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.
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
Study Design: An analysis of 14 cases of ruptured uterus was done during January 2003 to December 2003 in Obstetrics & Gynae Department of Lahore General Hospital, Lahore. Objective: The purpose of this Audit was to analyse the different management options, maternal and fetal outcome in uterine rupture. Material and Methods: Total no of births in 2003 was 4840. Total number of ruptured uterus found to be 14 (2.9%/1000) deliveries. Among these incomplete rupture were 3 (21.4%) and complete rupture were 11 (78.4%). Regarding the common sites of uterine rupture lower uterine segment interior surface = 11 (78.4%). Lower uterine segment posterior surface = 2 (14.2%) and upper uterine segment rupture was = 1 (7.14%). The most common cause of uterine rupture was found to be multiparity and injudicious use of oxytocin by TBA in 5 cases. (35.7%) and previous uterine surgery in 5 cases (35.7%). 2 cases (14.21) were due to cephalopelvic disproportion due to hydrocephalus and 2 (14.2%) cases were of malpresentation (transverse lie) mostly handled at home by TBAs. Hysterectomy, total or sub total was done in 7 cases (50%). Repair of uterus was done in 5 cases (35.7%), in 2-cases (14.2%). Bladder repair alongwith uterine repair was done. In two cases (14.2%) of scar dehiscence, repeat cesarean section was done. The maternal mortality was found to be zero, while intrauterine death were 10(71.4%) and alive babies were 4 (28.5%) high perinatal mortality of 71% were found. Conclusion: Ruptured uterus is avoidable catastrophe by proper education, training of patients and TBA`s and by providing effective family planning services, transportation, diagnostic facilities and by reducing the unnecessary caesarean section.
Objective: To evaluate the effectiveness of sweeping of the membranes in nulliparous women to reduce the need for a formal induction of labor. Design: A randomized controlled clinical trial. Place and duration of study: The study was conducted in the Gynae unit 1 of Jinnah Hospital Complex. Lahore, from April 2001to March 2003. Patients and methods: 100 nulliparous women attending the antenatal clinic at 39 weeks of gestation were randomly allocated for the study. 50 women were randomized to sweeping of membranes and 50 to control group. Their outcome measures in terms of proportion of women achieving spontaneous labor, duration of labor and bishop score at the time of admission to the hospital were assessed. Results: Spontaneous labor occurred more often in the sweeping of the membranes group than in the control group (38/50(76%) vs. 19/50(38%) P = 0.002). In addition a greater proportion of women in the sweeping group had a cervical dilatation of 4 cm or more at the first vaginal examination in the labo r ward (25/50 (49%) vs. 8/50 (16%) P = 0.005. Women allocated to sweeping showed a trend towards having a shorter randomization-delivery interval: 9.4 days vs. 10.6 days in the controls P = 0.087. The need for induction of labor was significantly reduced in those women who underwent sweeping (11% vs26% P = 0.004). Conclusion: Sweeping of membranes in nulliparous women at 39weeks of gestation significantly decreases the number that will reach 41 weeks of gestation.
Objectives: The aim of the study is to assess the awareness about various aspects of HPV infection and vaccine among female doctors working in tertiary care centres. Study Design: Cross Sectional study. Setting: 3 Tertiary Care Hospitals Lahore. Period: Jan 2018 Jan 2019. Material & Methods: 478 female doctors from 03 tertiary care hospitals (Lady Atchison hospital, Lahore General Hospital and Services Institute of Medical Sciences) in Lahore who voluntarily filled 18-point self-administered questionnaire assessing their knowledge about HPV infection (8) HPV vaccine (5) and opinions about it (5). Knowledge score (range 0-8), assuming adequate knowledge > median. Factors associated with opinions were explored and analysed. Results: Most replied knowledge questions correctly 67.2%, 39.5% perceived it as frequently occurring infection. Median knowledge was 6 out of 8 questions; lack of knowledge was associated with non ob-gynae speciality or junior level. None of the participants were immunized but 46.3% were willing to get vaccinated themselves 78.1% were willing to get their daughters vaccinated. Self-perceived under exposure of HPV infection was 67.9%. Lack of feeling it as important in our social setting (28.6%), and expensiveness (19.4%) were most common causes of not counselling the patient about HPV vaccine and counselling to get vaccinated was most commonly done as it saves patients from cervical cancer (86.8%). Conclusions: Despite adequate knowledge of HPV infection and effectiveness of its vaccination, female doctors working in tertiary care hospitals of Lahore’s are not efficiently spreading awareness to the society and prescription of the vaccination is also deficient.
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