CHALLENGES IN THE DIAGNOSIS AND TREATMENT OF PATIENTS WITH COLORECTAL CANCER AND COVID-19 COINFECTION - CASE REPORT

Patients with colorectal cancer (CRC) are more likely to become infected with COVID-19 than healthy individuals. The risk of comlications and death in COVID-19 positive colorectal cancer patients is higher due to treatments that suppress the immune system. We discuss a 71-year-old woman with a history of metastatic rectal cancer and underwent surgery and chemotherapy. With no clinical feathers of an acute abdomen or COVID-19 infection. Further researches are needed to rule out if COVID-19 can mask clinical and biological features presentation in cancer patients. Keywords: metastatic colorectal cancer, COVID-19 infection, surgical treatmen

For optical flickering in symbiotic star MWC 560

This study is based on observations of MWC560 during the last two observational seasons (2020/2021 and 2021/2022). Other than looking for flickering we were interested in following the variability of brightness in the same period. Looking for similarities in the spectra with other types of stars is also of great interest to us because it could help clarify the stellar configuration of such objects. Our observations during the last two observational seasons of MWC560 confirm the absence of flickering. From the similarities of the gathered spectra of XX Oph and MWC560 we assume that the components in XX Oph are a red giant and a white dwarf, which are also surrounded by a common shell

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

Abstract 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

Recurrent pilonidal disease - individualization and pathogenesis-oriented surgery

INTRODUCTIONRecurrence after pilonidal disease surgery are common and difficult to treat. Many options are proposed including cleft lift procedure, Karydakis flap and advanced flaps. The aim of the study is to present and analyze our experience with individualized pathogenesis-based surgery of recurrent pilonidal disease. METHODSFor a 10-year period (2009-2019) patients with recurrent pilonidal disease were operated by authors. RESULTSThe healing time in 60 patients was 14-40 days. 22 patients had concomitant hidradenitis suppurativa in gluteal and/or inguinal regions. In 51 patients modified Karydakis operation was performed. In 9 patients complex advanced flaps were used. General or spinal anesthesia is used. In all patients perioperative antibiotics were administered and closed suction drains were used. Major complications occurred in 7 patients – 3 postoperative hematoma formation and 4 partial wound dehiscence managed conservatively. All patients are recurrence free. CONCLUSIONThe main issues in surgery of recurrent pilonidal disease is to avoid repeated procedures, to prevent new recurrence and to have acceptable functional and cosmetic results. Radical surgery with individualization following principles of cleft lift and avoiding of midline suture lines leads to best results and patient satisfaction. According to our experience and literature, we propose tailored radical surgical treatment of recurrent pilonidal disease:(1) recurrence after primary midline closure or pit piking (Bascom 1), or multiple incisions with midline sinus tract or wound with limited lateral extension – Bascom cleft lift procedure or modified Karydakis flap; (2) recurrence after lay open techniques – Karydakis or advanced flap; (3) recurrence with gluteal extension or combination with hidradenitis suppurativa – advanced flap with avoiding of midline suture line - “modified cleft lift”. &nbsp

Crystal-Chemical and Thermal Properties of Decorative Cement Composites

The advanced tendencies in building materials development are related to the design of cement composites with a reduced amount of Portland cement, contributing to reduced CO2 emissions, sustainable development of used non-renewal raw materials, and decreased energy consumption. This work deals with water cured for 28 and 120 days cement composites: Sample A—reference (white Portland cement + sand + water); Sample B—white Portland cement + marble powder + water; and Sample C white Portland cement + marble powder + polycarboxylate-based water reducer + water. By powder X-ray diffraction and FTIR spectroscopy, the redistribution of CO32−, SO42−, SiO44−, AlO45−, and OH− (as O-H bond in structural OH− anions and O-H bond belonging to crystal bonded water molecules) from raw minerals to newly formed minerals have been studied, and the scheme of samples hydration has been defined. By thermal analysis, the ranges of the sample’s decomposition mechanisms were distinct: dehydration, dehydroxylation, decarbonation, and desulphuration. Using mass spectroscopic analysis of evolving gases during thermal analysis, the reaction mechanism of samples thermal decomposition has been determined. These results have both practical (architecture and construction) and fundamental (study of archaeological artifacts as ancient mortars) applications

Updated distribution and species composition of the amphibians and reptiles along the Lower Danube, Bulgaria

In a recently published paper (Popgeorgiev et al. 2019), we compiled for the first time published and unpublished data on localities of the herpetofaunal species observed up to ca. 10 km south of the Bulgarian Danube River. Overall, we identified 687 published records belonging to 62 cells of the 10×10 km MGRS grid. Another 1918 records with real coordinates of our unpublished data from the past ca. 13 years belong to 1269 cells of the 1×1 MGRS grid. As a result, 34 native species – 15 amphibians (4 salamanders and 11 frogs) and 19 reptiles (1 turtle, 2 tortoises, 8 lizards and 8 snakes), and one invasive turtle, have been recorded; further species findings are unlikely. This study further identifies areas that are under-sampled and species such as Pelophylax lessonae that are cryptic. Our data are especially relevant concerning the high economic incentives to change the hydrology of the Danube, which will likely negatively impact the biodiversity along the river and its surrounding

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research