Risk factors for unfavourable postoperative outcome in patients with Crohn's disease undergoing right hemicolectomy or ileocaecal resection An international audit by ESCP and S-ECCO

Background Patient and disease-related factors, as well as operation technique all have the potential to impact on postoperative outcome in Crohn's disease. The available evidence is based on small series and often displays conflicting results. Aim To investigate the effect of pre- and intra-operative risk factors on 30-day postoperative outcome in patients undergoing surgery for Crohn's disease. Method International prospective snapshot audit including consecutive patients undergoing right hemicolectomy or ileocaecal resection. This study analysed a subset of patients who underwent surgery for Crohn's disease. The primary outcome measure was the overall Clavien-Dindo postoperative complication rate. The key secondary outcomes were anastomotic leak, re-operation, surgical site infection and length of stay at hospital. Multivariable binary logistic regression analyses were used to produce odds ratios (OR) and 95% confidence intervals (CI). Results Three hundred and seventy five resections in 375 patients were included. The median age was 37 and 57.1% were female. In multivariate analyses, postoperative complications were associated with preoperative parenteral nutrition (OR 2.36 95% CI 1.10-4.97)], urgent/expedited surgical intervention (OR 2.00, 95% CI 1.13-3.55) and unplanned intraoperative adverse events (OR 2.30, 95% CI 1.20-4.45). The postoperative length of stay in hospital was prolonged in patients who received preoperative parenteral nutrition (OR 31, CI [1.08-1.61]) and those who had urgent/expedited operations (OR 1.21, CI [1.07-1.37]). Conclusion Preoperative parenteral nutritional support, urgent/expedited operation and unplanned intraoperative adverse events were associated with unfavourable postoperative outcome. Enhanced preoperative optimization and improved planning of operation pathways and timings may improve outcomes for patients

Population, Land Use and Deforestation in the Pan Amazon Basin: a Comparison of Brazil, Bolivia, Colombia, Ecuador, Perú and Venezuela

This paper discusses the linkages between population change, land use, and deforestation in the Amazon regions of Brazil, Bolivia, Colombia, Ecuador, Perú, and Venezuela. We begin with a brief discussion of theories of population–environment linkages, and then focus on the case of deforestation in the PanAmazon. The core of the paper reviews available data on deforestation, population growth, migration and land use in order to see how well land cover change reflects demographic and agricultural change. The data indicate that population dynamics and net migration exhibit to deforestation in some states of the basin but not others. We then discuss other explanatory factors for deforestation, and find a close correspondence between land use and deforestation, which suggests that land use is loosely tied to demographic dynamics and mediates the influence of population on deforestation. We also consider national political economic contexts of Amazon change in the six countries, and find contrasting contexts, which also helps to explain the limited demographic-deforestation correspondence. The paper closes by noting general conclusions based on the data, topics in need of further research and recent policy proposals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42720/1/10668_2003_Article_6977.pd

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

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

Efeito da adição de óleos ao acaricida cyhexatin sobre o ácaro Brevipalpus phoenicis e na retenção de calda por folhas de citros

A adição de óleos à calda de pulverização, muitas vezes, é utilizada a campo sem o adequado conhecimento sobre a absorção do produto fitossanitário pelo alvo, retenção de calda e até mesmo sobre a praga e a cultura. O objetivo do trabalho foi avaliar o efeito da adição de óleos ao acaricida cyhexatin sobre o ácaro Brevipalpus phoenicis e na retenção de calda por folhas de citros. Avaliou-se a mortalidade de ácaros, utilizando-se de frutos de laranja com uma arena circundada com cola entomológica para confinar os ácaros. Adotou-se o delineamento inteiramente casualizado, em esquema fatorial, constituído pelos fatores: duas formulações de cyhexatin (WG e SC), dois tipos de óleo (mineral e vegetal) e duas concentrações dos óleos (0,5 e 1,0%), e mais dois tratamentos adicionais (acaricidas não adicionados de óleo) e uma testemunha sem aplicação. A aplicação dos produtos foi realizada sobre frutos de laranja até além do ponto de escorrimento. Logo após a aplicação, transferiram-se 10 ácaros B. phoenicis para cada fruto.A contagem dos ácaros vivos, mortos e retidos na barreira adesiva foi realizada um dia após a aplicação. Para a determinação da quantidade de calda retida, utilizaram-se folhas de laranjeira, que foram pulverizadas até além do ponto de escorrimento, adotando-se os mesmos tratamentos e o delineamento estatístico mencionados para a avaliação da mortalidade de ácaros, com exceção da testemunha sem aplicação. Determinou-se a massa de líquido retido após a aplicação dos produtos por folha, com auxílio de balança de precisão. Verificou-se que um dia após a aplicação dos produtos, todos os tratamentos apresentaram mortalidade de B. phoenicis acima de 99%. Dessa forma, a adição de óleo, seja mineral, seja vegetal, ao acaricida cyhexatin não afetou a eficácia biológica deste acaricida nas formulações SC e WG. A maior fuga de B. phoenicis para a barreira de cola foi verificada nos tratamentos com adição de óleos, em comparação ao cyhexatin aplicado isoladamente. A adição de óleo, seja mineral, seja vegetal, ao cyhexatin na calda de pulverização reduziu a quantidade máxima de líquido retido pelas folhas de citros, podendo contribuir para a redução da quantidade de calda necessária para uma boa cobertura da planta