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

PATOGENICIDAD DE AISLADOS NATIVOS (Beauveria bassiana) Y (Cordyceps javanica) SOBRE LARVAS DE Galleria mellonella (LEPIDOPTERA: PYRALIDAE)

The objective of this work was evaluated of the pathogenic capacity of native isolates of entomopathogenic fungi Beauveria bassiana (IDIAP D-Bb1400) and Cordyceps javanica (IDIAP RS-Cj006), obtained from the Institute of Agricultural Innovation of Panama (IDIAP). The evaluation was carried out through bioassays under laboratory conditions, using V instar larvae of the G. mellonella model insect dipping then in fungal suspensions of 1x107, 1x108 and 1x109 conidia ml-1 obtained from a breeding stock of the Faculty of Agricultural Sciences of the University of Panama. For the evaluation, the mortality expressed by the isolates in relation to time was determined, estimating the mean lethal time TL50, and the mean lethal concentration LC50. In all cases, mortality percentages greater than 80% were presented for both isolates and intraspecific differences were observed in the mortality of the treated larvae at concentrations of 1x107, 1x108 y 1x109 conidia ml-1 for both isolates. According to the results obtained, the isolation of Cordyceps javanica was more pathogenic with (TL50: 7.00 days and LC50:1.23x108 conidia ml-1), although the isolate IDIAP D-Bb1400 also showed excellent potential (TL50: 7.31 days and LC50: 1.55x108 conidia ml-1). However, there were no significant interspecific differences (p = 0.41) between both isolates and concentrations evaluated (χ2 (2) = 0.41, p = 0.81). Through this work, the great pathogenic potential of both isolates was evidenced for the first time in the treated larvae of G. mellonella under laboratory conditions, so it would be important and coherent to carry out field evaluations with these and other native strains, due to their promising potential in pest control in agriculture.El objetivo de este trabajo fue evaluar la capacidad patogénica de aislados nativos de los hongos entomopatógenos Beauveria bassiana (IDIAP D-Bb1400) y Cordyceps javanica (IDIAP RS-Cj006), obtenidos del Instituto de Innovación Agropecuaria de Panamá (IDIAP). La evaluación fue realizada mediante bioensayos en condiciones de laboratorio, utilizando larvas de V instar del insecto modelo Galleria mellonella, sumergiéndolas en suspensiones de 1x107, 1x108 y 1x109 conidios ml-1, obtenidas de un pie de cría de la Facultad de Ciencias Agropecuarias de la Universidad de Panamá, sede Chiriquí. Se determinó la mortalidad expresada por los aislados en relación con el tiempo, estimándose el tiempo letal medio TL50, y la concentración letal media CL50. En todos los casos se presentaron porcentajes de mortalidad mayores al 80% para ambos aislados y se observaron diferencias intraespecíficas en la mortalidad de las larvas tratadas a concentraciones de 1x107, 1x108 y 1x109 conidios ml-1 para ambos aislados. De acuerdo con los resultados obtenidos Cordyceps javanica fue más patogénico con TL50: 7.00 días y CL50: 1.23x108 conidios ml-1, aunque el aislado IDIAP D-Bb1400, también mostro un excelente potencial (TL50: 7.31 días y CL50: 1.55x108 conidios ml-1). Sin embargo, no hubo diferencias significativas interespecíficas (p=0.41) entre ambos aislados y concentraciones evaluadas (χ2 (2) = 0.41, p=0.81). Mediante este trabajo se evidencio por primera vez el gran potencial patogénico de ambos aislados en las larvas tratadas de G. mellonella en condiciones de laboratorio, por lo que sería importante y coherente realizar evaluaciones en campo con estos y otros aislados nativos, debido a su promisorio potencial en el control de plagas en la agricultura

PRESENCIA DE Orius insidiosus Say (HETEROPTERA: ANTHOCORIDAE) EN LA REGIÓN DE AZUERO, PANAMÁ

Horticultural production in Panama is impacted by vector insects, from which Thrips palmi Karny stands out. This insect causes direct and indirect damage to economically important crops, which implies risks for production and agro-exports. The purpose of this research was to determine the presence of Orius insidiosus, its distribution and reservoirs, both cultivated plants and weeds. The study was carried out in the Azuero region, Panama. During the period from 2009 to 2021, samples were taken in 11 localities, both in crop areas and ruderal vegetation. All biological material was transferred to the Plant Protection laboratory of the Centro de Innovación Agropecuaria de Divisa, Instituto de Innovación Agropecuaria de Panamá, for identification. A total of 348 specimens belonging to the Orius insidiosus species were collected and identified, the sex ratio 61.5% female and 38.5% male. The insect is widely distributed in agroecosystems in the region, both in cultivated plants and weeds, natural reservoirs of the species. The predator was found in crops, with presence of Thysanoptera such as Thrips palmi and other species of the genus Frankliniella. This finding is important within the integrated management strategy of Thrips palmi, which includes natural, conservative, and classical biological control.La producción hortícola de Panamá se ve impactada por insectos vectores de los que destaca Thrips palmi Karny. Este insecto tiene la capacidad de ser vector de diferentes especies de virus del género Tospovirus, no reportados en Panamá, causando daños directos e indirectos en cultivos de importancia económica, lo que implica riesgos para la producción y agroexportación. El propósito de la investigación fue determinar la presencia del chinche depredador Orius insidiosus, su distribución y reservorios tanto plantas cultivadas como arvenses presentes. El estudio se realizó en la región de Azuero, Panamá. Durante el periodo comprendido 2009 al 2021, se realizaron muestreos en 11 localidades, en áreas cultivadas como en la vegetación ruderal. Todo el material biológico fue trasladado al laboratorio de Protección Vegetal del Centro de Innovación Agropecuaria de Divisa, Instituto de Innovación Agropecuaria de Panamá; para su identificación. Se recolectaron e identificaron 348 especímenes perteneciente a la especie Orius insidiosus, la proporción de sexo fue de 61.5% hembras y 38.5% machos. El insecto está distribuido ampliamente en agroecosistemas de la región, tanto en plantas cultivadas y arvenses, que son reservorios naturales de la especie. El depredador, se encontró en plantas cultivadas con presencia de Thysanoptera, como Thrips palmi, y otras especies del género Frankliniella. Este hallazgo, es importante dentro de la estrategia de manejo integrado de Thrips palmi, que incluye el control biológico natural, conservativo y clásico