Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Differences in clinical features, etiology, types, and risk factors for complications between young and older patients with skin and soft tissue infections [Deri ve yumuşak doku enfeksiyonlu genç ve yaşli hastalar arasinda klinik özellikler, tip, etiyoloi ve komplike edici risk faktörleri açisindan farkliliklar]

Introduction: This study investigated differences in clinical features, types, etiology, and risk factors for complications between young and older patients with skin and soft tissue infections. Futhermore, age-related differences in healthcare-associated and complicated infections were identified. Materials and Method: This retrospective study included 206 skin and soft tissue infection patients hospitalized during an 8-year period. Data were collected using a form: patients’ characteristics, clinical features, laboratory values, prior antibiotic use, causative microorganisms, and antibiotic treatment. For cases with clinically diagnosed, samples were taken from the suspected infection sites. Gram staining, deep swab, deep tissue and blood culture results were evaluated. Results: The incidence of diabetes mellitus was significantly higher among patients aged ?65 years. Among these old patients, Escherichia coli (11/31, 35.5%) and Pseudomonas aeruginosa (8/31, 25.8%) were the most frequently isolated pathogens. Approximately half of the Staphylococcus aureus and Staphylococcus epidermidis strains isolated from patients with health care-associated infection were resistant to methicillin (8/15, 53.3%), and these patients produced higher levels of extended-spectrum beta-lactamase. Venous insufficiency (p=0.008) and prior hospitalization (p=0.001) were identified as risk factors for complication in patients aged ?65. The median time- to -clinical response was 7 days in older patients with non-complicated infection (p=0.007). Conclusion: Diabetes mellitus was the most common co-morbid factor in older patients. Risk factors for complication may differ by age. Gram-negative pathogens were more commonly isolated in older patients. The time- to -clinical response was significantly longer in older patients with non-complicated infection than young patients. © 2018 Geriatrics Society. All rights reserved

Seroprevalence of measles, rubella, mumps and varicella in health care workers [Sağlık personelinde kızamık, kızamıkçık, kabakulak ve suçiçeği seroprevalansının değerlendirilmesi]

Objective: Health care workers are exposed to many infectious agents when compared with general population. Immunization to vaccine-preventable diseases is an important part of infection control among health care workers, both for their own health and against the spread of infections. The aim of this study is to detect the immune status of health care workers of our hospital to measles, mumps, rubella (MMR) and varicella and to define an appropriate vaccination program and also to analyze the cost efficiency of pre-vaccination screening. Methods: This study was conducted at Bülent Ecevit University Hospital between March 2014 and January 2015. The following data were recorded for each participant: age, gender, profession, department, duration of employment, childhood residence location, history of MMR and varicella, and status of vaccinations. The specific IgG antibodies were screened by im-munosorbent enzyme-linked assay. Results: 184 health care workers participated in the study. 61.2% were female, and 38.8% were male. The mean age was 32.43±6.4. The serologic test results revealed that 92.2% of the health care workers were immune to measles, 98.2% were immune to rubella, 94% were immune to mumps and 94.3% were immune to varicella. The validity of the medical history of participants were high for mumps and measles (81.6% and 80.5%, respectively) and low for rubella (43.4%). The positive predictive values for the history of rubella, mumps, varicella and measles were 98.9%, 97.5% and 96.9%, 95.6%, respectively. Cost efficiency analysis showed that the cost of vaccination without screening was more expensive for varicella and MMR (cost difference 18 253 Turkish Lira and 1432 Turkish Lira, respectively) Our findings support that a negative medi-cal history or serological screening before vaccination is cost effective especially for varicella. Conclusions: In conclusion, immune status of health care workers who worked in high-risk departments should be determined by serologic tests and susceptible health care workers must be vaccinated. © 2019, AVES İbrahim KARA. All rights reserved