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

Plants of Sabkha Ecosystems of the Arabian Peninsula.

Sabkhas are unique ecosystems that are highly saline and where specially adapted plants are able to grow, flower, and fruit. In general, saline environments are poor in species – for the Arabian Peninsula about 120 taxa are recorded as halophytes which constitute about 4% of the total flora of the Arabian Peninsula. Key halophytes of Arabia are nearly always perennial; predominant life-forms are somewhat succulent, semiwoody dwarf shrubs belonging to the families Amaranthaceae, Zygophyllaceae, and Plumbaginaceae and hemicryptophytes belonging to the Poaceae, Cyperaceae, and Juncaceae; annuals are exceptions. Coastal species are either obligate halophytes or salt-tolerant genera from unspecialized families, such as Sporobolus and Aeluropus (Poaceae), or salt-secreting species such as Avicennia (Acanthaceae) and Limonium (Plumbaginaceae). The submerged coastal vegetation, e.g., seagrasses, is one of the most important vegetation types of the Gulf coast and is of great importance to marine fauna. The north-south distribution of coastal species is more distinct on the Red Sea coast, with the border lying near Jeddah, than on the Persian Gulf coast where there is a broad transitional zone between Qatar and northern Oman. The east-west distribution of coastal species is not as distinct. The eastern elements are either restricted to the coasts around the Arabian Gulf or are Irano-Turanian species extending into the Gulf region. Several vicariant species groups of halophytes are represented in the Arabian Peninsula. Halophytes have developed strategies for seed germination such as high germination levels and fast germination speed. These traits are found in the sabkha plants of the Arabian Peninsula. Some halophytes have been investigated for their potential for phytoremediation in their ability to survive weathered oil-contaminated soils. They have been found to have a set of micoorganisms around their root system that are related to the degradation of oil in contaminated soils. Sabkha ecosystems are being degraded and altered throughout the Gulf countries as they appear to be nonproductive. Over the last two decades, there has been a growing concern in protecting and restoring mangroves, and programs do to so have seen promising results. But, on the whole, coastal and inland sabkhas are neglected, and these unique ecosystems require urgent protection