Press counterweight of a torcularium with a latin inscription from the Los Palacios' roman archaeological site (Villanueva del Pardillo, Madrid)

Presentamos una nueva inscripción reutilizada como contrapeso de un torcularium en el yacimiento romano de Los Palacios (Madrid). A pesar del mal estado de conservación del texto, su lectura ha podido ser realizada en parte gracias a la ayuda de modernas técnicas de fotogrametría. El bloque tiene un paralelo directo tanto de soporte como del tipo de contenido en otra pieza de la localidad de Villamanta. De acuerdo con nuestra lectura, ambas inscripciones corresponden a epitafios de miembros de la gens Aelia, lo que junto a parámetros formales semejantes, permiten plantear una procedencia común para ambas piezas.A new Latin inscription, reused as counterweight of a torcularium in the Roman site of Los Palacios (Madrid), is presented. Although the corrupt condition of the text, the reading was partially made thanks to current photogrammetric technics. There is another inscription from Villamanta, which seems to be a direct parallel as well in shape as in contents. According to our reading, both are epitaphs of members of the gens Aelia and, in addition, there are some formal parameters that allow suggesting a shared origi

Contrapeso de un torcularium con inscripción latina procedente del yacimiento romano de Los Palacios (Villanueva del Pardillo, Madrid)

Presentamos una nueva inscripción reutilizada como contrapeso de un torcularium en el yacimiento romano de Los Palacios (Madrid). A pesar del mal estado de conservación del texto, su lectura ha podido ser realizada en parte gracias a la ayuda de modernas técnicas de fotogrametría. El bloque tiene un paralelo directo tanto de soporte como del tipo de contenido en otra pieza de la localidad de Villamanta. De acuerdo con nuestra lectura, ambas inscripciones corresponden a epitafios de miembros de la gens Aelia, lo que junto a parámetros formales semejantes, permiten plantear una procedencia común para ambas piezas.A new Latin inscription, reused as counterweight of a torcularium in the Roman site of Los Palacios (Madrid), is presented. Although the corrupt condition of the text, the reading was partially made thanks to current photogrammetric technics. There is another inscription from Villamanta, which seems to be a direct parallel as well in shape as in contents. According to our reading, both are epitaphs of members of the gens Aelia and, in addition, there are some formal parameters that allow suggesting a shared origin

The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

BACKGROUND: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. METHODS: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. RESULTS: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. CONCLUSIONS: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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<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<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. Funding: National Institute for Health and Care Research