angiotensin-converting enzyme 2 expression levels correlate with allergic sensitization, higher levels of total immunoglobulin E, and type 2 inflammatory cytokines. [3][4][5] Interleukin 13, a major type 2 inflammatory cytokine, is found to significantly reduce angiotensinconverting enzyme 2 expression in airway epithelial cells. 5 Our findings of the association of AR and eczema with decreased need of hospitalization for COVID-19 provide robust clinical data to support these mechanistic findings.The role of asthma and its association with COVID-19 severity is more complicated. 6,7 Asthma was not reported in previously published cohorts of COVID-19 from China 1,2 ; although data from the Centers for Disease Control indicate that asthma is present in as high as 27% of hospitalized COVID-19 patients in the United States in the 20 to 49 year age range. 6 This could be explained by the lower rates of asthma in China (2%-4%) than those in the United States (8%-11%). 8,9 In the current report, allergic asthma was not associated with any COVID-19 outcome variable despite AR being protective against hospitalization. Furthermore, nonallergic asthma was associated with a prolonged intubation time which confirms an earlier study. 10 It is possible that asthma, as a chronic pulmonary disease susceptible to viral-induced exacerbations, places those with more severe COVID-19 illness at risk for more prolonged lung involvement. However, a coexisting atopic background may mitigate the severe inflammatory response syndrome of COVID-19 in those with allergic asthma, leading to the absence of the prolonged intubation time reported in individuals with nonallergic asthma.The knowledge that atopy is associated with less severe COVID-19 outcomes can be instructive in clinical risk stratification. Further studies are needed to understand the underlying mechanism of these apparent protective physiological factors that may prove advantageous in future prevention and treatment strategies.

Placenta chorioangioma represents a challenge with its potentially serious complications adversely affecting pregnancy outcome. An international registry of pregnancies with this rare complication and documentation of pregnancy outcomes will improve the evidence base for prospective management.

Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.

Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien–Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.

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