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.

Investigar os fatores associados à prática do sexo sob o efeito de drogas (chemsex) entre homens que fazem sexo com homens (HSH) durante período de isolamento social, no contexto da pandemia da COVID-19. Inquérito multicêntrico online, aplicado aos territórios de Brasil e Portugal em abril de 2020, enquanto os dois países vivenciavam medidas sanitárias restritivas para a doença. Os participantes foram recrutados valendo-se de uma adaptação do método respondent driven sampling (RDS) ao ambiente virtual. Os dados foram coletados usando redes sociais e aplicativos de encontro voltados a HSH. Utilizamos regressão logística bivariada e multivariada para a produção das odds bruto (OR) e ajustado (ORa). Em um universo de 2.361 sujeitos, 920 (38,9%) realizaram a prática do chemsex, que, em 95% dos casos, foi realizada com parceiro casual. Aumentaram as chances de se envolver em chemsex: morar no Brasil (ORa = 15,4; IC95%: 10,7-22,1); não estar em isolamento social (ORa = 4,9; IC95%: 2,2-10,9); fazer sexo casual durante o distanciamento social (ORa = 52,4; IC95%: 33,8-81,4); fazer sexo grupal (ORa = 2,9; IC95%: 2,0-4,4); não apresentar nenhum tipo de sintoma para a COVID-19 (ORa = 1,3; IC95%: 1,1-1,8); não residir com o parceiro (ORa = 1,8; IC95%: 1,2-2,6) e estar em uso da profilaxia pré-exposição (ORa = 2,6; IC95%: 1,8-3,7). A ocorrência de chemsex foi elevada, sobretudo no Brasil, onde o isolamento social proposto não sensibilizou os HSH à adesão.

COVID-19 vaccine hesitancy (VH) has caused concerns due to the possible fluctuations that may occur directly impacting the control of the pandemic. In this study, we aimed to estimate the prevalence and factors associated with COVID-19 VH in Portuguese-speaking countries. We developed a web survey (N:6,843) using an online, structured, and validated questionnaire. We used Measurement Models, Exploratory Factor Analysis, Exploratory Structural Equation Models, and Confirmatory Factor Analysis for the data analysis. The overall prevalence of COVID-19 VH in Portuguese-speaking countries was 21.1%. showed a statistically significant direct effect for VH: vaccine-related conspiracy beliefs (VB) (β = 0.886), perceived stress (PS) (β = 0.313), COVID-19 Misinformation (MIS) (β = 0.259) and individual responses to COVID-19 (CIR) (β = −0.122). The effect of MIS and CIR for VH was greater among men and of PS and VB among women; the effect of PS was greater among the youngest and of VB and CIR among the oldest. No discrepant differences were identified in the analyzed education strata. In conclusion, we found that conspiracy beliefs related to the vaccine strongly influence the decision to hesitate (not to take or to delay the vaccine). Specific characteristics related to gender, age group, social and cognitive vulnerabilities, added to the knowledge acquired, poorly substantiated and/or misrepresented about the COVID-19 vaccine, need to be considered in the planning of vaccination campaigns. It is necessary to respond in a timely, fast, and accurate manner to the challenges posed by vaccine hesitancy.

Resumo O objetivo deste artigo é compreender como os sentimentos e as emoções de homens contribuem para o enquadramento da doença Covid-19 no Brasil. Estudo sócio-histórico, qualitativo, realizado com 200 homens residentes no Brasil, mediante pesquisa online em plataforma digital. Os dados apreendidos foram analisados pelo método do Discurso do Sujeito Coletivo à luz do referencial de doença epidêmica proposto por Charles Rosemberg. Prevaleceram sentimentos negativos e ansiedade como consequência do conhecimento acerca do crescente número de hospitalizados e mortos pela pandemia veiculada nos noticiários. Para os homens, o otimismo é necessário para encorajar atitudes com responsabilidade e confiar de que a crise será superada. Na sequência os homens apresentam um conjunto de atitudes e comportamentos para o enfrentamento da pandemia. E, a aceitação sinaliza a emergência do quarto ato dramatúrgico do enquadramento da Covid-19. Os sentimentos e as emoções de homens, no presente contexto histórico, atravessam três dos quatro atos de enquadramento da Covid-19 no Brasil.