Length of stay after colorectal surgery in Italy: the gap between “fit for” and “actual” discharge in a prospective cohort of 4529 cases

Background: It is common to observe a gap between the day on which the discharge criteria are reached and the actual day of discharge after colorectal surgery. The aim of this study is to understand the reasons for this difference and its clinical impact on the overall length of stay (LOS). Methods: All patients enrolled in the prospective iCral3 study were analyzed regarding any difference and reason between the "fit for discharge" (FFD) and "actual discharge" (AD) dates. The association between the gap and the LOS in the whole population was then assessed through a multivariate regression model including other confounding variables. Results: The analysis included 4529 patients, with a median [IQR] LOS of 6 [4-8] days. The median [IQR] LOS was 6 [4-8] days in the no-gap group (3,910 patients, 86.3%), significantly lower (p < .001) than 7 [6-10] days in the gap group (619 patients, 13.7%). Among the gap reasons, the "need for postoperative rehabilitation" compared to "not willing to return home" and "social constraints" was associated with the longest LOS (9 [6.0-12.5] days, p < 0.001 vs other reasons). The existence of the gap independently determined a 2.3-day lengthening of LOS. Conclusions: Among other factors, the gap between FFD and AD had an independent impact on LOS. The most frequent reasons for this gap were "not willing to return home" and "social constraint", while the "need for postoperative rehabilitation" had the greater clinical impact

A genome-wide association study for survival from a multi-centre European study identified variants associated with COVID-19 risk of death

: The clinical manifestations of SARS-CoV-2 infection vary widely among patients, from asymptomatic to life-threatening. Host genetics is one of the factors that contributes to this variability as previously reported by the COVID-19 Host Genetics Initiative (HGI), which identified sixteen loci associated with COVID-19 severity. Herein, we investigated the genetic determinants of COVID-19 mortality, by performing a case-only genome-wide survival analysis, 60 days after infection, of 3904 COVID-19 patients from the GEN-COVID and other European series (EGAS00001005304 study of the COVID-19 HGI). Using imputed genotype data, we carried out a survival analysis using the Cox model adjusted for age, age2, sex, series, time of infection, and the first ten principal components. We observed a genome-wide significant (P-value < 5.0 × 10-8) association of the rs117011822 variant, on chromosome 11, of rs7208524 on chromosome 17, approaching the genome-wide threshold (P-value = 5.19 × 10-8). A total of 113 variants were associated with survival at P-value < 1.0 × 10-5 and most of them regulated the expression of genes involved in immune response (e.g., CD300 and KLR genes), or in lung repair and function (e.g., FGF19 and CDH13). Overall, our results suggest that germline variants may modulate COVID-19 risk of death, possibly through the regulation of gene expression in immune response and lung function pathways

Acute diverticulitis management: evolving trends among Italian surgeons. A survey of the Italian Society of Colorectal Surgery (SICCR)

Acute diverticulitis (AD) is associated with relevant morbidity/mortality and is increasing worldwide, thus becoming a major issue for national health systems. AD may be challenging, as clinical relevance varies widely, ranging from asymptomatic picture to life-threatening conditions, with continuously evolving diagnostic tools, classifications, and management. A 33-item-questionnaire was administered to residents and surgeons to analyze the actual clinical practice and to verify the real spread of recent recommendations, also by stratifying surgeons by experience. CT-scan remains the mainstay of AD assessment, including cases presenting with recurrent mild episodes or women of child-bearing age. Outpatient management of mild AD is slowly gaining acceptance. A conservative management is preferred in non-severe cases with extradigestive air or small/non-radiologically drainable abscesses. In severe cases, a laparoscopic approach is preferred, with a non-negligible number of surgeons confident in performing emergency complex procedures. Surgeons are seemingly aware of several options during emergency surgery for AD, since the rate of Hartmann procedures does not exceed 50% in most environments and damage control surgery is spreading in life-threatening cases. Quality of life and history of complicated AD are the main indications for delayed colectomy, which is mostly performed avoiding the proximal vessel ligation, mobilizing the splenic flexure and performing a colorectal anastomosis. ICG is spreading to check anastomotic stumps' vascularization. Differences between the two experience groups were found about the type of investigation to exclude colon cancer (considering the experience only in terms of number of colectomies performed), the size of the peritoneal abscess to be drained, practice of damage control surgery and the attitude towards colovesical fistula

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Geophysical Investigations of the South-Western Wairarapa Region of New Zealand

&lt;p&gt;A model of the sub-surface structure of the south-western part of the Wairarapa sedimentary basin in central New Zealand was constructed from geophysical data obtained by the author during the period 1990-1991. A total of 122 new gravity observations, eight magnetotelluric (MT) stations and approximately two kilometres of seismic refraction lines were established in the study area. All methods complemented each other in the determination of the final result. The gravity data provided the depth for the basement layer of the basin, and determined the position of a fossil fault in the region of the Wharepapa River channel. The MT and seismic data confirmed the fossil nature of the fault. The results for the boundaries determined by the MT surveys were also shown to agree with the upper layers of the gravity model. The final model presented is of a sedimentary basin with thickness of approximately 2km, with a fossil fault dividing the basin near the vicinity of the Wharepapa River. To the west of the study area is a highly anomalous region which could not be fully modelled in this study because of lack of data in this particular area.&lt;/p&gt;</jats:p

The Opening of the Great Bush, 1869-1881: a Social History of the Bush Settlements of Taranaki, Hawke's Bay and Wellington

&lt;p&gt;In undertaking this study I had the two-fold object of investigating an area of our history which appears to me to have been too long neglected, and, in presenting my results, of grappling with the problems of writing colonial social history. So far we have only had limited studies of selected aspects of the bush settlement era of North Island history. I believe we cannot properly understand this great colonising effort unless we endeavour both to view it whole and to place it in the larger context of colonial history. I have therefore taken the whole southern half of the North Island as my area of study, and have endeavoured to show how the assault on the Great Bush relates to the aftermath of the Maori Wars, the larger social history of the colony as a whole, and the agrarian history of the Old World from which so many of the bush settlers came. I had hoped originally to carry the story through at least three decades, but it became apparent that my broad canvas required some kind of narrowing, and I reluctantly decided to limit myself to the period 1869-1881, which seemed to have a sufficient political and economic unity to stand on its own. I have, however, done a good deal of research on through the 1880s and 1890s, and this, I trust, has enabled me to see the significance of the 1870s with a sense of perspective.&lt;/p&gt;</jats:p

The Opening of the Great Bush, 1869-1881: a Social History of the Bush Settlements of Taranaki, Hawke's Bay and Wellington

&lt;p&gt;In undertaking this study I had the two-fold object of investigating an area of our history which appears to me to have been too long neglected, and, in presenting my results, of grappling with the problems of writing colonial social history. So far we have only had limited studies of selected aspects of the bush settlement era of North Island history. I believe we cannot properly understand this great colonising effort unless we endeavour both to view it whole and to place it in the larger context of colonial history. I have therefore taken the whole southern half of the North Island as my area of study, and have endeavoured to show how the assault on the Great Bush relates to the aftermath of the Maori Wars, the larger social history of the colony as a whole, and the agrarian history of the Old World from which so many of the bush settlers came. I had hoped originally to carry the story through at least three decades, but it became apparent that my broad canvas required some kind of narrowing, and I reluctantly decided to limit myself to the period 1869-1881, which seemed to have a sufficient political and economic unity to stand on its own. I have, however, done a good deal of research on through the 1880s and 1890s, and this, I trust, has enabled me to see the significance of the 1870s with a sense of perspective.&lt;/p&gt;</jats:p