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Abstract Treatment based on immune checkpoint blockade has revolutionized cancer therapy. Despite the remarkable success achieved and the preclinical development of multiple checkpoint inhibitors targeting other checkpoints, only antibodies targeting the PD-1/PD-L1 axis and CTLA-4 have been approved for patient treatment, especially in solid tumors. Currently, with the approval of relatlimab, a LAG-3 blocking antibody, a third player, has been used in the fight against cancer. The endorsement of relatlimab marks a significant milestone in cancer immunotherapy, opening new avenues for combination therapies and enhancing treatment outcomes. However, the complex biology of LAG-3 may hinder its full development as a therapeutic alternative. In this review, we provide in-depth insight into the biology of LAG-3 and its current and future development in cancer treatment.

Abstract Background Access to essential diagnostics is crucial for primary healthcare (PHC) in low-and-middle income countries (LMICs). Many LMICs have invested in equipping PHC with point-of-care (PoC) diagnostics for infectious diseases, however there has been no similar investment to improve PHC capacities for clinical chemistry. The biochemistry gap is among the deterrents to universal health coverage. Methods A social sciences project was conducted with the aim to understand the key PHC stakeholders’ insights on the pertinence of PoC biochemistry for PHC in LMICs. Data generation was conducted between July-November 2023 in Mongolia, Nigeria and Peru. Decision-makers in healthcare delivery, healthcare professionals, and patient and community advocates were engaged using a combination of sampling techniques. Unstructured individual and group conversations, and non-participant observation were conducted. Analysis involved an inductive line-by-line coding on printed transcripts, followed by a deductive coding and theme-by-theme analysis on digitized transcripts. Results Fifteen, 51 and 20 informants from Mongolia, Nigeria and Peru, respectively, participated. Fifty-five of the 94 informants were female. Most informants considered that PoC biochemistry in PHC would be pertinent, from a clinical and a resources-saving perspective. Those households that currently bear the burden of referrals (i.e., the poor, the bedridden, the older adults) would benefit the most from the deployment of PoC biochemistry for essential biochemistry parameters. Improved access to PoC glycated hemoglobin (HbA1c), lipid, liver and kidney profile was perceived as helpful to inform clinicians’ decision-taking. The value of PoC biochemistry for the management of noncommunicable diseases (diabetes, hypertension) and infectious conditions (dengue, malaria, tuberculosis), to improve child health outcomes (severe dehydration in children with diarrhea and/or malnutrition) and to reduce preventable causes of death (dengue-related renal failure) was highlighted. Conclusions PoC biochemistry holds potential to revert the impact that the biochemistry gap has for patient care in some LMICs’ PHC settings. PoC equipment for parameters such as HbA1c, urea, creatinine or electrolytes could enhance community-level management of preventable causes of mortality, improve service delivery for patients affected by locally-prevalent infectious conditions, and improve the psychosocial and economic wellbeing of patients facing the burden of referrals to remote biochemistry-equipped centers. Trial Registration Not applicable.

Rosario Tourino-Peralba,1,2,* David Lamas-Francis,1,* Laura Freijeiro-Gonzalez,3 Laura Martínez-Pérez,1 Teresa Rodríguez-Ares1 1Department of Ophthalmology, University Hospital of Santiago de Compostela, Santiago, Spain; 2Department of Surgery and Medical-Surgical Specialities, Faculty of Medicine, University of Santiago de Compostela, Santiago, Spain; 3Department of Statistics, Faculty of Mathematics, University of Santiago de Compostela, Santiago, Spain*These authors contributed equally to this workCorrespondence: Rosario Tourino-Peralba, Department of Ophthalmology, University Hospital of Santiago de Compostela, Ramón Baltar s/n, 15706, Santiago de Compostela, Spain, Tel +34 981 951 749, Email rtourinop2@gmail.com; david.lamas@outlook.esPurpose: This study aims to analyze the incidence of pseudophakic macular edema (PME) and the role of contributing risk factors following prepupillary or retropupillary implantation of iris-claw lenses.Methods: This retrospective cohort study included patients who underwent iris-claw intraocular lens implantation over a 16-year period at the University Hospital of Santiago de Compostela, Spain. The presence of risk factors for PME was recorded, and surgical outcomes included visual acuity, macular OCT scans, and description of complications.Results: A total of 148 eyes from 147 patients were included. Seventy-nine eyes (54.4%) underwent prepupillary iris-claw lens implantation and 69 eyes (46.6%) underwent retropupillary implantation. The mean age of the patients was 68.9 ± 17.2 years. The incidence of PME post-surgery was 23.0% (26.6% prepupillary and 18.8% retropupillary), and the mean time between surgery and diagnosis was similar for both locations (4.8 and 4.7 months, respectively). PME recurred in 33% of the patients, reaching a high rate of 72.7% when the lens location was prepupillary. The mean best-corrected visual acuity was 0.66± 0.55 logMAR preoperatively and 0.38± 0.50 logMAR postoperatively. Postoperative complications occurred in 29 patients (19.6%).Conclusion: PME following iris-claw lens implantation tends to be more frequent and recurrent when the location is prepupillary. Planning for iris-claw lens surgery should consider the risk factors for the development of PME.Keywords: macular edema, aphakia, pseudophakia, iris-anchored intraocular lenses

La animación se ha hecho eco de la importancia que la salud mental ha adquirido recientemente en la sociedad. Identificar las emociones propias e interpretarlas para saber cómo desarrollar habilidades, tomar decisiones y, en definitiva, conocerse individualmente, suponen uno de los principales retos a los que se enfrenta el sujeto contemporáneo. Este artículo explora, desde una perspectiva de género, el tratamiento de la inteligencia emocional en la ficción surcoreana a través de la serie Yumi’s Cells (2021-2022), que combina imagen real y animación. Mediante un análisis textual, se confirma que la representación de los personajes animados sirve como una herramienta pedagógica para que la audiencia aprenda a detectar las emociones cotidianas, particularmente en un contexto como el de la sociedad surcoreana que adolece de determinados recursos psicológicos, pues la extroversión de las emociones es considerada un tabú social.

The use of technologies at home directly influences how children perceive them for their learning at school. Numerous studies have focused on the different ways in which digital technologies are used at home and in schools. These studies attempt to explain how previous experience and knowledge can be linked to the use of technologies at school, the differences between home and school literacies, or how socio-economic status influences the availability of technology in these socio-educational institutions. All of them show that technology has become part of children's lives. Consequently, the aim of this study was to obtain information about the habits, norms and use of technology by children aged 2-6 years in their homes and the differences between genders. To this end, a validated questionnaire was created. A total of 1016 parents completed the questionnaire. The results show the most used technologies, the time of use and whom they are used with, as well as the rules imposed and their opinion about this use. Likewise, there are significant differences that lead to carry out and discuss proposals for STEAM work in Early Childhood Education classrooms in order to empower students.

Introduction and aim: Adherence to colorectal cancer (CRC) screening is essential for the effectiveness of screening programs. Even though organized screening programs can improve the quality of the process and adherence, there are still challenges to overcome. The aim of the present study, in which we implemented a biennial organized screening program for CRC, was to describe adherence and participation patterns. Materials and methods: A longitudinal, descriptive study was conducted, in which a team of trained patient navigators carried out interventions, with reminders via cellphone communication, to follow a cohort of 301 subjects eligible for CRC screening, utilizing a fecal immunochemical test (FIT). All the follow-up subjects received a FIT kit. Results: A total of 747 cellphone calls were made and divided into three interventions. From the initial cohort, 126 subjects completed their biennial screening process through the FIT, indicating a consistent adherence rate of 41.8% to our program. The participation patterns were: 126 consistent participants (41.8%), 160 inconsistent participants (53.2%), and 15 participants that were never contacted (5%). Conclusions: In conclusion, our study underlines the importance of organized screening programs in the early detection of CRC. The implementation of follow-up interventions, through reminders and the training of patient navigators, can improve adherence, but there is a need for examining new strategies, to overcome barriers to communication via cellphone. Resumen: Introducción y objetivo: La adherencia al tamizaje del cáncer colorrectal (CCR) es esencial para la efectividad de los programas de escrutinio. A pesar de que los programas de tamizaje organizado pueden mejorar la calidad del proceso y la adherencia, aún hay desafíos para lograrlo. En este estudio, implementamos un programa bienal de tamizaje organizado para CCR con el objetivo de describir la adherencia y los patrones de participación. Materiales y métodos: Se realizó un estudio longitudinal y descriptivo en el que un equipo de navegadores de pacientes capacitados realizó intervenciones con recordatorios mediante llamadas telefónicas para dar seguimiento a una cohorte de 301 sujetos elegibles para el tamizaje de CCR mediante una prueba de inmunoquímica fecal (FIT). Todos los participantes que cumplieron con su seguimiento recibieron un Kit FIT. Resultados: Se realizaron 747 llamadas telefónicas divididas en tres intervenciones. De la cohorte inicial, 126 sujetos completaron su proceso de tamizaje bienal mediante FIT, lo que indica una adherencia consistente del 41.8% a nuestro programa. Los patrones de participación fueron 126 participantes consistentes (41.8%), 160 inconsistentes (53.2%) y 15 nunca atendidos (5%). Conclusiones: En conclusión, nuestro estudio resalta la importancia de los programas de tamizaje organizado en la detección temprana del cáncer colorrectal. La implementación de intervenciones de seguimiento mediante recordatorios y la capacitación de navegadores de pacientes, puede lograr mejoras en la adherencia, sin embargo, es necesario explorar nuevas estrategias para superar las barreras en la comunicación telefónica.

Resumen: Introducción y objetivo: La adherencia al tamizaje del cáncer colorrectal (CCR) es esencial para la efectividad de los programas de escrutinio. A pesar de que los programas de tamizaje organizado pueden mejorar la calidad del proceso y la adherencia, aún hay desafíos para lograrlo. En este estudio implementamos un programa bienal de tamizaje organizado para CCR con el objetivo de describir la adherencia y los patrones de participación. Materiales y métodos: Se realizó un estudio longitudinal y descriptivo en el que un equipo de navegadores de pacientes capacitados realizó intervenciones con recordatorios mediante llamadas telefónicas para dar seguimiento a una cohorte de 301 sujetos elegibles para el tamizaje de CCR mediante una prueba de inmunoquímica fecal (FIT). Todos los participantes que cumplieron con su seguimiento recibieron un kit FIT. Resultados: Se realizaron 747 llamadas telefónicas divididas en tres intervenciones. De la cohorte inicial, 126 sujetos completaron su proceso de tamizaje bienal mediante FIT, lo que indica una adherencia consistente del 41.8% a nuestro programa. Los patrones de participación fueron 126 participantes consistentes (41.8%), 160 inconsistentes (53.2%) y 15 nunca atendidos (5%). Conclusiones: Nuestro estudio resalta la importancia de los programas de tamizaje organizado en la detección temprana del cáncer colorrectal. La implementación de intervenciones de seguimiento mediante recordatorios y la capacitación de navegadores de pacientes, puede lograr mejoras en la adherencia; sin embargo, es necesario explorar nuevas estrategias para superar las barreras en la comunicación telefónica. Abstract: Introduction and aim: Adherence to colorectal cancer (CRC) screening is essential for the effectiveness of screening programs. Even though organized screening programs can improve the quality of the process and adherence, there are still challenges to overcome. The aim of the present study, in which we implemented a biennial organized screening program for CRC, was to describe adherence and participation patterns. Materials and methods: A longitudinal, descriptive study was conducted, in which a team of trained patient navigators carried out interventions, with reminders via cellphone communication, to follow a cohort of 301 subjects eligible for CRC screening, utilizing a fecal immunochemical test (FIT). All the follow-up subjects received a FIT kit. Results: A total of 747 cellphone calls were made and divided into three interventions. From the initial cohort, 126 subjects completed their biennial screening process through the FIT, indicating a consistent adherence rate of 41.8% to our program. The participation patterns were: 126 consistent participants (41.8%), 160 inconsistent participants (53.2%), and 15 participants that were never contacted (5%). Conclusions: In conclusion, our study underlines the importance of organized screening programs in the early detection of CRC. The implementation of follow-up interventions, through reminders and the training of patient navigators, can improve adherence, but there is a need for examining new strategies, to overcome barriers to communication via cellphone.

Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.

Introduction ISMiHealth is a clinical decision support system, integrated as a software tool in the electronic health record system of primary care, that aims to improve the screening performance on infectious diseases and female genital mutilation (FGM) in migrants. The aim of this study is to assess the health impact of the tool and to perform a process evaluation of its feasibility and acceptability when implemented in primary care in Catalonia (Spain).Methods and analysis This study is a cluster randomised control trial where 35 primary care centres in Catalonia, Spain will be allocated into one of the two groups: intervention and control. The health professionals in the intervention centres will receive prompts, through the ISMiHealth software, with screening recommendations for infectious diseases and FGM targeting the migrant population based on an individualised risk assessment. Health professionals of the control centres will follow the current routine practice.A difference in differences analysis of the diagnostic rates for all aggregated infections and each individual condition between the intervention and control centres will be performed. Mixed-effects logistic regression models will be carried out to identify associations between the screening coverage and predictor factors. In addition, a process evaluation will be carried out using mixed methodology.Ethics and dissemination The study protocol has been approved by the institutional review boards at Hospital Clínic (16 June 2022, HCB/2022/0363), Clinical Research Ethics Committee of the Primary Care Research Institute IDIAPJGol (22 June 2022, 22/113-P) and the Almería Research Ethics Committee (27 July 2022, EMC/apg). The study will follow the tenets of the Declaration of Helsinki and Good Clinical Practice. All researchers and associates signed a collaboration agreement in which they undertake to abide by good clinical practice standards.Findings will be disseminated in peer-reviewed journals and communications to congresses.Trial registration number NCT05868005.

ABSTRACT The impact of third-generation cephalosporin-resistant Enterobacterales (3GCR-E) rectal colonization in the development of subsequent infection after surgery is controversial. In particular, there is a lack of data in the context of hepato-pancreato-biliary (HPB) surgery. The objective of this study was to assess the prevalence of 3GCR-E intestinal carriage among patients undergoing elective HPB resection surgery and its impact on the incidence and etiology of surgical site infections (SSIs). This retrospective cohort study (January 2016–December 2022) was performed at Valme University Hospital (Seville, Spain). The inclusion criteria included (i) 18 years of age or older, (ii) undergoing elective HPB resection surgery, and (iii) availability of a periprocedural surveillance rectal swab culture to detect 3GCR-E. The prevalence of 3GCR-E intestinal carriage at elective HPB resection surgery was assessed, as well as SSI incidence at 30 days and possible associated factors. Two hundred nine patients were included. Eleven (5.3%) patients were colonized by 3GCR-E at baseline. According to 3GCR-E carriage status, 6 (55%) of the carriers developed SSI, whereas this occurred in 50 (25%) of non-carriers (P = 0.033). Likewise, the rates of SSI caused specifically by 3GCR-E were 83% (5 of 6) in 3GCR-E carriers and 6% (3 of 50) in non-carriers (P < 0.001). After multivariate analyses, 3GCR-E colonization at the time of surgery was identified as an independent predictor for developing SSI (adjusted odds ratio 4.63, 95% confidence interval: 1.177–18.232, P = 0.028). Despite a low prevalence of 3GCR-E intestinal carriage at surgery, 3GCR-E rectal colonization is associated with a higher risk of SSI among patients undergoing elective HPB resection surgery, with most SSIs being caused by the colonizing bacteria.IMPORTANCEIn this Spanish retrospective cohort study, previous 3GCR-E rectal colonization was associated with a higher risk of SSI after hepato-pancreato-biliary resection surgeries. Most of SSIs were caused by the colonizing bacteria, suggesting a rationale for adapted perioperative antibiotic prophylaxis in known 3GCR-E colonized patients.

The acceptance of strawberries in international trade has increased due to their organoleptic qualities, high nutritional value, and richness in antioxidants. This research evaluated the effect of foliar spray with chitosan, brassinosteroids, and thidiazuron as metabolic enhancers on growth, productivity, quality parameters, and bioactive compounds in ‘Portola’ strawberry cultivar in the first year of production. This experiment included six treatments and control with doses of CTS of 100, 300, and 400 mg L-1, of Brassinosteroids (Vitazyme™) 0.5, 1-, and 5-mL L-1 and 0.15 mL L-1 of TDZ (Charger plex™) in applications of these biostimulants alone and combination CTS and BRs. The findings indicated that CTS treatments increased plant length, leaf count, leaf area, and fruit firmness. The joint application of CTS and BRs significantly promotes crown diameter, photosynthetic pigments, carotenoids, fresh and dry weight of roots and aerial parts, and ripening. Applications of CTS 300 mg L-1 and 1 mL L-1 of Vitazyme have shown the highest fruit length, diameter, and weight values. Regarding TDZ, this work showed an increase in crown diameter and in the fresh and dry weight of both the root and the aerial part without significant differences in the content of the chlorophyll and titratable acidity compared to the control. Therefore, it could be safely recommended that foliar application with CTS, BRs, and TDZ can be used as biostimulants to improve the growth, quality and bioactive compounds of strawberry cv ‘Portola’.

Se describe un reporte de caso de un paciente masculino de 61 años que acude a emergencia por presentar cuadro clínico de una semana de evolución caracterizada por disnea de mínimos esfuerzos, disfonía, dolor precordial, y fatiga, acompañado de pérdida de peso. En la analítica de laboratorio destaca: anemia normocítica normocrómica, leucocitosis con neutrofilia, trombocitosis, creatinina de 10.1mg/dL, PCR elevada, proteinuria con hematuria y Anti-PR3-ANCA positivo. Biopsia renal revela glomerulonefritis proliferativa extracapilar pauci-inmune (“crescéntica”), etiquetando el diagnóstico como vasculitis asociada a ANCA con glomerulonefritis rápidamente progresiva. Se maneja inducción y mantenimiento con rituximab y esteroides en pulsos.

La arteritis de Takayasu (TAK) es una vasculitis crónica, poco frecuente, de grandes vasos que afecta a la aorta y sus grandes ramas. El daño valvular no es bajo, aunque su incidencia difiere entre poblaciones, con un reporte entre el 20 a 45% con un radio mujer:hombre de 4.8 a 1.La inflamación arterial es la característica central de la enfermedad, asociada de forma variable con una respuesta sistémica de fase aguda. Se presenta el caso de una mujer de 25 años con antecedentes de atrofia renal e insuficiencia cardiaca que presentó convulsiones, se identifica discrepancia en presión arterial y pulsos periféricos de extremidades; corroborándose sospecha diagnóstica.

The time-consuming nature of many sample treatment protocols continues to be recognized as the main bottleneck of analytical procedures, which, in most cases, use long analysis times, excessive amounts of solvents and reagents, and energy. However, the increased awareness of the need for environmental protection and the development of Green Analytical Chemistry (GAC) has led to significant advancements in the field of sample treatment. Today, advances in the miniaturization of sample treatment techniques, the development of sorbents with tunable properties, and greener alternatives (for example from waste valorization) are gaining interest in the analysis of psychoactive compounds. Indeed, techniques offering rapid sample preparation, minimal use of solvents, reagents, and energy, and a significant reduction of waste generation are chosen by the scientific community. In recent years, non-toxic extraction media, such as ionic liquids, and deep eutectic solvents have emerged as alternatives to petroleum-based solvent extractions. Similarly, sorbent-based techniques have benefited from engineered materials and nanotechnology, incorporating novel sorbents with optimized physicochemical properties to enhance extraction efficiency and selectivity. To meet sustainability standards, GAC provides a wealth of information in the field of green awareness, and the application of green metrics has been extended into the literature in the past decade. These tools serve as guides and encourage scientists to develop the most appropriate methodologies that focus on both analytical performance and sustainability, using different concepts and criteria. This article collects and discusses examples of different sample preparation techniques applied to drug analysis, highlighting their strategies for greening the processes and their evaluation using tools such as HEXAGON, Analytical greenness metric for sample preparation (AGREEprep), and Sample preparation metric of sustainability (SPMS) tools.

Hydrological models can benefit from soft calibration, a process by which the proper simulation of hydrological variables is proved while or before addressing hard calibration. Soft calibration reduces the probability of obtaining a statistically accurate but unrealistic model. However, it requires soft data, which is often hard to acquire or unavailable. This work presents HydRoVars, an R tool developed to facilitate the estimation of data which can be implemented in a soft calibration procedure. It allows us to estimate two key hydrological indices (the runoff coefficient and baseflow index) and weather-related variables at the catchment scale for one or numerous basins. The runoff coefficient is calculated automatically from precipitation and streamflow datasets. Groundwater contribution is estimated through a semi-automatic process based on a baseflow filter which considers hydrogeological properties. Modellers would benefit from incorporating soft calibration in their calibration procedures, and this tool might help to estimate these relevant hydrological variables in their modelled area. The tool has been tested in 19 subbasins of the Tagus River basin (Spain) located in different geological regions. In the test cases, we demonstrate the usefulness of this tool to improve the model representation and gain an understanding of the catchments' hydrology. HIGHLIGHTS An R tool has been developed to collect weather and hydrological variables.; It allows estimating the runoff coefficient, and the baseflow index at the catchment scale.; Runoff coefficient can be automatically obtained for multiple basins.; Guidance is provided for a realistic groundwater contribution estimation.; Its usefulness has been tested in the Upper Tagus River basin (Spain).;

Abstract Background Due to population aging, healthcare expenditure is projected to increase substantially in developed countries like Spain. However, prior research indicates that health status, not merely age, is a key driver of healthcare costs. This study analyzed data from over 1.25 million residents of Spain's Murcia region to develop a capitation-based healthcare financing model incorporating health status via Adjusted Morbidity Groups (AMGs). The goal was to simulate an equitable area-based healthcare budget allocation reflecting population needs. Methods Using 2017 data on residents' age, sex, AMG designation, and individual healthcare costs, generalized linear models were built to predict healthcare expenditure based on health status indicators. Multiple link functions and distribution families were tested, with model selection guided by information criteria, residual analysis, and goodness-of-fit statistics. The selected model was used to estimate adjusted populations and simulate capitated budgets for the 9 healthcare districts in Murcia. Results The gamma distribution with logarithmic link function provided the best model fit. Comparisons of predicted and actual average costs revealed underfunded and overfunded areas within Murcia. If implemented, the capitation model would decrease funding for most districts (up to 15.5%) while increasing it for two high-need areas, emphasizing allocation based on health status and standardized utilization rather than historical spending alone. Conclusions AMG-based capitated budgeting could improve equity in healthcare financing across regions in Spain. By explicitly incorporating multimorbidity burden into allocation formulas, resources can be reallocated towards areas with poorer overall population health. Further policy analysis and adjustment is needed before full-scale implementation of such need-based global budgets.

Abstract Background Klebsiella aerogenes has been reclassified from Enterobacter to Klebsiella genus due to its phenotypic and genotypic similarities with Klebsiella pneumoniae. It is unclear if clinical outcomes are also more similar. This study aims to assess clinical outcomes of bloodstreams infections (BSI) caused by K. aerogenes, K. pneumoniae and Enterobacter cloacae, through secondary data analysis, nested in PRO-BAC cohort study. Methods Hospitalized patients between October 2016 and March 2017 with monomicrobial BSI due to K. aerogenes, K. pneumoniae or E. cloacae were included. Primary outcome was a composite clinical outcome including all-cause mortality or recurrence until 30 days follow-up. Secondary outcomes were fever ≥ 72 h, persistent bacteraemia, and secondary device infection. Multilevel mixed-effect Poisson regression was used to estimate the association between microorganisms and outcome. Results Overall, 29 K. aerogenes, 77 E. cloacae and 337 K. pneumoniae BSI episodes were included. Mortality or recurrence was less frequent in K. aerogenes (6.9%) than in E. cloacae (20.8%) or K. pneumoniae (19.0%), but statistical difference was not observed (rate ratio (RR) 0.35, 95% CI 0.08 to 1.55; RR 0.42, 95% CI 0.10 to 1.71, respectively). Fever ≥ 72 h and device infection were more common in K. aerogenes group. In the multivariate analysis, adjusted for confounders (age, sex, BSI source, hospital ward, Charlson score and active antibiotic therapy), the estimates and direction of effect were similar to crude results. Conclusions Results suggest that BSI caused by K. aerogenes may have a better prognosis than E. cloacae or K. pneumoniae BSI.

Abstract Background Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann’s procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P