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.
Fifty patients with colonic tuberculosis are reported in whom a colonoscopic diagnosis confirmed by histological examination was possible in 40. Bacteriological studies did not increase the diagnostic yield. Abdominal pain was the most common symptom (90%) and an abdominal mass the most common abnormal physical finding (58%) Results Colonic tuberculosis was diagnosed in 50 patients during this 10 year study period. Sixteen had disease confined to the ileocaecal region, 14 had ileocaecal and contiguous involvement of variable lengths of the ascending colon, 13 had segmental colonic tuberculosis with involvement of the ascending colon in five, transverse colon in six, and descending colon in two. Five had ileocaecal and non-confluent involvement of another part of the colon, and in two the entire colon was affected.Abdominal pain occurred in 90%, weight loss in 74%, anorexia in 60% and fever and diarrhoea in 56% of all patients. None had pulmonary symptoms.A firm, usually tender abdominal mass of variable size (58%), and ascites (10%) were the only abnormal physical findings. The erythrocyte sedimentation rate was raised (>30 mm/h) in 38 of the 50 patients.Chest radiographs showed evidence of healed tuberculosis (fibrosis and/or calcification) in nine patients and active pulmonary tuberculosis (presence of acid fast bacilli in the sputum and/or gastric juice) in seven patients with ileocaecal disease and in both patients with pancolitis. COLONOSCOPYUlcerated areas a few millimetres up to 2 cm long, and a nodular friable mucosa were the most common lesions. These were often present in the same patient. The areas of ulceration were superficial and generally had sharply defined but irregular margins. The ulcer base was not friable and was covered with slough which was difficult to wash away. The surrounding mucosa was nodular and hyperaemic and blended imperceptibly with normal mucosa. In two patients numerous pale, polypoidal mucosal lesions of variable size arising from a slightly hyperemic mucosa were seen, and in one patient a solitary linear ulcer in the caecum was present. When the ileocaecal valve was involved it was oedematous and deformed and usually had areas of superficial ulceration. In the two patients with diffuse involvement of the colon, the mucosa from the rectum to the caecum was hyperaemic and friable 347 on 9 May 2018 by guest. Protected by copyright.
Purpose To characterize seasonal variation in the myopic progression of Chinese children. Methods Myopia progression data are presented for a total of 85 Chinese children, aged 6 to 12 years, with baseline myopia of −0.75 D to −3.50 D sphere and astigmatism ≤−1.50 D, who wore traditional single-vision spectacles in two clinical trials (trial A: n = 37, trial B: n = 48). Refractive error and axial length data were obtained at 6-month intervals using cycloplegic autorefraction and partial coherence interferometry, respectively. Progression rates for right eyes were defined for the first and second 6 months of the studies and classified in terms of “summer,” “autumn,” “winter,” or “spring” based on the mid-point of the 6-month period between visits. Results The mean 6-month spherical equivalent progression was −0.31 ± 0.25 D for summer, −0.40 ± 0.27 D for autumn, −0.53 ± 0.29 D for winter, and −0.42 ± 0.20 D for spring (p < 0.001). Mean axial elongation was 0.17 ± 0.10 mm for summer, 0.24 ± 0.09 mm for autumn, 0.24 ± 0.09 mm for winter, and 0.15 ± 0.08 mm for spring (p < 0.001). Post hoc analysis indicated that data for summer and winter were different from each other at p < 0.05 for both myopia progression and axial elongation after adjusting for age. Conclusions Myopia progression in summer months was approximately 60% of that seen in winter, and axial elongation was likewise significantly less in summer. It is unclear whether more time spent outdoors in summer vs. winter is a contributing factor, or the difference in progression rates is a result of “seasonal” variations in the intensity or amount of close work performed. These results indicate that studies of potential myopia treatment strategies should be at least 12 months in duration to take seasonal variations into account.
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