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.

Background. A single-center ESRD care experience in a Nigerian teaching hospital is presented as a surrogate case to demonstrate the prevailing ESRD care situation in Nigeria and most SSA countries. Methods. The data of 320 consecutive ESRD patients undergoing maintenance haemodialysis treatment during a seven-year period were retrospectively analyzed. Results. Over 80% of the subjects funded dialysis treatments from direct out of pocket payment. The mean duration on dialysis before dropout was 5.2 ± 7.6 weeks, with majority 314 (98.1%) of the patients unable to sustain dialysis above 12 weeks. Total dialysis sessions during the 7-year period was 1476 giving an average weekly dialysis session of 0.013 (0.05 hour/week) per patient per week. One hundred and twenty-eight (40%) patients died within 90 days of entry into dialysis care. Conclusions. ESRD care in this single centre was characterized by gross dialysis inadequacy and case fatality due to the inability to access and afford care. The opportunities for kidney transplantation are also very low. Poverty and the absence of government support for ESRD care are responsible for the poor outcomes. A global focus on ESRD care in SSA countries has thus become imperative.

Background. Acute kidney injury in adults is a common cause of hospitalization, associated with high morbidity and mortality especially in developing countries. In spite of RRT the in-hospital mortality rates remain high even in the developed countries. Though a proportion of our patients receive renal replacement therapy as part of their management, data on outcomes are sparse. Study Objective. To determine the clinical outcomes of dialysis-treated AKI in our hospital. Methods. A retrospective analysis of the clinical data of all adult AKI patients treated with haemodialysis at the University of Teaching Hospital during an interrupted six-year period was conducted. Analysis was done using SPSS version 17.0. Results. 34 males and 28 females with mean age of 41.3 ± 18.5 years were studied. The leading causes of AKI were sepsis (22.7%), acute glomerulonephritis (20.5%), acute gastroenteritis (15.9%), and toxic nephropathies (11.4%) and presented with mean e-GFR of 14.7 ± 5.8 mls/min/1.73 m2. Of the 62 patients, 29 (46.8%) were discharged from the hospital, 27 (43.5%) died in hospital, while 6 (9.7%) absconded from treatment. Survivors had better Rifle grade than those who died (P < 0.001). Conclusion. Hospital mortality rate of dialysis-treated AKI patients is high and the severity of renal damage at presentation may be an important factor.

Most reports of Multisystem Inflammatory Syndrome (MIS-C) have come from Europe and North America. The paucity of reports in Africa is in contrast with the demographics of the series in New York, Paris and UK with children of African ancestry accounting for over 40%, of all cases of MIS-C. With the global trend of higher prevalence of MIS-C in children of African ancestry, enhanced surveillance and awareness for this syndrome in children with COVID-19 in Africa are therefore important. A case report of a 12-year old Nigerian girl with MIS-C is presented in line with the WHO global surveillance especially in areas were MIS-C is considered a rarity. This case report stimulates a call for vigilance and expanded effort at surveillance to promote early recognition and diagnosis of MIS-C in Nigeria and Africa. The favourable outcome and experience from this case will create awareness, expand knowledge, and support clinicians in Nigeria and the African continent in their approach to other potential cases.