Thirty years of leatherback turtle Dermochelys coriacea nesting in Espírito Santo, Brazil, 1988-2017: Reproductive biology and conservation

This is the final version. Available from Inter Research via the DOI in this record. In the southwestern Atlantic Ocean, leatherback turtles Dermochelys coriacea are only known to regularly nest in eastern Brazil, on the coast of the state of Espírito Santo. Here, we present an analysis of the nesting ecology, population trends and conservation status of this leather - back turtle colony between 1988 and 2017. We observed an increasing, although variable, trend in the annual number of nests, with the mean increasing from 25.6 nests in the first 5 yr of the study to 89.8 in the last 5 yr. Concurrently, there was also a significant decrease in the mean curved carapace length of the population, which we hypothesize was caused by recruitment of new females to the nesting population. Throughout the study period, nests were concentrated in the southern part of the 160 km long study area. No change was observed in the annual median nesting date. Mean annual hatching success was 66.0% and no significant variation in hatching success was detected after a major spill of mining tailings into the nesting area in 2015. We postulate that local conservation actions that started in the 1980s have contributed to the gentle recovery of this population; however, given the small population size and restricted nesting geographical distribution alongside the persistence of various threats-fisheries bycatch, climate change, pollution and coastal development-this population continues to be of conservation concern.National Council for Scientific and Technological Development (CNPq)University of ExeterRufford FoundationBritish Chelonia Grou

Fetal deaths in Brazil: a systematic review

OBJECTIVE To review the frequency of and factors associated with fetal death in the Brazilian scientific literature. METHODS A systematic review of Brazilian studies on fetal deaths published between 2003 and 2013 was conducted. In total, 27 studies were analyzed; of these, 4 studies addressed the quality of data, 12 were descriptive studies, and 11 studies evaluated the factors associated with fetal death. The databases searched were PubMed and Lilacs, and data extraction and synthesis were independently performed by two or more examiners. RESULTS The level of completeness of fetal death certificates was deficient, both in the completion of variables, particularly sociodemographic variables, and in defining the underlying causes of death. Fetal deaths have decreased in Brazil; however, inequalities persist. Analysis of the causes of death indicated maternal morbidities that could be prevented and treated. The main factors associated with fetal deaths were absent or inadequate prenatal care, low education level, maternal morbidity, and adverse reproductive history. CONCLUSIONS Prenatal care should prioritize women that are most vulnerable (considering their social environment or their reproductive history and morbidities) with the aim of decreasing the fetal mortality rate in Brazil. Adequate completion of death certificates and investment in the committees that investigate fetal and infant deaths are necessary

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care