Global Level of Harm experienced by Bariatric Surgeons for Bariatrics surgical interventions: An exploration of predictors

Background: COVID-19 pandemic has taken the world by surprise with the depth and breadth of its effect on all walks of life, bariatric surgery being no exception. With the scientific literature hitherto unable to comment and ascertain the influence of the COVID-19 pandemic on bariatric surgery and the level of harm experienced by bariatric surgeons, we- TUGS 'Level of Harm' collaborative group- attempted to gauge the effect of the said pandemic on bariatrics surgery specifically vis a vis the level of harm experienced by bariatric surgeons due to the pandemic. Method(s): A virtual questionnaire- developed on both: Google forms and Survey Monkey- was circulated via TUGS social media platforms to reach bariatric consultant surgeons, fellows and residents practising throughout the world in a bid to explore the influence of the COVID-19 pandemic on their surgical practice including but not limited to the annual surgical volume including re-do surgeries volume and postoperative complications. Moreover, they were also requested to categorise their respective level of harm vis a vis bariatric surgical interventions they undertake. After de-identification of the data, SPSS (V.26) was adopted to undergo statistical analysis. After exploring the dataset by descriptive analyses, the Chi-square test was applied to pursue the association of categorical variables with the reported level of harm. A double-sided p-value of less than 0.05 was considered statistically significant. Result(s): 16.8% of the respondents (21/125) indicated no harm vis a vis bariatrics surgery work whereas a comparative 18.4% of the respondents (23/125) reported moderate harm with significant worsening of symptoms. None of those who indicated less than 10% increase in surgery waitlisted patients being subjected to endoscopic interventions (0/14) reported Moderate Harm for bariatrics surgery work with significant worsening of symptoms whereas 1 in every 3 of those who indicated between 10% to 25% increase in surgery waitlisted patients being subjected to endoscopic interventions (5/15) reported such level of harm for bariatrics surgery work. (p < 0.001) Upon exhaustive sub-group analysis, it was uncovered that 33.6% of bariatrics surgical professionals perceived no harm (no evidence of change in clinical condition) during gastric band or related surgery work with only 4% perceiving Moderate Harm (significant worsening of symptoms/ comorbidities control/ minor increase in medications) for such surgical interventions. All of those who reported No harm for gastric band or related surgical work reported that Single anastomosis duodeno-ileal bypass (SADI-S) accounts for 10% of their practice whereas none of those who indicated that SADI-S accounts for more than 10% of their practice reported No harm for such surgical work. (p = 0.019) Conclusion(s): The global snapshot illustrates a trend of low harm vis a vis bariatrics surgery work in surgical professionals practising in the private sector with a lesser number of patients developing COVID-19 postoperatively and no postoperative COVID-19 related mortality. The patient being subjected to endoscopic intervention portends a higher level of harm for bariatrics surgical work- strict adherence to criteria and safety protocols being a logical inference. For gastric band and related surgery work, preoperative COVID-19 testing appears to be influenced by confounders in its effect on the surgeon's level of harm for the said interventions warranting further exploration. SADI-S, at a cut-off of 10%, exhibits strong interaction with the surgeon's level of harm for gastric band insertion and relation surgery work. Women surgical professionals came out to exhibit equivalent mental resilience and technical prowess at par with their male colleagues when it came to bariatrics surgical intervention.

Gastric Remnant Cancer: Complete Pathological Response - Case report

Background: Remnant gastric cancer (RGC) refers to carcinoma of the residual stomach occurring after gastrectomy. With an incidence of 1-7%, it is believed to have a different disease mechanism and a poorer prognosis than primary gastric cancer (PGC). However, due tu its rarity, the standard treatment for RGC remains undefined. Therefore, the multidisciplinary/tailored approach becomes crucial for the treatment of these patients. Materials and Methods: We present the case of a 64 years old male patient with family history of GC (father) and personal history of distal gastrectomy for peptic disease with Billroth-II reconstruction in 1979, orchiectomy for pT1 seminoma in 2017, and COPD. During follow-up for his seminoma the patient was diagnosed with clinical stage III intestinal type G1 gastric adenocarcinoma. The case was presented to our multidisciplinary team meeting (MDTm) and neoadjuvant treatment (FLOTx4) was started. In november 2019 an exploratory laparotomy was performed finding a RGC of the lesser curvature infiltrating the pancreas, the surgical team decided not to perform resection. The case was again presented in our MDTm and FLOT Protocol was completed (x4 cicles). CT scan showed good response and new laparotomy was planned. However, due to SARS-CoV2 outbreak the patient could not be operated on and was presented again to MDTm, deciding to proceed with chemoradiotherapy (50Gy + Taxol + CBP for 6 weeks). After the outbreak a new laparotomy was performed and a subtotal (95%) gastrectomy + Roux-n-Y reconstruction was performed. Results: After a period of 2 weeks in ICU due to aspiration pneumonia the patient recovered well and was discharged 23 days after surgery. Pathological report showed complete pathological response (grade 0) ypT0ypN0. The patient is currently well and will under surveillance. Conclusions: Although not as frequent as PGC, RGC is a disease with poor prognosis due to its diagnosis at advanced stages and the lack of standard treatment in current guidelines for both systemic and surgical treatment. In this setting, the role of MDTs and tailored treatments can contribute to both short- and long-term oncological outcomes and patient’s quality of life. In this case, FLOT followed by chemoradiotherapy (50Gy + Taxol + Carboplatinum) for 6 weeks, followed by subtotal gastrectomy allowed us to achieve a complete pathological response. Eventhough these results need further research, this could be a good treatment option in selected patients.

SARS-CoV-2 Genome Sequencing Methods Differ in Their Abilities To Detect Variants from Low-Viral-Load Samples.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomic surveillance has been vital in understanding the spread of coronavirus disease 2019 (COVID-19), the emergence of viral escape mutants, and variants of concern. However, low viral loads in clinical specimens affect variant calling for phylogenetic analyses and detection of low-frequency variants, important in uncovering infection transmission chains. We systematically evaluated three widely adopted SARS-CoV-2 whole-genome sequencing methods for their sensitivity, specificity, and ability to reliably detect low-frequency variants. Our analyses reveal that the ARTIC v3 protocol consistently displays high sensitivity for generating complete genomes at low viral loads compared with the probe-based Illumina Respiratory Viral Oligo panel and a pooled long-amplicon method. We show substantial variability in the number and location of low-frequency variants detected using the three methods, highlighting the importance of selecting appropriate methods to obtain high-quality sequence data from low-viral-load samples for public health and genomic surveillance purposes.

The revival of secular spirituality in Europe and its implication for the Dutch Reformed Church in South Africa

This article critically reflected on the insights of David Tacey in which he notes that there is currently a revival in post-secular spirituality in the West, but that its deep religious roots are lacking. What would be the implication of these trends for the South African religious landscape where traditional mainstream churches such as the Dutch Reformed Church are shrinking significantly? People often say yes to God, but no to the church. Some in the church may totally renounce God. What lessons could be learned by the South African mainstream churches and theology if these trends in the West were taken into account? In this article a critical literature review (desk research) was done and the study was structured as follows: In the first place, the implication of superdiversity, supermobility and the reality of a post-COVID-19 consciousness was discussed. Next we engaged in research by scholars in which it was shown that our time, at least in the West, is characterised by existential anxiety and uncertainty. Thirdly, we engaged in the insights of David Tacey in which he also argued the fact that the uncertainty of the time in which we live, often causes people to return to spirituality. Finally, the implication of these trends for the Dutch Reformed Church in South Africa was reflected on. Contribution: This research makes a contribution to the nature and scope of the journal, in that it finds that the rise in secular spirituality, in the context of anxiety and uncertainty in a post-COVID-19 world, provides an opportunity for the Dutch Reformed Church to find meaning and significance.

Laboratory diagnosis of severe acute respiratory syndrome coronavirus 2.

The first laboratory confirmed case of Coronavirus disease 2019 (COVID-19) in Australia was in Victoria on 25 January 2020 in a man returning from Wuhan city, Hubei province, the People's Republic of China. This was followed by three cases in New South Wales the following day. The Australian Government activated the Australian Health Sector Emergency Response Plan for Novel Coronavirus on 27 February 2020 in anticipation of a pandemic. Subsequently, the World Health Organization declared COVID-19 to be a Public Health Emergency of International Concern followed by a pandemic on 30 January 2020 and 11 March 2020, respectively. Laboratory testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, is key in identifying infected persons to guide timely public health actions of contact tracing and patient isolation to limit transmission of infection. This article aims to provide a comprehensive overview of current laboratory diagnostic methods for SARS-CoV-2, including nucleic acid testing, serology, rapid antigen detection and antibody tests, virus isolation and whole genome sequencing. The relative advantages and disadvantages of the different diagnostic tests are presented, as well as their value in different clinical, infection control and public health contexts. We also describe the challenges in the provision of SARS-CoV-2 diagnostics in Australia, a country with a relatively low COVID-19 incidence in the first pandemic wave but in which prevalence could rapidly change.

The SARS-CoV-2 'perfect storm': from humble betacoronavirus to global pandemic

The novel betacoronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a global pandemic unprecedented in modern times. Understanding the key features that have enabled this virus to propagate so widely in the global community is critical to current and future clinical and public health efforts. High proportions of mild disease and peak viral loads at, and likely prior to, symptom onset have hindered efforts to identify and isolate infected persons effectively, facilitating undetected spread of the virus. In countries with limited diagnostic and/or contact tracing capabilities, population-wide transmission escalated beyond a critical threshold, challenging even well-developed healthcare systems. This 'perfect storm' for transmissibility has led to widespread outbreaks and deaths in many regions around the world. Extensive testing and contact tracing, together with Australia's geographic advantage, tightening of international travel restrictions, physical distancing and public health messaging measures, have contributed to limiting the extent of coronavirus disease 2019 (COVID-19) spread in the country, but recent case escalation in Victoria highlights the country's vulnerability to future outbreaks due to low population immunity.

Revealing COVID-19 transmission in Australia by SARS-CoV-2 genome sequencing and agent-based modeling

In January 2020, a novel betacoronavirus (family Coronaviridae), named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified as the etiological agent of a cluster of pneumonia cases occurring in Wuhan City, Hubei Province, China. The disease arising from SARS-CoV-2 infection, coronavirus disease 2019 (COVID-19), subsequently spread rapidly causing a worldwide pandemic. Here we examine the added value of near real-time genome sequencing of SARS-CoV-2 in a subpopulation of infected patients during the first 10 weeks of COVID-19 containment in Australia and compare findings from genomic surveillance with predictions of a computational agent-based model (ABM). Using the Australian census data, the ABM generates over 24 million software agents representing the population of Australia, each with demographic attributes of an anonymous individual. It then simulates transmission of the disease over time, spreading from specific infection sources, using contact rates of individuals within different social contexts. We report that the prospective sequencing of SARS-CoV-2 clarified the probable source of infection in cases where epidemiological links could not be determined, significantly decreased the proportion of COVID-19 cases with contentious links, documented genomically similar cases associated with concurrent transmission in several institutions and identified previously unsuspected links. Only a quarter of sequenced cases appeared to be locally acquired and were concordant with predictions from the ABM. These high-resolution genomic data are crucial to track cases with locally acquired COVID-19 and for timely recognition of independent importations once border restrictions are lifted and trade and travel resume.

Interpret with caution: An evaluation of the commercial AusDiagnostics versus in-house developed assays for the detection of SARS-CoV-2 virus.

INTRODUCTION: There is limited data on the analytical performance of commercial nucleic acid tests (NATs) for laboratory confirmation of COVID-19 infection. METHODS: Nasopharyngeal, combined nose and throat swabs, nasopharyngeal aspirates and sputum was collected from persons with suspected SARS-CoV-2 infection, serial dilutions of SARS-CoV-2 viral cultures and synthetic positive controls (gBlocks, Integrated DNA Technologies) were tested using i) AusDiagnostics assay (AusDiagnostics Pty Ltd); ii) in-house developed assays targeting the E and RdRp genes; iii) multiplex PCR assay targeting endemic respiratory viruses. Discrepant SARS-CoV-2 results were resolved by testing the N, ORF1b, ORF1ab and M genes. RESULTS: Of 52 clinical samples collected from 50 persons tested, respiratory viruses were detected in 22 samples (42 %), including SARS CoV-2 (n = 5), rhinovirus (n = 7), enterovirus (n = 5), influenza B (n = 4), hMPV (n = 5), influenza A (n = 2), PIV-2 (n = 1), RSV (n = 2), CoV-NL63 (n = 1) and CoV-229E (n = 1). SARS-CoV-2 was detected in four additional samples by the AusDiagnostics assay. Using the in-house assays as the "gold standard", the sensitivity, specificity, positive and negative predictive values of the AusDiagnostics assay was 100 %, 92.16 %, 55.56 % and 100 % respectively. The Ct values of the real-time in-house-developed PCR assay targeting the E gene was significantly lower than the corresponding RdRp gene assay when applied to clinical samples, viral culture and positive controls (mean 21.75 vs 28.1, p = 0.0031). CONCLUSIONS: The AusDiagnostics assay is not specific for the detection SARS-CoV-2. Any positive results should be confirmed using another NAT or sequencing. The case definition used to investigate persons with suspected COVID-19 infection is not specific.