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.

Background and Objectives: Diagnosis of perinatal asphyxia is mostly establishedretrospectively. But it is difficult to diagnose perinatal asphyxia retrospectively in theabsence of perinatal records. As because of hypoxaemia, different organ systems ofthe body are affected in perinatal asphyxia, this study was done to assess the hepaticfunction for the diagnosis of perinatal asphyxia and to find out any correlation existingbetween hepatic enzyme change and the severity of perinatal asphyxia.Methods: A total of 70 full-term asphyxiated newborns (study group) were studiedduring January 2008 to December 2008 in the department of Paediatrics, MymensinghMedical College Hospital. After enrolment these babies were grouped according toSarnat and Sarnat stages of HIE as stage I, II and III. Another 50 healthy newbornswere also studied as reference group. Venous blood was analyzed between 2nd and5th day of life to estimate serum AST, ALT and alkaline phosphatase (ALP), serumtotal bilirubin (STB), serum total protein (STP), serum albumin and prothrombin time(PT). Unpaired student’s 't' test and Spearman's rank correlation was used for dataanalysis and P value of <0.05 were considered significant.Results: The mean AST, ALT, ALP, STP, S. albumin and TSB of asphyxiated babieswere 76.3±37.4 U/L, 82.2±48.08 U/L, 369.6±123.05 U/L, 55.7±8.8 U/L, 32.6±5.5 g/L& 5.5±2.01mg/dL respectively and those of normal babies were 23.5±8.5 U/L, 26.5±7.8U/L, 208.2±46.9 U/L, 66.3±10.4 g/L, 40.9±6.5 g/L and 4.5±1.2 mg/dl respectively andthese differences were statistically significant (P <0.001). On the other hand nosignificant changes were noted in prothrombin time. The rise of AST, ALT, ALP andPT also showed a significant positive correlation with the severity of asphyxia and thestages of HIE.Conclusion: It is concluded that estimation of hepatic enzymes can be used todiagnose perinatal asphyxia and also to assess its severity.Key words: Alanine aminotransferase; aspartate aminotransferase; newborn; perinatalasphyxia.DOI: 10.3329/bjch.v34i1.5695Bangladesh Journal of Child Health 2010; Vol.34(1): 7-10

No abstract

Objectives: The study was done to find out the relationship between constipation andurinary tract infection (UTI) in children.Methods: The study was a case control study between two groups in a tertiary carechildren hospital in Dhaka city. In group-1 (n=45) those children having history ofconstipation and in group-2 (n=78) as a control group having no history of constipationwere included in this study. Growths of a single species of organism with colony countof >105/ml in a clean-catch midstream single urine sample was considered as evidenceof urinary tract infection.Results: Positive urine culture was found in 8.9% (4/45) cases in children who hadhistory of constipation and 1.3% (1/78) in children who had no history of constipation.Though the number of positive urine culture was seven times more in children withconstipation than those who were not constipated but the difference between the twogroups was not statistically significant (p=0.059) .Conclusion: Culture documented UTI in children with constipation is seven timesmore than without constipation showing impact of constipation on urinary tract infection(UTI) in children.Key words: Urinary tract infection (UTI); constipation.DOI: 10.3329/bjch.v34i1.5697Bangladesh Journal of Child Health 2010; Vol.34(1): 17-20

Objective General: To assess the virucidal efficacy of povidone iodine (PVP-I) on COVID-19 virus located in the nasopharynx Specific: i. To evaluate the efficacy of povidone iodine (PVP-I) to removeCOVID-19 virus located in the nasopharynx ii. To assess the adverse events of PVP-I Trial design This is a single-center, open-label randomized clinical trial with a 7-arm parallel-group design. Participants The study will be conducted at Dhaka Medical College Hospital, Dhaka, Bangladesh. Inclusion criteria All RT-PCR-confirmed COVID-19 cases aged between 15-90 years with symptoms for the past 4 days will be screened. Those who give informed consent, are willing to participate, and accept being randomized to any assigned group will also be considered for final inclusion. Exclusion criteria Patients with known sensitivity to PVP-I aqueous antiseptic solution or any of its listed excipients or previously diagnosed thyroid disease or who had a history of chronic renal failure: stage ≥3 by estimated glomerular filtration rate (eGFR) Modification of Diet in Renal Disease (MDRD) or had acute renal failure (KDIGO ≥stage 2: creatinine ≥2 times from the baseline) or patients who required invasive or noninvasive ventilation or planned within the next 6 hours were considered for exclusion. Moreover, lactating or pregnant women will also be restricted to include here. Intervention and comparator This RCT consist of seven arms: Arm-1 (intervention group): will receive povidone iodine (PVP-I) nasal irrigation (NI) at a concentration of 0.4% Arm-2 (intervention group): will receive PVP-I nasal irrigation at a concentration of 0.5% Arm-3 (intervention group): will receive PVP-I nasal irrigation at a concentration of 0.6%. Arm-4 (intervention group): will receive PVP-I nasal spray (NS) at a concentration of 0.5%. Arm-5 (intervention group): will receive PVP-I nasal spray at a concentration of 0.6%. Arm-6 (placebo comparator group): will receive distilled water through NI Arm-7 (Placebo comparator group): will receive distilled water through NS The intervention arms will be compared to the placebo comparator arms. Other supportive and routine care will be the same in both groups. Main outcomes The primary outcome is the proportion of cases that remain COVID-19 positive following the intervention. It will be assessed from 1 minutes to 15 minutes after the intervention. Any occurrence of adverse effects following the intervention will be documented as a secondary outcome. Randomization The assignment to the study (intervention) or control (comparator) group will be allocated in equal numbers through randomization using random number generation in Microsoft Excel by a statistician who is not involved in the trial. The allocation scheme will be made by an independent statistician using a sealed envelope. The participants will be allocated immediately after the eligibility assessment and consenting procedures. Blinding (masking) This is an open-label clinical trial, and no blinding or masking will be performed. Numbers to be randomized (sample size) A total of 189 confirmed cases of COVID-19 will be randomized into seven groups. In each arm, a total of 27 participants will be recruited. Trial Status The current trial protocol is Version 1.5 from September 10, 2020. Recruitment began September 30, 2020 and is anticipated to be completed, including data analysis by February 28, 2021. Trial registration The trial protocol has been registered in the ClinicalTrials.gov on September 16, 2020. NCT Identifier number: NCT04549376. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting the dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol.

Background: The pandemic of Corona Virus Disease 2019 (COVID-19) has cost a large number of lives and is causing substantial mental stress among people. We conducted a study to identify the sociodemographic and clinical characteristics and prevalence of anxiety and depression among confirmed COVID-19 cases in Bangladesh.Methods: An online cross-sectional survey using a preformed questionnaire adapted in Google form was conducted for data collection. The form was shared along with a brief introduction and rationale via Facebook, Twitter, Facebook Messenger, Viber, and What’s App. Formal ethical clearance was taken from the Biomedical Research Foundation, Bangladesh. Informed consent was ensured before participation.Results: Seventy-four patients with COVID-19 who had an average age of 42.59±14.43 years with male predominance (77%) were included. A total of 29.7% were doing health-care related jobs, and 14.9% lost their jobs due to COVID-19. Patients had a median income of BDT 30000. Of all, 87.8% of patients were symptomatic and presented with fever (77%), cough (58.8%), breathlessness (24.3%), myalgia (24.3%), sore throat (21.6%), fatigue (17.6%), nausea and/or vomiting (12.2%), headache (12.2%), runny nose (9.5%), chest pain (9.5%), diarrhea (8.1%), ARDS (2.7%), stuffy nose (2.7%), conjunctivitis (1.4%) and oral ulcer (1.4%). Overall, the prevalence of anxiety and depression was 60% and 52.9%, respectively. Among the participants, 11.4% had only anxiety, 4.3% had only depression and 48.6% had both.Conclusion: Patients were mostly middle aged, male and healthy workers. Typical presentations were fever and cough. Nearly two-thirds of the patients had either or both anxiety and depression.

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.