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.
To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.
Este estudo teve como objetivo analisar a interação e network de sequências ofensivas coletivas que resultaram em finalização de uma Seleção de Futebol de Sub-20. A amostra consistiu na análise de 76 ações ofensivas que foram transformadas em golo. Foi realizada uma análise quantitativa e qualitativa das ações de jogo através do software VideObserver ®. As networks de interação entre jogadores foram obtidas através do mesmo programa. As métricas de centralidade foram calculadas através do software Social Network Visualizer ®. Os resultados indicaram que as ações ofensivas que terminaram em finalização ocorreram em sequências de passe mais curtas e emergiram com um maior número de finalizações e golos. Por seu lado, o maior nível de interação ocorreu entre o jogador 9 (avançado) e o jogador 18 (extremo direito). Concluiu-se que as interações que emergiram durante as ações ofensivas que resultaram em golo foram originadas, maioritariamente, pelos médios, extremos e avançados, ocorrendo, sobretudo, no setor ofensivo. Neste sentido, o jogador 7 (médio centro) foi considerado o jogador-chave na circulação e desenvolvimento das ações ofensivas que resultaram em finalização da equipa, assumindo um papel preponderante na dinâmica coletiva da equipa.
Resumo: Este artigo aborda a manifestação do queer e da aids na exposição Queermuseu: Cartografias da diferença na arte brasileira. Com curadoria de Gaudêncio Fidelis, a mostra, inaugurada e censurada no ano de 2017, é contextualizada a partir de seu encerramento prematuro e também das críticas que recebeu por sua abordagem frágil da diferença. A partir das considerações de autores como David Getsy (2016), Douglas Crimp (2004), Guacira Louro (2001) e Larissa Pelúcio (2014), a relação entre o queer e a enfermidade foi investigada nos textos do catálogo da Mostra, utilizando como método a análise de conteúdo. Tal estudo permitiu perceber que a abordagem do tema na exposição foi superficial, sem apresentar um debate teórico satisfatório ou mesmo um conceito sólido sobre o queer, sendo um dos principais indícios dessa fragilidade a ignorância sobre a sua relação com a crise da aids.
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