Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...
To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.
Objective: To analyze the behavior of people with dizziness when faced with the easing of the COVID-19 social distancing rules, immunization and use of vitamin supplementation. Method: A self-perception questionnaire was applied in electronic format, during the period of easing of the COVID-19 social distancing rules, with 19 closed questions. The following aspects were addressed: identification, general health (COVID-19, influenza, immunization and comorbidities), time of onset of dizziness, means of protection against COVID-19, vitamin supplementation, homemade recipes and use of teas. Results: 667 Brazilians were interviewed, all eligible to participate in the research. Of these, 261 (39.1%) self-reported the presence of dizziness, with a mean age of 37.91 years, with a prevalence of females. The use of masks and hand hygiene were protective measures that continued to be adopted during the easing of the COVID-19 social distancing rules, with 89.2% reporting, even after having been immunized, that they were afraid of contracting SARS COV -two. It was observed that 11.1% triggered dizziness after a positive test for COVID-19; in addition, 32.2% consulted a nutritionist to start the supplementation process (p=0.005), 65.1% used vitamin supplements (p=0.001) and 19.8% reported having used homemade recipes such as Espinheira Santa Tea and Chamomile, Ginko Biloba in order to minimize dizziness. Conclusion: Participants with dizziness were diagnosed with a vestibular disorder by a specialist, since there was a positive relationship with dizziness in the post-COVID-19 period. In order to reduce vestibular symptoms, the interviewees consulted a nutritionist to start vitamin supplementation and used vitamin complexes from A to Z, among others such as zinc, vitamin B12 and homemade teas. Even after the COVID-19 immunization, the participants continued to follow the guidelines for hand hygiene and the use of protective masks.
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