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Background Acute cholecystitis is a common reason for emergency general surgery admission. The declaration of the COVID-19 pandemic may have resulted in treatment delays and corresponding increases in severity of disease. This study compared cholecystitis admissions and disease severity pre- and post-declaration of pandemic. Materials and Methods Retrospective review of adult acute cholecystitis admissions (1/1/20-5/31/20). Corresponding time periods in 2018 and 2019 comprised the historical control. Difference-in-differences analysis compared biweekly cholecystitis admissions pre- and post-declaration in 2020 to the historical control. Odds of increased severity of disease presentation were assessed using multivariable logistic regression. Results Cholecystitis admissions decreased 48.7% from 5.2 to 2.67 cases [RR 0.51(0.28,0.96), p=0.04] following pandemic declaration when comparing 2020 to historical control (p=0.02). After stratifying by severity, only Tokyo I admissions declined significantly post-declaration [RR 0.42(0.18,0.97)], when compared to historical control (p=0.02). There was no change in odds of presenting with severe disease after the pandemic declaration [aOR 1.00 (95% CI 0.30, 3.38) p<0.99] despite significantly longer lengths of symptoms reported in mild cases. Conclusion Post-pandemic declaration we experienced a significant decrease in cholecystitis admissions without corresponding increases in disease severity. The pandemic impacted healthcare-seeking behaviors, with fewer mild presentations. Given that the pandemic did not increase odds of presenting with increased severity of disease, our data suggests that not all mild cases of cholecystitis progress to worsening disease and some may resolve without medical or surgical intervention.

The historical, social, and economical importance of precolonial connections between Africa and the rest of the world has been undervalued. In the present study, we use crops as historical and social markers to analyze intercontinental connections from the perspective of Kenyan and Ugandan regions northeast of Lake Victoria. Crops were inventoried in 148 small farms from 74 localities, using successively free listing, to reveal their socio-cultural salience, and a closed list method, for a more complete picture of the agricultural, environmental and social diversity. The total sample included 75 crops (30 African, 21 Asian, 21 American, and 3 European). Among farms, crop richness varied from 6 to 32. It was higher in Uganda than in Kenya, and lowest around the Winam Gulf. The 12 American crops introduced at Renaissance were uniformly distributed, and the observed structure was mostly due to differences in African and Asian crop richness. In terms of crop frequency, exotic crops account for 74%, with 46% for American crops. The 14 most frequent crops included 10 from America, 3 from Asia, and 1 for Africa, with negligible differences among linguistic groups. Consistently, the free listing citation order demonstrated the high cultural salience of American crops. The spatial distribution of minor crops suggest differential diffusion among linguistic groups, which could be further studied using linguistic approaches on crop names.

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