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.
Differentiating the injuries exclusively due to falls from a height is difficult if no proper history is provided. Some clinical studies and case reports have been published on the subject, but an autopsy-based approach to the subject is missing in the literature of recent decades. A retrospective study was carried out on 80 cases of fatal falls from a height brought for autopsy. In selected instances police reports, suicide notes, medical records and scene photographs were reviewed. The principal aim was to look for a pattern of skeletal injuries formed as a result of falls from a height. The majority of the victims were male, aged between 20-30 years and labourers by occupation. Most of them fell from a height of 0-10 feet. The head is the most vulnerable structure with fractures of the vertex being common. As the height of falls increases, fractures of the ribs and sternum are also found. Finally, it is concluded that falls on the head are more likely and the most fatal of all. However, it cannot be taken as a sole indicator of the manner of death. Risk assessment should be carried out before any work at a height is undertaken.
Background. The epidemiology of human papilloma virus (HPV) infection and the pattern of HPV genotype distribution are much-needed parameters to assess the risk of cervical cancer among females. However, due to less availability of data on HPV burden and its genotypes from various geographical regions in India makes cervical cancer screening modalities and vaccination strategies difficult to implement. Objective. The present study was conducted to identify the various genotypes particularly high-risk HPV types in premalignant or malignant cervical lesions. Methods. The study was a hospital-based cross-sectional study wherein 295 symptomatic women were screened by Pap smear and multiplex real-time PCR was performed for HPV genotypes identification in women with abnormal cervical cytology. Results. Out of 295 women, 237 (80.3%), 45 (15.3%), and 13 (4.4%) women had normal Pap smear, squamous cell carcinoma and precancerous cytology, respectively. Among these 58 women having abnormal cervical cytology, HPV was detected in 48 (81.0%) participants. Most common HPV genotypes in our study were HPV 16 ( n = 29 ; 60.4%) followed by mixed infections; i.e., more than one type of HPV was detected ( n = 10 , 20.8%). HPV 18 was detected only in 6.25%, whereas other high-risk HPV genotypes were found to be 12.5%. Conclusion. HPV positivity was >80% in women having abnormal Pap smear. The prevalence of HPV 18 was found to be much less in Central India, compared to other parts of country. HPV 16 was the most common genotype followed by mixed HPV genotype infections. It is evident from our study that symptomatic women even if having normal Pap smear should be screened for HPV and followed up with periodic Pap smears for detecting any change in cervical cytology, thus preventing cervical cancer in women.
Objective: To evaluate the diagnostic utility of Typhidot-M and Widal test in the early diagnosis of enteric fever (EF) in terms of sensitivity and specificity. Methods: The study included 270 children in the age group of 1-18 years admitted to the Department of Pediatrics from November 2012 to February 2014, with fever of 5 days or more and with clinical symptoms and signs suggestive of typhoid fever. Detailed history and clinical examination findings were recorded on a standard pro forma. Complete hemogram (hemoglobin, platelet count, and total and differential leukocyte count), Typhidot-M test, Widal tube test, and blood culture weredone on day 1 of admission. For Widal test, a titer of 1 in 160 or more for “O” agglutinins and a titer of 1 in 320 or more for “H” agglutinins were considered as positive results. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Of 270 children included in the study, Salmonella typhi was isolated from 82 samples (30.4%) and the remaining 188 (69.6%) were blood culture negative. Widal test was positive in 107 children (39.6%) and Typhidot-M was positive in 136 (50.4%). The sensitivity was 78%, specificity was 79.3%, PPV was 59.8%, and NPV was 91.4% for Widal test. Typhidot-M test had a sensitivity of 81.7%, specificity of 84.6%, PPV of 69.8%, and NPV of 91.4%. Conclusion: Prompt diagnosisof EF is essential for appropriate management and it is, therefore, important to have a satisfactory test to replace conventional tests used for diagnosis. The present study compares newer test (Typhidot-M) against conventional tests such as Widal test and blood culture, and it appears to be a practical alternative to Widal test in the early detection of EF even in the resource-poor laboratories as it neither requires much laboratory equipment nor laboratory expertise to conduct the test. This test can be done within 7 days of illness, but whenever feasible confirmation with blood culture is strongly recommended, especially with the well-documented presence of multidrug-resistant strains of salmonella typhi worldwide. However, both Widal and Typhidot-M appear to correlate less satisfactorily with blood culture, and thus, there is a need for developing a test which allows accurate and early diagnosis of EF to manage a child effectively and limit its morbidity and mortality.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.