland. The oldest event from a less historically documented event occurred in 1537. The 1787 earthquake, and tsunami and a probable predecessor in 1537, suggest a plausible recurrence interval of 250 years. We prove that the common believe that great tsunamis do not occur on the Mexican Pacific coast cannot be sustained

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

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

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&lt;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&lt;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

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries