ABSTRACT
Air pollution associated health issues are increasing globally. This is due to both anthropogenic sources, such as traffic, and natural sources, such as bushfires. Natural disasters, such as bushfires, impact air quality by releasing large concentrations of pollutants affecting respiratory health. However, another recent global event has also had severe impacts on the environment and health, the global COVID-19 pandemic. Global pandemics, such as COVID-19, can also influence air quality by altering human activity, resulting in its own associated health impacts. This study aimed to investigate the impact of a natural disaster and global pandemic on outdoor ambient air pollution by quantifying and comparing the spatial distribution of two air pollutants, nitrogen dioxide (NO2) and particulate matter (PM10), during the different periods across the Greater Sydney region, Australia, while correcting for anthropogenic sources and meteorological influences such as temperature and rain. COVID-19 and bushfire affected periods were compared to a control period when both of these influences were absent. We found that NO2 was significantly higher during the COVID-19 pandemic than during the control period and the recent 2019 bushfires. Conversely, PM10 was significantly lower during the COVID-19 pandemic than the bushfire and control periods. The spatial distribution of both pollutants and influencers also varied across the study site. These results suggest that both events markedly impacted air quality, although they impacted the air pollutants differently. These findings further demonstrate a greater need to understand the impact of natural disasters and anthropocentric events on air pollution as multifaceted, spatially relevant policies are required to address these events, particularly if they increase in frequency or severity in the future.
ABSTRACT
PURPOSE OF REVIEW: This review explores recent international guidance on the anesthetic management of patients undergoing thoracic surgery during the COVID-19 pandemic: those with suspected or confirmed COVID-19 requiring urgent thoracic surgery and those presenting for elective procedures. RECENT FINDINGS: A significant mortality risk is associated with patients with COVID-19 undergoing thoracic surgery; therefore, where possible, it should be avoided. Thoracic surgery also carries a significant risk of viral transmission to healthcare workers due to the necessarily high frequency of intraoperative aerosol-generating procedures involved, such as lung isolation, one-lung ventilation, and flexible bronchoscopy. SUMMARY: Guidelines recommend appropriate personal protective equipment and numerous procedural modifications to prevent viral transmission to staff and other patients. With appropriate disease mitigation strategies in place, elective thoracic surgery, in particular for lung cancer, has been able to continue safely in many centres.
ABSTRACT
Background: The COVID-19 pandemic has placed significant strain on the health system, resulting in a backlog of individuals requiring surveillance colonoscopy for an increased risk of developing colorectal cancer (CRC). Quantitative faecal immunochemical tests (FIT) are widely used for CRC screening. It is possible that the FIT may also be used to triage colonoscopy in individuals at an increased risk for CRC. The aim of this study was to determine whether quantitative FIT results can be used to personalise an individual’s surveillance program. Methods: Patients enrolled within the Southern Adelaide Local Health Network colonoscopy surveillance program (SCOOP) completed a 2 sample FIT (OC Sensor, Eiken Chemical Company) within 28 days prior to their surveillance colonoscopy. The faecal haemoglobin (f-Hb) concentration was determined and the highest of the 2 samples was used. The subsequent colonoscopy was reviewed for quality and pathology results. The performance of FIT for the detection of advanced neoplasia was determined at various f-Hb thresholds between 2-80μg Hb/g faeces. Advanced neoplasia was defined as a diagnosis of CRC, advanced adenoma (adenomas ≥10mm, high grade dysplasia, villous change or ≥5 tubular adenomas) or high risk sessile serrated adenoma (SSA;≥10mm in size and/or dysplasia). Results: Findings at surveillance colonoscopy were analysed from 470 patients (median age 66y, range 29-85y, 52% male). Indications for surveillance included previous adenoma (73.2%, n=344), previous CRC (9.1%, n=43), genetic risk (8.9%, n=42), significant family history of CRC (7.9%, n=37) and immunosuppression (0.9%, n=4). At surveillance colonoscopy, advanced neoplasia was found in 15.3% (n=72) of the cohort. The FIT specificity and negative predictive values for advanced neoplasia are shown in Table 1 for various f-Hb thresholds. Using the highest assessed f-Hb threshold (80μg Hb/g faeces) to triage surveillance colonoscopy, only 4.7% (n=22) would need prioritised colonoscopy, and 22.7% (n=5) would have advanced neoplasia diagnosed. For the 95.3% (n=448) below the f-Hb threshold who would have a delayed colonoscopy, 15.0% (n=67) would have delayed diagnosis of advanced neoplasia. By reducing the f-Hb threshold to 2μg Hb/g faeces, 66.6% (n=313) would need prioritised colonoscopy, with a positive predictive value of 16.6% (n= 52/313) for advanced neoplasia. 33.4% (n=157) of colonoscopies would be delayed, and 12.7% (n=20) of these patients would have a delayed diagnosis of advanced neoplasia. Conclusion: The use of quantitative FIT before scheduling surveillance colonoscopies can provide clinicians with insight into the risk of finding advanced neoplasia at colonoscopy. This may allow for the possibility of extending the surveillance interval, facilitating more efficient management of endoscopic resources during the COVID-19 pandemic and beyond. (Table presented)
ABSTRACT
Background and Aim: Colonoscopic surveillance is undertaken at regular intervals (typically 3 or 5 years) to reduce the incidence of colorectal cancer (CRC) in people with an elevated risk (personal or family history of neoplasia). Pathology findings at index and each surveillance colonoscopy determine recall intervals. Due to coronavirus disease 2019, hospital services around the world have been limited, resulting in some surveillance colonoscopies being delayed beyond the recommended time frames. Previous studies suggest that delays to colonoscopy might increase the incidence of advanced neoplasia (advanced adenoma/CRC). However, it is possible that this risk could be reduced by ensuring that individuals are maintained in a CRC screening program with an immunochemical fecal occult blood test (FIT) in the interval between surveillance colonoscopies. Our aim was to determine whether risk of advanced neoplasia increases if surveillance colonoscopy is delayed in people with elevated CRC risk who perform and have a negative FIT result in the interval between colonoscopies. Methods: We performed a retrospective cohort study using data from the Southern Cooperative Program for the Prevention of Colorectal Cancer on people at elevated risk because of family history or personal history of adenoma or CRC. People with at least two consecutive colonoscopies of a 3- or 5-year surveillance interval and who had at least one negative interval FIT result were included in the study. They were stratified based on a previous colonoscopy finding of advanced adenoma, non-advanced adenoma, or no neoplasia. People with early colonoscopies (3 months before the recommended due date), poor bowel preparation, previous CRC, or hereditary CRC syndromes were excluded from the study. Colonoscopy was defined as 'delayed' if it did not occur within 6 months after the recommended recall interval and was further subdivided into delays of 6-12, 12-24, and >24 months. The incidence of advanced neoplasia was calculated for all groups. The relative risk (RR) and 95% confidence intervals estimated from a robust multivariable modified Poisson regression were used to assess the association between surveillance colonoscopy delay and risk of advanced neoplasia. Results: A total of 1748 public hospital surveillance colonoscopies (in 1516 participants) were included in the analysis. More than half of the colonoscopies (56.86%, 994/1748) were delayed by at least 6 months because of system and/or patient factors. In people with delayed colonoscopies, the incidence of advanced neoplasia was higher in those with previous advanced adenoma (16.72%, 48/287) and previous non-advanced adenoma (15.23%, 37/243) compared with those with no neoplasia (6.25%, 29/464) (P < 0.001). However, relative to on-time colonoscopy, delay of surveillance colonoscopy was not associated with an increased risk of advanced neoplasia for people who had at least one negative interval FIT result, regardless of previous colonoscopy finding (previous advanced adenoma: RR, 1.01;95% CI, 0.70-1.46;non-advanced adenoma: RR, 1.41;95% CI, 0.85-2.33;and no neoplasia: RR, 0.96;95% CI, 0.55-1.66) (Table 1). Conclusion: In an elevated-risk cohort undergoing FIT screening between surveillance colonoscopies, delays to colonoscopy did not increase risk of advanced neoplasia. These results suggest that surveillance colonoscopy could be safely extended in people at elevated CRC risk by participating in FIT testing between colonoscopies within a surveillance program.