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.
BackgroundThe prevalence of fetal macrosomia varies worldwide. Its trend has increased over the past decades in many developed nations. It is associated with various maternal and fetal complications. The information regarding the frequency of fetal macrosomia among non-diabetic women is limited in resource-limited countries such as Pakistan. Therefore, this study aimed to determine the number of fetal macrosomia cases among nondiabetic women. MethodologyThis was a cross-sectional study conducted in a tertiary care hospital in Peshawar, Pakistan. A total of 119 pregnant women were enrolled in the study. All pregnant women aged 15 to 45 years who had singleton pregnancies with any parity or gravida and a gestational age of ≥37 weeks were included in the study. Pregnant women with underlying chronic systemic disorders such as diabetes mellitus, gestational diabetes mellitus, hypertension, renal or cardiac disorders, and sickle cell anemia were excluded from the study. Women who did not consent to participate and those with a gestational age of ≥42 weeks at the time of delivery were also excluded from our study. Based on a 5.2% prevalence of fetal macrosomia in the general population, the sample size was calculated using the World Health Organization calculator at a confidence interval of 95%, absolute precision of 0.05 with anticipated population proportion, and a 4% margin of error. The required sample size was calculated at 119. The chi-square test was applied. P-values of ≤0.05 were considered significant. ResultsOut of 119 participants, fetal macrosomia among non-diabetic women was seen in 10 (8.4%) cases. The mean age of patients in our study was 29.80 ± 4.33 years. The mean gestational age was 36.05 ± 1.31 weeks, whereas the mean body mass index of participants was 29.17 ± 2.36 kg/m 2 . Post-stratification, spontaneous vaginal delivery was the only significant variable with a P-value of <0.05 in our study. ConclusionsThe number of fetal macrosomia among non-diabetic women in our study was 10 (8.4%). Because this was a single-center, hospital-based, cross-sectional study, we need to conduct large multi-centered randomized controlled studies to identify the actual prevalence of fetal macrosomia in non-diabetic women in our population.
Purpose: To determine the psychological impact and perception of covid -19 pandemic on pregnant women presenting to a tertiary care hospital, KPK, Pakistan. Methodology: An observational cross-sectional study was conducted on pregnant women in the outpatient department of Lady Reading Hospital, Peshawar from 1st February 2020 to 31st March 2021. All pregnant women (n=424) visiting gynae OPD who fulfilled the inclusion/exclusion criteria were included. The questionnaire was filled out by physicians for patients and the Kessel-10 scale was used to classify the anxiety. Findings: Fifty one 51% females fall in the 19-25 years age group. 54.5% were illiterate with most of the women (94.6%) being housewives. The majority of the 424 women in the study were multiparous (59%) and 59.1% presented in their third trimester. The highest number of patient women in the age group 19-25 years suffered mild distress. Moderate stress was found in 54 women. In all age groups, a total of 11 patients suffered severe psychological distress. 144 women reported having no stress. Nulliparous women were 109 in total and most of them had either mild disorder (n=54) or no stress at all (n=48). the majority of ladies who were housewives stated that they have been mildly stressed (n=208) or not stressed at all (n=139). A total of 11 women had faced severe stress. 247 women had third-trimester pregnancies and most of them (n=129) had mild stress. Severe distress affected 8 of the third-trimester women and 3 of the 2nd-trimester women. Most women (71.9%) believed that elective Cesarian surgery is not better than vaginal delivery during the covid -19 pandemic. COVID-19 pandemic has created anxiety in more than half (53%) of pregnant women visiting OPDs. The literacy rate and occupational status of women had little effect on the occurrence of psychological distress. Recommendations: Strict SOPs must be observed in hospitals and pregnant women should receive counseling regarding their fears and anxiety from medical care-takers. More studies are needed to measure mental health challenges in pregnant and postpartum women, as well as the resilience and risk factors associated with beneficial outcomes, to attenuate the pandemics' long-term mental health impacts.
Aims: We aim to present our experience of repair of genitourinary fistulae by abdominal approach with special emphases on repairs of high fistula. Methods: This study includes all the patients from January 2016 to December 2017 who underwent abdominal repair of VVF. The patient who had vaginal repair of VVF were excluded. Results: Forty cases were included in the study. Mean age was ( 20-50) 34.8 years with parity ranging from 2-8, Out of 40 cases 13( 32.5 %) were vesico cervical, 5(12.5%) were vesico uterine and 22 (55.00%) were vault fistula. So these all were high fistula involving uterus, cervix and vault, resulting after caesarean section, caesarean hysterectomy and Gynecological hysterectomy. All had abdominal repair which was successful in 39 cases giving success rate of (97.5%). Conclusions: An abdominal approach seems to give superior results especially for high fistulae.
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