Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of nonoperative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and perioperative antibiotic therapy.

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

Unconventional oil and natural gas extraction enabled by horizontal drilling and hydraulic fracturing (fracking) is driving an economic boom, with consequences described from "revolutionary" to "disastrous." Reality lies somewhere in between. Unconventional energy generates income and, done well, can reduce air pollution and even water use compared with other fossil fuels. Alternatively, it could slow the adoption of renewables and, done poorly, release toxic chemicals into water and air. Primary threats to water resources include surface spills, wastewater disposal, and drinking-water contamination through poor well integrity. An increase in volatile organic compounds and air toxics locally are potential health threats, but the switch from coal to natural gas for electricity generation will reduce sulfur, nitrogen, mercury, and particulate air pollution. Data gaps are particularly evident for human health studies, for the question of whether natural gas will displace coal compared with renewables, and for decadal-scale legacy issues of well leakage and plugging and abandonment practices. include data for (a) estimated ultimate recovery (EUR) of unconventional hydrocarbons, (b) the potential for further reductions of water requirements and chemical toxicity, (c) whether unconventional resource development alters the frequency of well integrity failures, (d ) potential contamination of surface and ground waters from drilling and spills, (e) factors that could cause wastewater injection to generate large earthquakes, and ( f ) the consequences of greenhouse gases and air pollution on ecosystems and human health.

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