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: Urinary tract infection is a major reason for hospital visits and a common clinical condition encountered by clinicians. The causative agents of urinary tract infection and their resistant pattern vary globally. The aim of this study was to highlight the profile of pathogens associated with urinary tract infections in our locality. The objective was to investigate the resistant pattern of these microbial isolates from patients with urinary tract infection and offer recommendations for effective treatment. Materials and methods: We retrospectively analyzed the urine culture and antimicrobial sensitivity reports of patients with suspected urinary tract infection at the University of Calabar Teaching Hospital, Calabar, Nigeria, from September 2019 to August 2020. Methicillin resistance was detected by disk diffusion method using 30 µg cefoxitin disk. Production of Extended spectrum beta lactamases was detected by the Combination disk and the double-disk synergy method. Results: Of 979 urine culture and sensitivity reports, 306 (31.26%) were positive for microbial growth. Two microbial isolates each were recovered from urine samples of 5 patients giving a total number of 311 isolates from 306 patients. 45.75% of positive results were in males. The predominant isolate was Escherichia coli (n=97, 31.19%). Extended Spectrum Beta Lactamases (ESBL) producing strains comprised 10.08% (10/238) of Gram-negative group of organisms, while 47.39% (145/306) of all bacterial isolates in our study were multi drug resistant (MDR). 14.29% (6/42) of S. aureus isolates were methicillin resistant S. aureus, while 33.33% (2/6) of methicillin resistant S. aureus (MRSA) were multi drug resistant. Conclusion: Urinary tract infection caused by antimicrobial resistant organisms is common among studied patients. This emphasizes the need for urine culture and sensitivity tests in the management of urinary tract infection.

Targeted empirical antibiotic therapy based on local microbiology and antibiotic resistance patterns is essential for the treatment of empyema thoracis. Our retrospective review of 105 pleural empyema culture and sensitivity reports aimed at determining the causative microorganisms and their antimicrobial resistance pattern. Of 105 pleural aspirate samples, 46 (43.8%) were positive on culture. Gram-negative organisms (n = 43) were the predominant isolates, the commonest of which was Klebsiella pneumoniae. It was concluded that empyema thoracis is predominantly caused by Gram-negative organisms in our locality. This should guide protocols on the initiation of empirical therapy.

Indigestible intra-gastric foreign bodies are encountered in the mentally deranged, transporters of illicit drugs or those desiring weight control. They are often complicated by obstruction, migration, or perforation. Pseudobezoars are indigestible objects introduced intentionally into the digestive system. They may be indicated in bariatric practice for control of obesity. We present an 87-year-old man managed for a 2-year history of burning epigastric pain, aggravated by lying down and relieved by antacids. He had associated reflux symptoms for which he adopted lifestyle modifications. He had an upper gastrointestinal endoscopy which showed a stone attached to the anterior wall of the body of the stomach with associated pseudo-pouch formation. Mucosal overgrowth on the stone could be noted. Attempts at endoscopic retrieval failed as the stone could not be dis-impacted from its lodgement in a mucosal pouch. He had a laparotomy and gastrotomy for retrieval. A piece of stone, identified as granite, which measured 2 × 2 × 2.5 cm was retrieved from the stomach with accompanying formation of the mucosal pouch. Mucosal response, which may include overgrowth, could be an initial step in the migration of intra-gastric foreign bodies.