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.

Introduction Appendicitis is an inflammation of the vermiform appendix and is one of the most common causes of an acute abdomen in young adults. If left untreated, it can lead to appendiceal abscess, perforation and peritonitis. Objective To assess treatment outcomes of acute appendicitis and associated factors among admitted patients with a diagnosis of acute abdomen. Methods and materials: A cross sectional study was employed among 169 patients using a census. Data were collected from patient medical records by using a checklist. Data were entered using Epi-data and analysed by statistical product and service solution. Logistic regression analysis was employed. Results Among 303 patients with a diagnosis of acute abdomen, 169 (55.7%) developed acute appendicitis; of whom, 45 (26.6%) developed unfavourable treatment outcomes. Patients who had elevated white blood cell count at the time of presentation (adjusted odds ratio = 4.7; 95% confidence interval (1.95, 11.35)) and intraoperative appendiceal abscess (adjusted odds ratio = 3.8; 95% confidence interval (1.61, 9.07)) were significantly associated with an unfavourable appendicitis treatment outcome. Conclusion and recommendation: Nearly a quarter of the patients developed unfavourable treatment outcomes. Elevated white blood cell count and intraoperative appendiceal abscess were significantly associated with unfavourable appendicitis treatment outcome. Therefore, early detection and treatment of appendiceal abscess is crucial for a better outcome.

Human coronaviruses (HCoVs) have long been considered in consequential pathogens, causing the-common cold‖ in otherwise healthy people. However, in the 21 st century, 2 highly pathogenic HCoVs-severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)-emerged from animal reservoirs to cause global epidemics with alarming morbidity and mortality. In December 2019, yet another pathogenic HCoV, 2019 novel coronavirus (2019-nCoV), was recognized in Wuhan, China, and has caused serious illness and death. The ultimate cope and effect of this outbreak is unclear at present as the situation is rapidly evolving. Middle East respiratory syndrome coronavirus (MERS-CoV) is zoonotic diseases causing severe respiratory illness emerged in 2012 in Saudi Arabia. Phylogenetic studies and viral sequencing results strongly suggest that MERS-CoV originated from bat ancestors after evolutionary recombination process, primarily in dromedary camels in Africa. The prevalence of MERS-CoV antibodies, the identification of MERS-CoV RNA and viable virus from dromedary camels of Eastern Africa and the Arabian Peninsula are the suggestive evidence for inter-transmission of the virus, primarily from camels to humans and its public health risks. However, the infection in camel is mostly asymptomatic. In contrast to the camel case, the clinical signs and symptoms of MERS-CoV infection in humans ranges from an asymptomatic or mild respiratory illness to severe pneumonia and multi-organ failure with an overall mortality rate of about 35%. Though inter-human spread within health care settings is responsible for the majority of reported MERS-CoV human cases, the virus is currently incapable of causing sustained human-to-human transmission (pandemic occurrence). Currently, there is no specific drug or vaccine available for treatment and prevention of MERS-CoV. The important measures to control MERS-CoV spread are strict regulation of camel movement, regular herd screening and isolation of infected camels, use of personal protective equipment by camel handlers and awareness creation on the public where consumption of unpasteurized camel milk is common. Therefore, urgent global epidemiological studies are required, to understand the transmission patterns and the human cases of MERS-CoV and also for the proper implementation of the above-mentioned control measures.

Introduction- Acute abdomen is a sudden onset abdominal disease condition which often requires an immediate surgical intervention. Appendicitis is an inflammation of the vermiform appendix and is one of the most common causes of an acute abdomen in young adults. Appendicitis can cause severe periumbilical pain that radiates to the right lower quadrant, nausea, vomiting and anorexia. If left untreated, it can also cause appendiceal abscess, perforation and peritonitis. Objective - To assess treatment outcomes of Acute Appendicitis and associated factors among admitted patients with a diagnosis of acute abdomen in Debre Markos referral hospital from September 11/2018 to March 9/2019. Methods and materials - Institutional based cross sectional study was employed among 169 patients using a census sampling method. Data were collected from patient medical records, registration books and anesthesia charts available in the hospital by using checklist. Data was entered using Epi-data version 4.2 and analyzed by SPSS version 25 software. Logistic regression analysis was employed to describe the relationship between outcome and predictor variables. Results - Among 303 patients with a diagnosis acute abdomen, 169(55.7%) were developed acute appendicitis, of whom, 107(63.7%) were males and 62 (36.7%) were females. Among 169 patients who underwent appendectomy for treatment of acute appendicitis, 45(26.6%) of them were developed unfavorable treatment outcomes. The odds of unfavorable treatment outcomes for acute appendicitis was higher among patients who had elevated WBC count at the time of presentation [AOR=4.7; 95% CI (1.95, 11.35)] as compared with their counterparts. Similarly, those patients who had an intraoperative appendiceal abscess were more likely to have unfavorable treatment outcome for acute appendicitis [AOR= 3.8; 95% CI (1.61, 9.07)] as compared to those who didn’t have appendiceal abscess. Conclusion and recommendation- Nearly one-fourth of patients who underwent appendectomy for appendicitis treatment were developed unfavorable treatment outcomes. Elevated WBC count at the time of presentation and presence of intraoperative appendiceal abscess were the factors associated with unfavorable treatment outcome of acute appendicitis. Therefore, immediately evaluate patients having similar features with laboratory investigations is crucial.