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.

CONTEXT AND OBJECTIVE: Alcohol consumption during pregnancy is a significant social problem that may be associated with adverse perinatal outcomes. The aim of this study was to describe alcohol consumption during pregnancy and to study its association with low birth weight, newborns small for gestational age and preterm birth. DESIGN AND SETTING: Nested cohort study, in the city of Ribeirão Preto, São Paulo, Brazil. METHODS: 1,370 women and their newborns were evaluated. A standardized questionnaire on health and lifestyle habits was applied to the mothers. Anthropometry was performed on the newborns. Alcohol consumption was defined as low, moderate or high, as defined by the World Health Organization. Adjusted logistic regression analysis was used. RESULTS: 23% of the women consumed alcohol during pregnancy. Consumption mainly occurred in the first trimester (14.8%) and decreased as the pregnancy progressed. The median alcohol intake was 3.89 g (interquartile range, IQR = 8 g) per day. In the unadjusted analysis, alcohol consumption increased the risk of low birth weight almost twofold (odds ratio, OR 1.91; 95% confidence interval, CI: 1.25-2.92). The risk was lower in the adjusted analysis (OR 1.62; 95% CI: 1.03-2.54). Alcohol consumption did not show associations with small for gestational age or preterm birth. There was greater risk of low birth weight and newborns small for gestational age and preterm birth among mothers who were both smokers and drinkers. CONCLUSIONS: The alcohol consumption rate during pregnancy was 23% and was independently associated with low birth weight, but there was no risk of newborns small for gestational age or preterm birth.RESUMO CONTEXTO E OBJETIVO: O consumo de álcool durante a gravidez é um problema social significativo que pode estar associado a resultados perinatais adversos. O objetivo deste estudo foi descrever o consumo de álcool na gestação e avaliar sua associação com recém-nascido de baixo peso, pequeno para idade gestacional e pré-termo. TIPO DE ESTUDO E LOCAL: Estudo de coorte aninhado, na cidade de Ribeirão Preto, São Paulo, Brasil. MÉTODOS: Foram avaliadas 1.370 mulheres e seus recém-nascidos. Foi aplicado às mães um questionário padronizado sobre saúde e hábitos de vida. Antropometria foi realizada nos recém-nascidos. Consumo de álcool foi definido como baixo, moderado e elevado segundo a Organização Mundial de Saúde. Foi utilizada análise de regressão logística ajustada. RESULTADOS: 23% das gestantes consumiram álcool durante a gravidez. A maior parte do consumo ocorreu no primeiro trimestre (14,8%) e diminuiu conforme progredia a gravidez. A mediana de ingestão de álcool foi de 3,89 g (interval interquartil, IIQ = 8 g) por dia. Na análise não ajustada, o consumo de álcool aumentou em quase duas vezes (odds ratio, OR 1,91, intervalo de confiança, IC 95%; 1,25-2,92) o risco de baixo peso, que se reduziu após ajuste (OR 1,62; IC 95%; 1,03-2,54). Não houve associação entre consumo de álcool e pequeno para idade gestacional ou pré-termo. Observou-se maior r...

Introduction: Infection is one of the most feared complications in surgeries with the inclusion of breast implants, associated with the need for new procedures and aesthetic compromise. The agents that are most associated with this conditions are the ones that colonize the skin, such as Staphylococcus aureus and Coagulase-negative staphylococci. Case Report: We described the case of a 25-year old patient, who came to our service after an augmentation mammoplasty performed about 60 days before in a hospital in the countryside. She reported bilateral seroma and extrusion of the right breast implant on the 14th postoperative day, being submitted to antibiotic therapy and a new procedure for site review, with the placement of new implants, bilaterally. When she came to our service, on the 45th day after the exchange of implants, she presented with pain, fever, hyperemia and drainage of the purulent secretion in the operative wounds with extrusion of the implants. In the transoperative period, after the changes were identified, on the 3rd, 4th and 5th costal arches to the right, suggestive of osteomyelitis, associated with partial necrosis of the intercostal muscles and pectoralis minor. The bacteriological test of the periprosthetic secretion was bilaterally positive for mycobacteruim abscessus, and the anatomopathological study of the right costal arch biopsy was compatible with chronic osteomyelitis. The patient presented favorable clinical evolution after the removal of the implants and antibiotic therapy. Discussion: Mycobacteria are opportunistic organisms, which hardly cause diseases in human beings. Despite being uncommon, the infection of breast implants by mycobacteria can be associated with the contamination of surgical instruments and immunosuppression of the host. The infection can be similar to those caused by more common agents. In many cases, it presents with the later onset of symptoms. Prophylaxis and antisepsis, including special care regarding the protocols of sterilization of surgical instruments, are still the main factors associated with the impact of this type of complication in surgeries with breast implants.

Introduction: The desmoid breast tumor was first described in 1832, by Mac Farianec. It originates in the parenchyma or in the thoracic wall muscles. In the presence of a breast implant, the origin can be related to the fibrous capsule. Primary breast fibromatosis is rare, less than 0.2% of the lesions. It is more common among women at reproductive age, with slow and progressive growth. It tends to be locally aggressive and present recurrence after resection, without metastatic potential. In imaging examinations, they simulate carcinomas. Case report: A 65-year old male patient complaining of palpable nodule in the left breast, with no family history of breast cancer or inherited genetic syndromes. Imaging examinations showed an irregular nodule, with spiculated margins, high density and posterior acoustic shadowing, measuring 1.4 cm (BI-RADS® 5). Percutaneous biopsy of the lesion favored desmoid-type fibromatosis. After sectorectomy, anatomopathological and immunohistochemical examinations confirmed the diagnosis. Discussion: The etiology and physiopathology of these lesions are still not totally known, and it is uncertain whether or not they are part of the abdominal and extra-abdominal fibromatosis spectrum. There are differences in the hormone receptor profile and recurrence rate. Cell proliferation occurs after trauma, hormone stimulation or genetic determination. It can rarely be associated with Gardner’s syndrome or familial multicenter fibromatosis. The treatment consists of surgical excision of the lesion, and radiotherapy can be used in extensive or unresectable tumors. The use of hormone, cytotoxic or anti-inflammatory agents is considered, according to etiology. Tamoxifen can be efficient in negative hormone receptors through the synthetic induction of transforming growth factor beta 1 (TGF b1) through fibroblasts and apoptosis. The highest local recurrence rate occurs in 3 years, when quarterly surveillance is recommended.