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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Introduction: The novel coronavirus (COVID-19) pandemic has necessitated the implementation of public health measures including social distancing, quarantine, and lockdown. Nigerian public universities have been closed since March 2020 after the viral outbreak. This study was carried out in order to investigate the psychological impact of COVID-19 on undergraduate students. Methods: The study was carried out among students of the College of Medicine, University of Ibadan. Study participants were recruited by snowballing sampling technique and data collection was via online self-administered questionnaires. The questionnaire was adapted from the Depression, Anxiety and Stress Scale (DASS-21) and the Revised Impact of Event Scale (IES-R) to determine scores for depression, anxiety, stress and post-traumatic stress disorder (PTSD). Results: There were 322 participants with a median age of 22.4 (IQR = 20.5-24.2) years. Psychological impact was mild to moderate in 20.2%, and severe in 19.6%. Depression was mild to moderate in 19.3%, severe to extremely severe in 5.3%. Anxiety was mild to moderate in 10.3%, severe to extremely severe in 7.5%. Stress was mild to moderate in 16.4%, severe to extremely severe in 2.2%. Factors associated (p < 0.05) with increased levels of depression, anxiety, stress and PTSD include increase in time spent on social media, TV and movies, sleep duration, and decrease in physical activity. Conclusion: The COVID-19 pandemic has resulted in significant changes for Nigerian university students. Two-fifth of them reported PTSD symptoms; one-fourth reported depression; about one-fifth reported anxiety and stress. Students need psychosocial support to help them cope with and to effectively adapt to the changes caused by the pandemic.

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Background: Since the onset of the COVID-19 pandemic, efforts have been aimed at promoting preventive measures towards curtailing the spread of the SARS-CoV-2 virus. The effectiveness of measures put in place by the government are mostly determined by the Knowledge, Attitude, and Practices (KAP) of the citizenry. We sought to determine the KAP of young Nigerian adults towards preventive strategies against COVID-19. Methods: An online survey was prepared using an 18-question questionnaire to assess the KAP of each participant that satisfied predefined criteria. Data obtained were screened for error and analyzed with SPSS version 23. The level of significance was set at p<0.05. Results: A total of 925 valid responses were received with a 96.25% response rate. Females made up 52.4% of the respondents, 62.4% were aged between 21-24, and 88.4% were from South-western Nigeria. The mean knowledge score was 9.02 (SD 1.18) with a maximum possible knowledge score of 13. Most of the participants (91.7%) agreed that COVID-19 will eventually be successfully controlled. Only 31.1% however had been wearing masks when leaving home. The confidence of winning the battle against COVID-19 differed significantly across the ethnic groups (p<0.01). Ages between 15 and 24 were more likely to visit crowded places (p<0.01). Conclusion: This study revealed a good knowledge level and an optimistic attitude towards the control of the COVID-19 pandemic. However, much more work is needed by government and health officials to translate these to better practices towards prevention and control as the fight against the COVID-19 pandemic continues.

<p class="abstract"><strong>Background:</strong> Trauma is one of the commonest causes of death among young people with significant increase in morbidity and mortality. Following injuries to tissues, the body responds in an attempt to cause repair of the damaged tissue. Although its significance depends on the interplay of various factors involving neurohormonal and immune responses. Monocyte chemoattractant protein-1 (MCP-1) is a pro-inflammatory chemoattractant produced by the monocyte and causes the further release of chemokines and cytokines needed at the site of tissue injury. It therefore plays a critical role in tissue healing.</p><p class="abstract"><strong>Methods:</strong> This was a prospective hospital-based study carried out at University College Hospital (UCH), Ibadan. Polytrauma patients admitted through the accident and emergency department that met a defined criteria were recruited and had their blood samples taken into an endotoxin free test tube at 48±2 hours after trauma. MCP-1 levels in the serum were estimated though the human MCP-1 enzyme-linked immunosorbent assay (ELISA) kit. This process was carried out using the ELISA technique based on the producer’s guide.<strong></strong></p><p class="abstract"><strong>Results:</strong> 110 patients were recruited for the study. There was no significant difference in gender variations in MCP-1 level (t=-0.935, p=0.351). For the male and female variations in MCP-1 levels, it ranges from 10 to 2841 and 22 to 2687 respectively. Likewise, there was no significant relationship in age variations in MCP-1 values (f=0.959, p&gt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> This study demonstrated no correlation between serum level of monocyte chemoattractant protein-1 with age and gender in polytraumatized patient according to age and gender.</p>

Traumatic Brain Injuries (TBI) or head injuries are injuries or trauma to the scalp and or brain caused by an outside force, usually a violent blow or collision to the head by accident or deliberate attack. It can also be called be craniocerebral trauma. TBI are examples of acquired, non-degenerative assault to the brain from an external mechanical force, causing impairment of brain functions, with or without alteration to the mental state or consciousness of the victim. This paper provides a synopsis of the epidemiology and patterns of associated injuries in mild and moderate head injuries in literature. Mild and moderate head injuries were selected because they are by far commoner than severe head injuries and the outcomes are widely varied than severe head injuries. Traumatic brain injury is a global and public health problem, which in the coming years, might be the leading cause of death in Africa. High incidence is found among the adolescent and the adult age group and gender-wise, it is common among the males of the same age group. Likewise, the provision of an ambulance system and standard healthcare facilities to manage 18 patients with a traumatic brain injury can not be overemphasized.