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.

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp . (20.3%), Escherichia coli (15.8%), and Pseudomonas spp . (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06944-2.

Background: The aim of the present study was to assess the prevalence of self-medication among undergraduate medical students in Alexandria Faculty of Medicine and recognize the patterns and the attitude of students towards intake. Methods: A cross-sectional study was conducted among undergraduate medical students attending Alexandria Faculty of Medicine from both national and international programs during the period of June 2013 until October 2013. A self-administrated, semi-constructed questionnaire was used to assess the practice of self-medication among 408 students who were randomly selected using a stratified random sample technique. Results: Self-medication was reported by 208 (52.7%) students, with no significant difference between males and females. The highest percentage of self-medication was reported among those who have completed six years of academic study and the lowest was reported among those who have completed two years of academic study. There was a statistically significant association between educational stage (preclinical and clinical) practice of self-medication. Most common medications involved were analgesic and anti-inflammatory followed by decongestants, antimicrobials and antihistaminic drugs. 309 (78.8%) students believed that self-medication is acceptable. Conclusion: The present study demonstrated that self-medication is practiced by more than half of undergraduate medical students in the Faculty of Medicine - Alexandria University. Acquiring medical knowledge seems to be associated with the practice of self-medication. Therefore, more attention should be paid to medical curricula to raise awareness and limit the hazardous effects of this phenomenon

AimsWe aimed to assess the impact of the current pandemic on the mental well-being of undergraduate medical students of Alexandria Faculty of Medicine, Egypt.MethodWe designed a structured anonymous online questionnaire and encourage students to fill it in on social platforms. The questionnaire is composed of seven parts, each one includes multiple choice questions aimed to measure the impact of the pandemic on different aspect of daily activities namely: academic performance, social and family relationship, eating and smoking habits, sleep pattern, physical activity and the Depression, anxiety and stress scale (DASS-21). The last part was an open question where participants can state their comments about the experiences during the quarantine and how they affected their mental health.ResultA total of 1181 students from the six academic grades responded. Females and students in the third academic year showed the highest prevalence of depression, anxiety and stress. Overall, most respondents reported that the current pandemic had negative impacts on their academic performance (71%) and social relationship (67.5 %). The majority of the students stated that they became less physically active (74.6%) and 52.2% experienced a weight gain. Despite that 60% of the studied population rated their sleeping quality as ‘’very good’’ and ‘’fairly good’’, 45.3% and 39.6% suffered from increased sleeping hours and disturbed sleep respectively. Based on students’ responses of the DASS-21, over half of the participants (62.2%) were experiencing moderate to extremely severe stress and over 33% were consistent with symptoms of extremely severe anxiety. In respect of depression, nearly half of the sample (46.4%) can be described as having extremely severe depression according to the cut-off points of the DASS-21.ConclusionThe current pandemic has increased the challenges and burdens on undergraduate medical students. These impacts can be more profound in developing countries such as Egypt. The levels of psychiatric symptoms are alarming compared to previous local and international studies. These unprecedented consequences should be addressed promptly through students’ counselling and psychiatric assistance. To date, this is the largest psychiatric and survey-based study conducted on Alexandria Faculty of Medicine.Financial disclosure: The study was not funded by any organization, the authors did not receive any financial aids.

HighlightsThe need for recording and maintaining fluid balance in the early postoperative period.Hyponatremia may occur in healthy patients after short, uneventful operations. Women and elderly are a higher risk and are more prone to permanent neurological deficits.Awareness of hyponatremia as a cause of postoperative seizures and the multiple causes of hyponatremia in these settings.Care should be taken not to continue with increased water intake following surgical correction of hypercalcaemia.

The argument surrounding the potential advantages and safety of the offpump is difficult to be settled. Off-pump CABG, in the hands of trained surgeons, offers favorable short-term outcomes particularly in patients with complex co-morbidities. It is highly indicated in heavily calcified aorta to avoid the thromboembolic events. The decision should be made on individual basis, taking into consideration the potential long-term adverse outcomes.First eligible comers in the period between 2018-2019.The following points were compared between the two groups Amount of bleeding, length of stay, duration of mechanical ventilation, operative time, completion of revascularization, complications; atrial fibrillation, neurological deficits, acute kidney injury.

Background: Palmar hyperhidrosis is a distressing condition implicating individuals’ social life and self-esteem. Surgery has proven to be highly effective with excellent safety profile. However, compensatory hyperhidrosis (CH), a relatively common adverse event of the procedure, is sometimes problematic in a few patients. Patients and Methods: A questionnaire, including Hyperhidrosis Disease Severity Scale (HDSS), was designed to assess the overall satisfaction of patients who underwent bilateral endoscopic thoracic sympathectomy between November 2018 and July 2021. They were requested to respond to the questionnaire before surgery and during the follow-up visits. Results: Sixty-three patients were recruited, 37 males and 26 females. The age of the participants ranged from 6 to 27 years (mean 17.05 ± 5.55 years). Most patients reported a positive impact on their professional and social life. Two patients experienced significant compensatory hyperhydrosis impacting their daily life. There was a significant improvement of the HDSS score after surgery. Around 95.2% of the participants (n = 60) had three-point improvement indicating 80% reduction of sweat production. Conclusion: : Bilateral endoscopic thoracoscopic sympathectomy has shown a high success rate with low adverse events. CH, however, remains a significant cause of morbidity in few patients. Therefore, continuous evaluation of patients’ satisfaction is of utmost importance to help improve our understanding to risk factors and prevalence of CH, improve our techniques to minimise its occurrence and treat patients with distressing symptoms. These data will guide surgeons when counselling patients to make insightful decisions based on the benefits and risks of the procedure.