Background
Routine preoperative screening of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with reverse transcriptase-polymerase chain reaction (RT-PCR) may reduce in-hospital SARS-CoV-2 transmission.
Methods
This was a prospective, observational, cohort study. The endpoints were the incidence of asymptomatic patients with positive preoperative RT-PCR results and the incidence and factors associated with postoperative SARS-CoV-2 infection in patients with cancer referred for elective surgery. Patients with elective surgery between May and October 2020 were included. RT-PCR of nasopharyngeal swabs was performed preoperatively for all patients. Postoperative SARS-CoV-2 infection was assessed within 30 postoperative days.
Results
A total of 1636 preoperative screening RT-PCR tests were performed. Of these, 102 (6.2%) cases were positive, and 1,298 surgical procedures were analyzed. The postoperative SARS-CoV-2 infection rate was 0.9%. The length of stay (odds ratio [OR] 1.08; 95% confidence interval [CI] 1.04–1.11;
p
< 0.001), surgical time (OR 1.004; 95% CI 1.001–1.008;
p
= 0.023), intensive care unit admission (OR 7.7; 95% CI 2.03–29.28;
p
= 0.003), and hospital readmissions (OR 9.56; 95% CI 2.50–36.56;
p
= 0.001) were associated with postoperative coronavirus disease (COVID-19). Using unadjusted and adjusted logistic regression, length of stay (OR 1.08; 95% CI 1.04–1.11;
p
< 0.001), and readmission (OR 9.02; 95% CI 2.30–35.48;
p
= 0.002) were independent factors of postoperative COVID-19.
Conclusions
Screening patients preoperatively may reduce in-hospital SARS-CoV-2 transmission. Length of stay and readmission were independently correlated with postoperative COVID-19.
Methods A descriptive study was conducted of all carcinoma of vulva cases managed from July 2014 to February 2019. The case records of all women diagnosed to have carcinoma of vulva were retrieved and socio-demographic characteristics, clinical presentations, histological type, treatment modalities and outcome were obtained and analyzed. Results There were 17 vulvar cancer patients during the study period. The ages ranged from 34 to 89 years (median age of 66 years). All of them were multiparous. Vulva wound and pruritus were the most frequent clinical features with presentations in stage I-52.9%, stage II-17.6%, stage III-17.6% and stage IV-11.7%. Squamous cell carcinoma 94.1% predominated and 5.9% cases had Basal cell carcinoma. Among the 17 cases, 94.1% were treated primarily with surgery, 5.9% with radiotherapy only while 47% with combined modality (Surgery and radiotherapy). Clinical follow-up of one to four years showed that 3 cases had local recurrence and 1died of disease. Conclusions Carcinoma of the vulva is a rare gynecological malignancy in Nepal. Surgery and radiotherapy remain to be the mainstay of treatment. Delayed presentation still result in greater morbidity and mortality rates.
In-hospital transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be reduced by routine preoperative screening with a reverse transcriptase-polymerase chain reaction (
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