Abstract
Background
Surgeons need guidance regarding appropriate personal protective equipment (PPE) during the COVID-19 pandemic based on scientific evidence rather than availability. The aim of ...this article is to inform surgeons of appropriate PPE requirements, and to discuss usage, availability, rationing and future solutions.
Methods
A systematic review was undertaken in accordance with PRISMA guidelines using MEDLINE, Embase and WHO COVID-19 databases. Newspaper and internet article sources were identified using Nexis. The search was complemented by bibliographic secondary linkage. The findings were analysed alongside guidelines from the WHO, Public Health England, the Royal College of Surgeons and specialty associations.
Results
Of a total 1329 articles identified, 95 studies met the inclusion criteria. Recommendations made by the WHO regarding the use of PPE in the COVID-19 pandemic have evolved alongside emerging evidence. Medical resources including PPE have been rapidly overwhelmed. There has been a global effort to overcome this by combining the most effective use of existing PPE with innovative strategies to produce more. Practical advice on all aspects of PPE is detailed in this systematic review.
Conclusion
Although there is a need to balance limited supplies with staff and patient safety, this should not leave surgeons treating patients with inadequate PPE.
Graphical Abstract
This systematic review provides a comprehensive overview of all the issues surrounding personal protective equipment for surgeons during the COVID-19 pandemic. To overcome this global challenge needs an evidence-based, collaborative, innovative multidisciplinary approach.
Graphical Abstract
Better to be safe than sorry
Summary
Background
Previous studies have identified an inverse association between melanoma and smoking; however, data from population‐based studies are scarce.
Objectives
To determine the ...association between smoking and socioeconomic (SES) on the risk of development of melanoma. Furthermore, we sought to determine the implications of smoking and SES on survival.
Methods
We conducted a population‐based case–control study. Cases were identified from the Welsh Cancer Intelligence and Surveillance Unit (WCISU) during 2000–2015 and controls from the general population. Smoking and SES were obtained from data linkage with other national databases. The association of smoking status and SES on the incidence of melanoma were assessed using binary logistic regression. Multivariate survival analysis was performed on a melanoma cohort using a Cox proportional hazard model using survival as the outcome.
Results
During 2000–2015, 9636 patients developed melanoma. Smoking data were obtained for 7124 (73·9%) of these patients. There were 26 408 controls identified from the general population. Smoking was inversely associated with melanoma incidence odds ratio (OR) 0·70, 95% confidence interval (CI) 0·65–0·76. Smoking was associated with an increased overall mortality hazard ratio (HR) 1·30, 95% CI 1·09–1·55, but not associated with melanoma‐specific mortality. Patients with higher SES had an increased association with melanoma incidence (OR 1·58, 95% CI 1·44–1·73). Higher SES was associated with an increased chance of both overall (HR 0·67, 95% CI 0·56–0·81) and disease‐specific survival (HR 0·69, 95% CI 0·53–0·90).
Conclusions
Our study has demonstrated that smoking appeared to be associated with reduced incidence of melanoma. Although smoking increases overall mortality, no association was observed with melanoma‐specific mortality. Further work is required to determine if there is a biological mechanism underlying this relationship or an alternative explanation, such as survival bias.
What's already known about this topic?
Previous studies have been contradictory with both negative and positive associations between smoking and the incidence of melanoma reported.
Previous studies have either been limited by publication bias because of selective reporting or underpowered.
What does this study add?
Our large study identified an inverse association between smoking status and melanoma incidence.
Although smoking status was negatively associated with overall disease survival, no significant association was noted in melanoma‐specific survival.
Socioeconomic status remains closely associated with melanoma. Although higher socioeconomic populations are more likely to develop the disease, patients with lower socioeconomic status continue to have a worse prognosis.
Linked Comment: Thompson and Friedman. Br J Dermatol 2020; 182:1080.
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We study the buildup of the bimodal galaxy population using the NEWFIRM Medium-Band Survey, which provides excellent redshifts and well-sampled spectral energy distributions of 2,000 galaxies with K ...< 22.8 at 0.4 < z < 2.2. We first show that star-forming galaxies and quiescent galaxies can be robustly separated with a two-color criterion over this entire redshift range. We then study the evolution of the number density and mass density of quiescent and star-forming galaxies, extending the results of the COMBO-17, DEEP2, and other surveys to z = 2.2. The mass density of quiescent galaxies with M 3 X 1010 M increases by a factor of ~10 from z ~ 2 to the present day, whereas the mass density in star-forming galaxies is flat or decreases over the same time period. Modest mass growth by a factor of ~2 of individual quiescent galaxies can explain roughly half of the strong density evolution at masses >1011 M , due to the steepness of the exponential tail of the mass function. The rest of the density evolution of massive, quiescent galaxies is likely due to transformation (e.g., quenching) of the massive star-forming population, a conclusion which is consistent with the density evolution we observe for the star-forming galaxies themselves, which is flat or decreasing with cosmic time. Modest mass growth does not explain the evolution of less massive quiescent galaxies (~1010.5 M ), which show a similarly steep increase in their number densities. The less massive quiescent galaxies are therefore continuously formed by transforming galaxies from the star-forming population.
The COVID-19 pandemic has heavily impacted elective and emergency surgery around the world. We aimed to confirm the incidence of perioperative severe acute respiratory syndrome coronavirus 2 ...(SARS-CoV-2) infection and associated mortality after surgery.
Analysis of routine electronic health record data from NHS hospitals in England. We extracted data from Hospital Episode Statistics in England describing adult patients undergoing surgery between January 1, 2020 and February 28, 2021. The exposure was SARS-CoV-2 infection defined by International Classification of Diseases (ICD)-10 codes. The primary outcome measure was 90 day in-hospital mortality. Data were analysed using multivariable logistic regression adjusted for age, sex, Charlson Comorbidity Index, Index of Multiple Deprivation, presence of cancer, surgical procedure type and admission acuity. Results are presented as n (%) and odds ratios (OR) with 95% confidence intervals (CI).
We identified 2 666 978 patients undergoing surgery of whom 28 777 (1.1%) had SARS-CoV-2 infection. In total, 26 364 (1.0%) patients died in hospital. SARS-CoV-2 infection was associated with a much greater risk of death (SARS-CoV-2: 6153/28 777 21.4% vs no SARS-CoV-2: 20 211/2 638 201 0.8%; OR=5.7 95% CI, 5.5–5.9; P<0.001). Amongst patients undergoing elective surgery, 2412/1 857 586 (0.1%) had SARS-CoV-2, of whom 172/2412 (7.1%) died, compared with 1414/1 857 586 (0.1%) patients without SARS-CoV-2 (OR=25.8 95% CI, 21.7–30.9; P<0.001). Amongst patients undergoing emergency surgery, 22 918/582 292 (3.9%) patients had SARS-CoV-2, of whom 5752/22 918 (25.1%) died, compared with 18 060/559 374 (3.4%) patients without SARS-CoV-2 (OR=5.5 95% CI, 5.3–5.7; P<0.001).
The low incidence of SARS-CoV-2 infection in NHS surgical pathways suggests current infection prevention and control policies are highly effective. However, the high mortality amongst patients with SARS-CoV-2 suggests these precautions cannot be safely relaxed.
Abstract
Introduction
At present, vaccines form the only mode of prophylaxis against COVID-19. The time needed to achieve mass global vaccination and the emergence of new variants warrants continued ...research into other COVID-19 prevention strategies. The severity of COVID-19 infection is thought to be associated with the initial viral load, and for infection to occur, viruses including SARS-CoV-2 must first penetrate the respiratory mucus and attach to the host cell surface receptors. Carrageenan, a sulphated polysaccharide extracted from red edible seaweed, has shown efficacy against a wide range of viruses in clinical trials through the prevention of viral entry into respiratory host cells. Carrageenan has also demonstrated in vitro activity against SARS-CoV-2.
Methods and analysis
A single-centre, randomised, double-blinded, placebo-controlled phase III trial was designed. Participants randomised in a 1:1 allocation to either the treatment arm, verum Coldamaris plus (1.2 mg iota-carrageenan (Carragelose®), 0.4 mg kappa-carrageenan, 0.5% sodium chloride and purified water), or placebo arm, Coldamaris sine (0.5% sodium chloride) spray applied daily to their nose and throat for 8 weeks, while completing a daily symptom tracker questionnaire for a total of 10 weeks.
Primary outcome
Acquisition of COVID-19 infection as confirmed by a positive PCR swab taken at symptom onset or seroconversion during the study. Secondary outcomes include symptom type, severity and duration, subsequent familial/household COVID-19 infection and infection with non-COVID-19 upper respiratory tract infections. A within-trial economic evaluation will be undertaken, with effects expressed as quality-adjusted life years.
Discussion
This is a single-centre, phase III, double-blind, randomised placebo-controlled clinical trial to assess whether carrageenan nasal and throat spray reduces the risk of development and severity of COVID-19. If proven effective, the self-administered prophylactic spray would have wider utility for key workers and the general population.
Trial registration
NCT04590365;
ClinicalTrials.gov
NCT04590365. Registered on 19 October 2020.
The COVID-19 response required the cancellation of all but the most urgent surgical procedures. The number of cancelled surgical procedures owing to Covid-19, and the reintroduction of surgical ...acivirt, was modelled.
This was a modelling study using Hospital Episode Statistics data (2014-2019). Surgical procedures were grouped into four urgency classes. Expected numbers of surgical procedures performed between 1 March 2020 and 28 February 2021 were modelled. Procedure deficit was estimated using conservative assumptions and the gradual reintroduction of elective surgery from the 1 June 2020. Costs were calculated using NHS reference costs and are reported as millions or billions of euros. Estimates are reported with 95 per cent confidence intervals.
A total of 4 547 534 (95 per cent c.i. 3 318 195 to 6 250 771) patients with a pooled mean age of 53.5 years were expected to undergo surgery between 1 March 2020 and 28 February 2021. By 31 May 2020, 749 247 (513 564 to 1 077 448) surgical procedures had been cancelled. Assuming that elective surgery is reintroduced gradually, 2 328 193 (1 483 834 - 3 450 043) patients will be awaiting surgery by 28 February 2021. The cost of delayed procedures is €5.3 (3.1 to 8.0) billion. Safe delivery of surgery during the pandemic will require substantial extra resources costing €526.8 (449.3 to 633.9) million.
As a consequence of the Covid-19 pandemic, provision of elective surgery will be delayed and associated with increased healthcare costs.
Authorship in surgical articles Grinsell, D; Jovic, T H; Saravolac, V ...
Journal of plastic, reconstructive & aesthetic surgery
73, Številka:
5
Journal Article
Highlights • The significance of low socio-economic status on burn risk has been questioned. • This retrospective study reviews 6441 burns and investigates association with socio-economic status. • ...Significant association between socio-economic deprivation, age and burn incidence ( p = 0.0005). • Patients under 16 in the most deprived areas at highest risk. • Specific burn prevention strategies should be designed to target these high-risk groups.
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