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.

More than 80% of the patients were operated on because of complicated gallstone disease. Although the outcomes of patients undergoing semielective cholecystectomy were similar to those of patients treated as outpatients, patients operated with acute cholecystitis presented extremely high morbidity and mortality rates. Thus, we can only recommend that early elective cholecystectomy be performed in elderly patients as soon as they are found to have symptomatic gallstones. Also, further trials are required to elucidate the optimal management of acute cholecystitis in elderly patients.

Results suggest that cytology could be used to diagnose anal cancer precursors.

As estimativas mundiais indicam que 20% dos indivíduos sadios estão contaminados com papilomavirus humano (HPV).1 A maior parte das infecções é assintomática 2 , e o principal ônus dessa infecção é o câncer cervical. Estima-se, ainda, que surjam 500.000 casos novos por ano, dos quais 70% ocorrem em países em desenvolvimento, 1 e que está associado a 90% dos carcinomas espinocelulares (CEC) anais.3,4 Além disso, acredita-se que tenha provocado 260 mil mortes ao redor do mundo, em 2005, 2 sendo a causa mais comum da letalidade por câncer em países em desenvolvimento.2,5 Também, imagina-se haver entre 10 a 20 lesões precursoras para cada um desses tumores, o que confirma haver contingente muito grande de indivíduos afetados pelo HPV.1 Essas condições fazem dessa infecção um problema de saúde pública mundial, tornando obrigatória a sua prevenção.A contaminação só pode ser efetivamente evitada com abstinência sexual completa para todas as práticas sexuais, porque os preservativos não garantem proteção total e o HPV pode ser transmitido mesmo por atividades sexuais sem penetração.6 É relatado que os métodos atuais de prevenção, uso de preservativos e os métodos de rastreamento, venham diminuindo a incidência do câncer genital e que mais de 90% das lesões detectadas no colo uterino são removidas ao longo de dois anos. Entretanto, é necessário conter de forma na eficaz o alastramento da infecção pelo HPV e das suas seqüelas, incluindo as verrugas anogenitais e o câncer genital e seus precursores, e a imunização preventiva oferece essa oportunidade.7 As vacinas contra o HPV atualmente disponíveis cobrem os sorotipos 16 e 18 e, no caso da quadrivalente, também os 6 e 11. 2,3,8 Esses tipos são responsáveis por 90% das verrugas, por 70% dos carcinomas e lesões pré-cancerosas de alto grau, e 35-50% das lesões anogenitais de baixo grau.9 São elaboradas a partir das cápsulas protéicas vazias produzidas por tecnologia

Laparoscopic cholecystectomy in octogenarians appears to be safe with acceptable morbidity.

In Group A, 39 patients had anal canal condylomas and the cytology was positive in 29 of them (74.3%). We also observed cytological alterations in 30 of 75 patients (40%) without clinical lesions in the anal canal. In Group B, there were 54 patients with condylomas and 13 of them (24.1%) were confirmed by cytology. In 40 patients with no clinical lesions, we observed that nine (22.5%) had cytological abnormalities Statistical analysis revealed that examination in Group A was more efficient. CONCLUSION. Specimens collected by inserting the brush deeper into the anal canal improved the efficiency of anal Pap smears.

the eradication of clinical lesions failed to locally control HPV infection.