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.

Purpose: To investigate in a large sample the prevalence rates of accessory spleens located in the greater omentum and to explain the embryological background and the vascular supply of this rare congenital disorder. Methods: Evaluation of the presence of accessory spleens located in the greater omentum was performed in 5 different international anatomical centers investigating a total of 1,045 body donors. Arterial and venous blood supply and the precise location of the respective vasculature within the splenic ligaments are described based on dissection of this rare condition in a male specimen. Results: The reported prevalence rates from 5 different centers were: 0.5% (out of 380 body donors), 0% (out of 230 donors), 0% (out of 200 donors), 2% (out of 200 donors), and 0% (out of 35 donors). The cumulative prevalence rate obtained from 1,045 anatomical dissections was 0.6%. The identified accessory spleen measured 3 × 3 × 2.5 cm and was located in the left upper abdominal quadrant. A vascular stag 7.5 cm in length was identified within the gastro-splenic ligament, containing an artery and a vein piercing the greater omentum from posterior. Conclusion: An accessory spleen located in the greater omentum is a rare congenital disorder. Physicians should be aware of the fact that in patients without any representative symptom history a nodular mass located within the greater omentum could be an accessory spleen.

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Objective: To assess the perspectives of the first year and second year MBBS students of College, regarding the effectiveness of flipped classroom learning as compared to the traditional mode of teaching. Study Design: A descriptive study. Place and Duration of Study: Shifa College of Medicine, Islamabad, Pakistan, from August to September 2021.Methodology: This descriptive study was conducted on all first and second year MBBS students in College after informed consent. A self-developed questionnaire formulated after a thorough literature search, with 16 questions was given. Quantitative data was collected after ethical approval and was analysed using SPSS version 22. Percentages and mean were calculated for descriptive analysis whereas qualitative data was analysed through thematic analysis Results: Out of the 156 responders, 61% students believed that flipped classroom buttressed a better understanding of study objectives, 24% stated that it didn't make much of a difference whereas 15% had a negative response in this respect. The majority (90%) reckoned that learning beforehand fostered better discussions and made the whole learning process much easier. Seventy-five percent believed that it has improved their grades. Although, some students did point out that sometimes meandering through various study sources consumed a lot of their time but overall they held a satisfactory opinion of flipped pedagogy (85%). Conclusion:The students enrolled in the study asserted the usage of flipped classrooms as a likeable and preferable teaching method in medical institutions. Not only it engaged students in active learning and helped them improve their grades but also enabled them to sharpen cognitive and presentation skills, which are the prime objects of undergraduate pedagogy.