Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Clinical and autopsy parameters of acute medical deaths in an emergency facility in South-west Nigeria

Background: Acute medical deaths are usually consequences of acute critical diseases, or acute exacerbations of chronic diseases. Thus, autopsy - confirmed characteristics would provide support for future management strategies. Objectives: To examine clinical and autopsy parameters including causes of death (COD) and mechanisms of death (MOD) among acute medical deaths. Methods: A 5-year (2005-2009) retrospective analysis was undertaken of Emergency Department (ED) related medical deaths occurring <24 hours after presentation. Case-notes provided clinical details while autopsy records supplied the COD and MOD respectively. Results: Decedents were 250 males (58.5%) and 177 females (41.5%), (male: female ratio=1.4: 1), predominantly (78%) young; with mean age of 43.7±16.6 years. In 22.8%, symptom duration was <1 day but >4 days in 42.8%. Coma -36%, and dyspnoea -10% prompted early presentation; but late presentation (>4days) characterised cough (4%), fever (10%), and body swelling (19%). Of the total, 23% presented after 10 pm, 16% were "dead on arrival" (DOA), and 40% died within six hours of arrival. Three commonest CODs were circulatory-cardiovascular disease [CVD](36%), infections/septicaemia (18%), and malignancies (8.4%). CVD subset was older (52 years), with significant male preponderance (62.5% vs 37.5%; p<0.05); but comparable mean age in both sexes. Common MODs were cerebral dysfunction (29%) - including sub-types of intra-cerebral haemorrhage (51.8%) and tonsillar herniation (33.3%), heart failure (19%), and septicaemia (15%). Conclusion: The highlights were late presentation, early demise from communicable and noncommunicable diseases; and common "exit" mechanisms of septicaemia, heart failure and cerebral dysfunction. These data will guide management and preventive strategies

Advanced carcinoma of the rectum with 5-year survival and complete tumour clearance follwing radiotherapy and 5-fluoro uracil therapy - a case report

No Abstract. NQJHM Vol. 8 (4) 1998: pp. 267-26

Screening for Preneoplastic Cervical Lesions: A Comparison of Visual Inspection with Acetic Acid, Liquid-based Cytology and HPV-DNA Testing

Background: Cervical cancer is the third most common malignancy and fourth leading cause of cancer death among women.&nbsp; Persistent infection with high-risk human papillomavirus (hrHPV) particularly HPV-16 and -18 is a necessary prerequite for the development of invasive carcinoma of the cervix.Objective: To screen for cervical preneoplastic lesions among female staff of our University using Visual Inspection with Acetic acid (VIA), Liquid-Based Cytology (LBC) and Human Papillomavirus DNA testing and to compare the detection rates of the screening methods.Methods: Following informed consent, VIA, LBC smear and HPV samples were collected. Individuals with abnormal result from any of the 3 screening modalities were recalled for colposcopy (± biopsy).Results: Out of the 208 screened, 9 (4.3%) were VIA positive and 13 (6.3%) had abnormal smear. The HPV DNA testing showed 15 (7.2%) were high-risk positive, and 3 (1.4%) were high- and low-risk positive. High-risk HPV type 18 was the commonest followed by types 52 and 58, and then type 31. All theVIApositive cases had normal LBC smear result and were negative for Hr-HPV DNA. Of the13 (6.3%) cases with LBC smear abnormality, 4 were Hr-HPV positive but all were VIA negative. Amongst the 4 cases with LBC and HPVabnormality, 2 of them (both HSIL and Hr-HPV positive) had colposcopically directed biopsy confirmed at histology as CIN 3. There was&nbsp; no significant correlation between VIA and HPV (p = 0.874) while LBC and HPV showed statistically significant correlation (p &lt; 0.001)Conclusion: VIA positivity rate was 4.3%, LBC 6.3% and HPV 8.6%. Confirmatory diagnostic test via colposcopically directed biopsy was possible in 2 out of the 34 women that were recalled for follow-up. Keywords: Cervical cancer, cytology, high-risk, precancerous, screening

Overexpression of p53 in Nigerian breast cancers and its relationship with tumour grade and oestrogen /progesterone expressions

Background: Mutation of the tumour suppressor gene, p53, is implicated in most cancers. This gene has also been associated with high tumour grade in breast cancers. African women are known to generally have high grade tumours. This study sought to determine the expression of p53 protein as well as the relationship with oestrogen receptor (ER) and progesterone receptor (PR) proteins.Methodology: Formalin-fixed, paraffin-embedded tissue samples of diagnosed invasive breast cancer were obtained from the Department of Anatomic and Molecular Pathology, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, Nigeria between 2002 and 2005. The clinical details of the patients were obtained from the histological request forms. Immunohistochemical studies were carried out in the Department of Histopathology, Royal Cornwall Hospital, Truro, United Kingdom with the automated Vision Biosystems Bond-Max Machines. The statistical analysis was done with SPSS version 12.Results: Overexpression of p53 is seen in (86/116) 73.1% in Nigerian breast cancers and 89.6% of these cancers were of higher grade. The study also showed that (27/35)77.1% of ER positive patients also showed p53 overexpression (p=0.592). We also found that (64/93) 68.8% of PR negative patients overexpressed p53 while (21/23) 91.3% of PR positive cases overexpressed p53 (p=0.036).Conclusion: Most Nigerian breast cancer cases were of high grade and showed p53 overexpression. We found no significant relationship between p53 overexpression and ER status but, there was a significant relationship between PR status and p53 overexpression. Further studies are advocated to determine the prognostic value of p53 in Nigerian breast cancer cases.Keywords: High grade, immunohistochemistry, low grade, tumour suppressor gene, well differentiate