Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

The Pleistocene Later Stone Age south of the Limpopo River

The earliest Later Stone Age (LSA) industries from southern Africa are microlithic and unstandardized and include the bipolar technique. The dating of these industries is controversial and the earliest microlithic industry is said to occur at Border Cave at about 39,000 B.P. By 18,000 B.P. a bladelet tradition was established and this was replaced in many parts of southern Africa, at about 12,000 B.P., by a widespread and prolific nonmicrolithic industry, characterized by side-struck flakes. The late Pleistocene environment was colder than present, with particularly harsh conditions during the Last Glacial Maximum (LGM), between about 20,000 and 18,000 B.P. Populations may have been isolated because archaeological visibility is low during the LGM and decreases further after the LGM. After 13,000 B.P. there is a dramatic increase in sites and this implies that there may have been widespread colonization of territory previously unoccupied for tens of thousands of years. By the end of the late Pleistocene there was a change in hunting patterns, in parts of southern Africa, from an emphasis on the capture of large, gregarious grazers to an emphasis on small, solitary browsers. Social complexity increased during the late Pleistocene, and by 12,000 B.P. it seems possible that Stone Age people were observing some social practices recorded historically among Bushmen (San)