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.

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The prediction of human diseases, particularly COVID-19, is an extremely challenging task not only for medical experts but also for the technologists supporting them in diagnosis and treatment. To deal with the prediction and diagnosis of COVID-19, we propose an Internet of Medical Things-based Smart Monitoring Hierarchical Mamdani Fuzzy Inference System (IoMTSM-HMFIS). The proposed system determines the various factors like fever, cough, complete blood count, respiratory rate, Ct-chest, Erythrocyte sedimentation rate and C-reactive protein, family history, and antibody detection (lgG) that are directly involved in COVID-19. The expert system has two input variables in layer 1, and seven input variables in layer 2. In layer 1, the initial identification for COVID-19 is considered, whereas in layer 2, the different factors involved are studied. Finally, advanced lab tests are conducted to identify the actual current status of the disease. The major focus of this study is to build an IoMT-based smart monitoring system that can be used by anyone exposed to COVID-19; the system would evaluate the user's health condition and inform them if they need consultation with a specialist for quarantining. MATLAB-2019a tool is used to conduct the simulation. The COVID-19 IoMTSM-HMFIS system has an overall accuracy of approximately 83%. Finally, to achieve improved performance, the analysis results of the system were shared with experts of the

Background: To assess awareness levels of Hepatitis B virus infection, transmission, treatment and prevention in medical and nonmedical students of Karachi. Methods: Undergraduate students in 6 medical and non-medical universities were randomly approached to fill out a questionnaire. A sample size of 530 students was collected and data was analyzed using SPSS 20 software and chi square tests for significance. Results: Of the 530 students interviewed, 361(68.1%) and 169(31.9%) were identified as medical and non-medical students respectively. Significantly greater knowledge on modes of transmission were noted in medical students as well as overall levels of awareness of Hepatitis B virus, (p=0.001) and (p=0.003) respectively. Conclusion: Both medical and non-medical students showed a moderate level of awareness of Hepatitis B virus, its modes of transmission, treatment and preventive measures. Medical students showed an overall greater level of awareness.