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Abstract Background Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Methods This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. Results A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28–66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4–10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0–1, 22.7% for those who had scores of 2–3, 46.8% for those who had scores of 4–5, and 86.7% for those who have scores of 7–8. Conclusions The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.

Abstract Background Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. Methods This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016–September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. Results A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%. Conclusions The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.

Para evitar la degradación física del suelo se necesitan estrategias de gestión sostenibles. En este sentido, la intensificación en la secuencia de cultivos genera un uso más eficiente de los recursos ambientales, aumentando el aporte de carbono al suelo y mejorando su condición física. El objetivo del presente trabajo fue estudiar en el corto plazo (un año), la incidencia de dos cultivos de cobertura (CC) con características contrastantes (CC Trigo y CC Vicia) y la de una situación bajo barbecho invernal (Barbecho), sobre distintas propiedades físicas del suelo, analizando además su relación con el rendimiento de dos cultivos de verano (maíz y soja). Para cumplir con dichos objetivos, se evaluó la respuesta de un Argiudol bajo siembra directa (SD), ubicado en el partido de San Antonio de Areco (Pcia. de Bs. As.). Se determinó la lámina de agua disponible de los primeros 60 cm de suelo en distintos momentos del ensayo. A la cosecha de los cultivos de verano se determinaron a dos profundidades las siguientes propiedades: densidad aparente, resistencia mecánica a la penetración, estabilidad de agregados, conductividad hidráulica saturada y porosidad estructural, como así también los rendimientos de soja y maíz. Las parcelas ocupadas durante el invierno con CC, no presentaron al momento de la siembra, floración y cosecha de los cultivos de verano, menor contenido hídrico en los primeros 60 cm de suelo respecto al Barbecho. Se comprobó en el corto plazo y sobretodo en el estrato superficial, el efecto favorable de los CC sobre la mayoría de las propiedades físicas evaluadas. En algunos casos se generaron respuestas distintas del suelo, según el CC presente. La estabilidad de agregados de los primeros centímetros de suelo a la cosecha del maíz, fue la variable más sensible para detectar los cambios sufridos, mientras que la resistencia mecánica a la penetración fue la menos eficaz.

This work aims to contextualize and analyze the potential contribution of pecan to SDG2 under the dual perspective of carbon storage and human nutrition. Particularly, the study focuses on the pecan agroecosystems in the Americas, representing the most important pecan-producing countries (the United States, Mexico, Brazil, Argentina, Uruguay, and Peru). We observed that pecan is a reliable sink for storing atmospheric C and also for quality nuts with high nutritional density. The Americas, hold a population of ca. 23 M pecan trees, with the younger tree populations and the highest C-storing potential in South America. This pecan tree population has removed 51.3 Mt CO2eq immobilizing the OC in their aboveground biomass, but if the C sequestration for the whole system is considered, the value reaches nearly 80 Mt CO2eq. From a nutritional perspective, there are different dietary needs to cover according to the country, although the common analysis output is a low proportion of nuts in the diet, which is expected to improve, given the efforts of each country to promote domestic consumption. All the mentioned countries in this study have a low pecan consumption going from 8 to 293 g per capita yr-1, which in the light of the Global Burden of Disease represents 0.08 to 3.2% of the recommended yearly dietary basis for nuts overall. The inclusion of pecan nuts in the daily diet is of utmost importance to offset the food nutrient dilution carbohydrates-based, linked to the excess of atmospheric CO2. Also, pecan orchards function as a platform to integrate sustainable systems. The global benefit of having pecan and alley crops has been proved in regions other than the Americas with interesting economic outputs leading to energizing the life of rural communities. Pecan orchards and pecan agroforestry may lead to sustainable agri-food systems, with global gains in SOC and nutritional richness and diversity. Therefore, more in-depth studies are needed not only to fully understand the functioning of the systems at a productive level but also to design and plan sustainable landscapes in rural land.