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

Predictive factors of Status Epilepticus and its recurrence in patients with adult-onset seizures: A multicenter, long follow-up cohort study

Purpose: Status epilepticus (SE) is associated with high morbidity and mortality. This multicenter retrospective cohort study aims to identify the factors associated with the occurrence of SE and the predictors of its recurrence in patients with adult-onset seizures. Methods: We retrospectively analyzed data of 1115 patients with seizure onset>18 years, observed from 1983 to 2020 in 7 Italian Centers (median follow-up 2.1 years). Data were collected from the databases of the Centers. Patients with SE were consecutively recruited, and patients without SE history were randomly selected in a 2:1 ratio. To assess determinants of SE, different clinical-demographic variables were evaluated and included in univariate and multivariate logistic regression model. Results: Three hundred forty-seven patients had a SE history, whereas the remaining 768 patients had either isolated seizures or epilepsy without SE history. The occurrence of SE was independently associated with increasing age at onset of disease (OR 1.02, 95% CI 1.01--1.03, p<0.001), female sex (OR 1.39, 95% CI 1.05--1.83, p=0.02) and known etiology (OR 3.58, 95% CI 2.61--4.93, p<0.001). SE recurred in 21% of patients with adult-onset SE and recurrence was associated with increasing number of anti-seizure medications taken at last follow-up (OR 1.88, 95% CI 1.31--2.71, p<0.001). Conclusions: In patients with adult-onset seizures, SE occurrence is associated with known etiologies, advanced age , female sex. Patients with recurrent SE are likely to have a refractory epilepsy, deserving careful treat-ment to prevent potentially fatal events

The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the "Delirium Day 2015"

BackroundUse of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium.AimThis analysis, from the Delirium Day 2015, a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients.MethodsPatients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age>65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score4: possible delirium; scores 1-3: possible cognitive impairment).ResultsAmong 1867 hospitalized patients (mean age 82.07.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.47.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia.DiscussionWe confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents.ConclusionEnvironmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence

B flavour tagging using charm decays at the LHCb experiment

An algorithm is described for tagging the flavour content at production of neutral B mesons in the LHCb experiment. The algorithm exploits the correlation of the flavour of a B meson with the charge of a reconstructed secondary charm hadron from the decay of the other b hadron produced in the proton-proton collision. Charm hadron candidates are identified in a number of fully or partially reconstructed Cabibbo-favoured decay modes. The algorithm is calibrated on the self-tagged decay modes B+ -> J/psi K+ and B-0 -> J/psi K*(0) using 3.0fb(-1) of data collected by the LHCb experiment at pp centre-of-mass energies of 7TeV and 8TeV. Its tagging power on these samples of B -> J/psi X decays is (0.30 +/- 0.01 +/- 0.01) %

Identification of beauty and charm quark jets at LHCb

Identification of jets originating from beauty and charm quarks is important for measuring Standard Model processes and for searching for new physics. The performance of algorithms developed to select b- and c-quark jets is measured using data recorded by LHCb from proton-proton collisions at root s = 7TeV in 2011 and at root s = 8TeV in 2012. The efficiency for identifying a b (c) jet is about 65%(25%) with a probability for misidentifying a light-parton jet of 0.3% for jets with transverse momentum pT > 20GeV and pseudorapidity 2 : 2 < eta < 4.2. The dependence of the performance on the pT and eta of the jet is also measured

Evidence for the decay X(3872) -> psi(2S)gamma

Evidence for the decay mode X(3872) -> psi(2S)gamma in B+ -> X(3872)K+ decays is found with a significance of 4.4 standard deviations. The analysis is based on a data sample of proton proton collisions, corresponding to an integrated luminosity of 3 fb(-1), collected with the LHCb detector, at centre-of-mass energies of 7 and 8 TeV. The ratio of the branching fraction of the X(3872) -> psi(2S)gamma decay to that of the X(3872) -> J/psi gamma decay is measured to be B(X(3872) -> psi(2S)gamma)/B(X(3872) -> J/psi gamma) = 2.46 +/- 0.64 +/- 0.29, where the first uncertainty is statistical and the second is systematic. The measured value does not support a pure D (D) over bar* molecular interpretation of the X(3872) state. (C) 2014 CERN for the benefit of the LHCb Collaboration. Published by Elsevier B.V

Measurement of the Xi(-)(b) and Omega(-)(b) baryon lifetimes

Using a data sample of pp collisions corresponding to an integrated luminosity of 3 fb(-1), the Xi(-)(b) and Omega(-)(b) baryons are reconstructed in the Xi(-)(b) -> J/psi Xi(-) and Omega(-)(b) -> J/psi Omega(-) decay modes and their lifetimes measured to be tau(Xi(-)(b)) = 1.55(-0.09)(+0.10) (stat) +/- 0.03 (syst) ps, tau(Omega(-)(b)) = 1.54(-0.21)(+0.26) (stat) +/- 0.05 (syst) ps. These are the most precise determinations to date. Both measurements are in good agreement with previous experimental results and with theoretical predictions. (C) 2014 The Authors. Published by Elsevier B.V

Effective lifetime measurements in the B-s(0) -> K+K-, B-0 -> K+pi(-) and B-s(0) -> pi K-+(-) decays

Measurements of the effective lifetimes in the B-s(0) -> K+K-, B-0 -> K+pi(-) and B-s(0) -> pi K-+(-) decays are presented using 1.0 fb(-1)of pp collision data collected at a centre-of-mass energy of 7 TeV by the LHCb experiment. The analysis uses a data-driven approach to correct for the decay time acceptance. The measured effective lifetimes are tau(Bs0 -> K+K-) = 1.407 +/- 0.016 (stat) +/- 0.007 (syst) ps, tau(Bs0 -> K+pi-) = 1.524 +/- 0.011 (stat) +/- 0.004 (syst) ps, tau(Bs0 ->pi+K-) = 1.60 +/- 0.06 (stat) +/- 0.01 (syst) ps. This is the most precise determination to date of the effective lifetime in the B-s(0) -> K+K- decay and provides constraints on contributions from physics beyond the Standard Model to the B-s(0) mixing phase and the width difference Delta Gamma(s). (C) 2014 The Authors. Published by Elsevier B.V

Measurement of the (B)over-bar(0)-B-0 and (B)over-bars(0)-B-s(0) production asymmetries in pp collisions at root s=7 TeV

The (B) over bar (0)-B-0 and (B) over bar (0)(s)-B-s(0) production asymmetries, A(P)(B-0) and A(P)(B-s(0)), are measured by means of a time-dependent analysis of B-0 -> J/Psi K-*0, B-0 -> D-pi(+) and B-s(0) -> D-s(-)pi(+) decays, using a data sample corresponding to an integrated luminosity of 1.0 fb(-1), collected by LHCb in pp collisions at a centre-of-mass energy of 7 TeV. The measurements are performed as a function of transverse momentum and pseudorapidity of the B-0 and B-s(0) mesons within the LHCb acceptance. The production asymmetries, integrated over p(T) and eta in the range 4 < p(T) < 30 GeV/c and 2.5 < eta < 4.5, are determined to be A(P)(B-0) = (-0.35 +/- 0.76 +/- 0.28)% and A(P)(B-s(0)) = (1.09 +/- 2.61 +/- 0.66)%, where the first uncertainties are statistical and the second systematic. (C) 2014 The Authors. Published by Elsevier B.V

First measurement of time-dependent CP violation in Bs0→K+K− B_s^0\to K^+K^- decays

Direct and mixing-induced CP-violating asymmetries in B-s(0) -> K+K- decays are measured for the first time using a data sample of p p collisions, corresponding to an integrated luminosity of 1.0 fb(-1), collected with the LHCb detector at a centre-of-mass energy of 7 TeV. The results are C-KK = 0.14 +/- 0.11 +/- 0.03 and S-KK = 0.30 +/- 0.12 +/- 0.04, where the first uncertainties are statistical and the second systematic. The corresponding quantities are also determined for B-0 -> pi(+)pi(-) decays to be C-pi pi = -0.38 +/- 0.15 +/- 0.02 and S-pi pi = -0.71 +/- 0.13 +/- 0.02, in good agreement with existing measurements