Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Effect of Spraying date of boron on Vegetative Growth and Yield of Cotton Plant (Gossypium hirsutum L.) Lashata Variety

Abstract A field experiment was conducted during the spring season of the year 2018 in the fields of the Cotton Research Unit at the Technical Agricultural College / Mosul to study the effect of spraying the element boron for different dates (the stage of vegetative growth, the stage of opening blooming buds, the stage of boll formation) and the interferences between these dates on the characteristics of vegetative growth and cotton components Lashata cultivar, and used the design of complete randomized block in the implementation of the experiment. The results of the study showed that the date of spraying with boron in the two stages of vegetative growth and flowering buds open significantly exceeds the rest of the dates in the characteristics of plant height (cm) and the number of nodes up to the first fruit branch and the number of vegetable branches and the number of fruit branches in values (135.8 cm, 6.1, 4.5, 16.8) respectively, the duration of spraying with boron in the vegetative stage exceeded the rest of the dates by its effect on the characteristics of the total number of bolls and the weight of one boll (gm), the seed index and the yield of the cast cotton values (36.8, 6.82 g, 4.050, 995.2 kg −1), respectively. the date of spraying is also superior in the vegetative stage of growth significantly on the rest of the dates on the characteristics of its effects type (E and percentage of hair and the percentage of the early) values (42.8, 40.5% staple guide, and 82.15%) respectively.</jats:p

Effect of concentration and date of spraying with trace elements on growth and yield of cotton plant ( Gossypium hirsutum L.)

Abstract This study was conducted in the fields of the Cotton Research Unit / Technical Agricultural College / Mosul, to study the effect of three concentrations of the trace element composition (0, 1.25, 2.5) ml / liter and three spraying dates (the vegetative growth stage, the flowering stage and the boll formation stage) on qualitative and quantitative characteristics of vegetative growth and yield of Lashata cultivar cotton plant. The seeds were sown at 15/4/2018 in mixed soil by adopting the design of complete random design. RCBD with three replicates and one experimental unit contained ten homogeneous plants. The results were analyzed and tested according to the Duncan polynomial test under the level of error probability of 5%. The results of this study showed a significant effect of the trace elements in most of the studied characteristics. Especially when adopting the spraying date in the vegetative growth stage as the vegetative growth characteristics increased (plant height, number of nodes until the first fruit branch, number of vegetative branches, number of fruiting branches) and quantity yield characteristics (number of bolls, weight of the existing boll, seed index, cotton yield Cast iron) and qualitative yield characteristics (staple index, percentage of hair, earliness percentage) and the interaction coefficients between spray concentrations and dates compared to control treatment.</jats:p

Date Palm Fiber-Reinforced Recycled Polymer Composites: Synthesis and Characterization

In this research study, Recycled Polymer (RP) composites are synthesized by using compression molding process, initial mixtures of RP and Date Palm Fibers (DPF) with four different lengths (e.g., 2.5, 5, 7.5, and 10 mm) and weight ratios (e.g., 5, 10, 15, and 20 wt%). The RP composites utilized in this study are polyethylene and polypropylene. The mixtures of RP and DPF are heated at 80°C and then poured into a priori prepared mold. The mold is designed to have three cavities for three specimens in order to characterize them through impact, creep, and tensile tests. The results showed that the hardness and impact increased with this process. In addition, an increase in the DPF up to 15 wt% was observed with a small increase in the DPF length. High creep resistance was also observed to be 10 mm with 20 wt% in the DPF specimens. The maximum strain was obtained in a 2.5 mm fiber length with 5% of DPF due to ductility of the plastic matrix. Moreover, with a small ratio of tough DPF, short fibers are unable to block or resist rapid plastic deformation in specimens. In fact, the DPF specimens of 10 mm length with 20 wt% exhibit a high tensile strength of 78 N/mm2 in comparison with other composite specimens. This is due to the length and content of fibers, which improve transferring action and microfailure modes.</jats:p

Date Palm Fiber-Reinforced Recycled Polymer Composites: Synthesis and Characterization

In this research study, Recycled Polymer (RP) composites are synthesized by using compression molding process, initial mixtures of RP and Date Palm Fibers (DPF) with four different lengths (e.g., 2.5, 5, 7.5, and 10 mm) and weight ratios (e.g., 5, 10, 15, and 20 wt%). The RP composites utilized in this study are polyethylene and polypropylene. The mixtures of RP and DPF are heated at 80°C and then poured into a priori prepared mold. The mold is designed to have three cavities for three specimens in order to characterize them through impact, creep, and tensile tests. The results showed that the hardness and impact increased with this process. In addition, an increase in the DPF up to 15 wt% was observed with a small increase in the DPF length. High creep resistance was also observed to be 10 mm with 20 wt% in the DPF specimens. The maximum strain was obtained in a 2.5 mm fiber length with 5% of DPF due to ductility of the plastic matrix. Moreover, with a small ratio of tough DPF, short fibers are unable to block or resist rapid plastic deformation in specimens. In fact, the DPF specimens of 10 mm length with 20 wt% exhibit a high tensile strength of 78 N/mm2 in comparison with other composite specimens. This is due to the length and content of fibers, which improve transferring action and microfailure modes