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

¿Qué hay de nuevo? Impactos del COVID-19 en las agendas de los gobiernos locales argentinos

The article recovers some of the results obtained in the project "State capacities in a post-pandemic municipal agenda" financed by the National Agency for Scientific and Technological Promotion and the Inter-American Development Bank, in the PISAC COVID 19 Call. Specifically, this article focuses on the configuration of the policy agendas in local governments in three particular moments: the agenda prior to the COVID 19 emergency, the emerging agenda during the pandemic, and finally, the future agenda in the coming years . Regarding the latter - the future agenda - the article explores the perspectives of decision makers about which are the main actors -social, economic and institutional- with the capacity to share the future agenda, pointing out that such assessments prefigure and account for the configuration of different governance strategies. The document begins with a brief presentation of the theoretical and methodological framework, emphasizing the classification of agendas: Urban Agenda, Economic Agenda, Social Agenda and Government Agenda. Later we present some results about the pre-pandemic agendas, the emerging agenda and the exit or post-pandemic agenda. Subsequently, we focus on a brief analysis of the impacts of the pandemic and local governments reactions to this. The analysis of social conflict and the perspective of local decision makers regarding the actors that are strategic to share these agendas is considered in the following section. Finally, in a way of conclusion, we present some local governments profiles, considering the policies that structure the local agendas.El artículo recupera algunos de los resultados obtenidos en el marco del proyecto “Capacidades estatales en una agenda municipal post pandemia” financiado por la Agencia Nacional de Promoción Científica y Tecnológica y el Banco Interamericano de Desarrollo, en la Convocatoria PISAC COVID 19. Específicamente se analizan la configuración de las agendas de políticas presentes en los gobiernos locales en tres momentos: la agenda previa a la emergencia del COVID 19, la agenda emergente de la gestión de la pandemia y por último, la agenda proyectada por los decisores locales para los próximos años. Respecto de esta última- la agenda proyectada- el artículo indaga en las perspectivas de los decisores sobre cuáles son los actores -sociales, económicos e institucionales- con capacidad de acompañar esas agendas señalando que tales valoraciones prefiguran y dan cuentas de la configuración de diversas modalidades y estrategias de gobernanza. El documento se inicia con una breve presentación del entramado teórico y metodológico haciendo énfasis en la clasificación de las agendas municipales. Posteriormente presentamos los rasgos más sobresalientes de las agendas pre- pandemia, la agenda emergente y la agenda de salida o post-pandemia. Posteriormente nos abocamos a un breve análisis de los impactos en las gestiones locales a instancias de la pandemia como así también a los desafíos de gestión que se ponen en juego para llevar adelante la misma. El análisis de la conflictividad social y la perspectiva de los decisores locales respecto de los actores que suponen estratégicos para acompañar estas agendas es considerada en el siguiente apartado. Finalmente, a modos de conclusión se intenta una clasificación provisoria en torno a perfiles municipales tomando como eje la construcción de las agendas públicas locales

Laparoscopic Liver Resection: A South American Experience with 2887 Cases

Background Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. Methods From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. Results Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. Conclusions This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers