SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study

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 (5.4 (95%CI 4.3–6.7)). 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

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

Free Convection Boundary Layer Flow of a Horizontal Circular Cylinder in a Micropolar Fluid with Convective Boundary Conditions

The free convection boundary layer flow over a horizontal circular cylinder has received much attention in recent years due to its application in physical, geophysical, and industrial fields. It appears that [Merkin, 1976] was the first to has presented a complete solution of this problem for a classical(Newtonian) fluid, using Blasius and Gortler series expansion method along with an integral method and finite difference scheme. Following Merkin’s work, [Nazar et al., 2002] studied the similar problem but immersed in a microplar (non-Newtonian) fluid by applying constant wall temperature in the boundary. Therefore, the aim of the present paper is to investigate the free convection boundary layer flow of a horizontal circular cylinder in a micropolar fluid with convective boundary conditions. The transformed boundary layer equations in the form of ordinary differential equations are solved numerically using an implicit finite-difference scheme, namely Keller-box method. Numerical results are obtained for the skin friction coefficient and wall temperature as well as in velocity and temperature profiles

Numerical Solution of The Free Convection Boundry Layer Flow Over a Horizontal Circular Cylinder With Convective Boundry Conditions

Numerical solution for steady free convection boundary layer flow near the lower stagnation point of a horizontal circular cylinder subjected to a convective boundary condition, where heat is supplied to the fluid through a bounding surface with a finite heat capacity are presented in this paper. The governing boundary layer equation are transformed using non-similar variables into non-similar equations and were solved numerically using an implicit finite difference scheme known as Keller-box method. The solution obtained for the skin friction coefficient, the local wall temperature, as well as the velocity and temperature profile with two the variations of two parameters, namely the conjugate parameter y and the Prandtl number P

Radiation effects on MHD flow and heat transfer over a stretching sheet with convective boundary conditions

In this study, the steady magnetohydrodynamic (MHD) boundary layer flow over a stretching sheet with radiation effect under convective boundary conditions, where the heat is supplied to the convecting fluid through a bounding surface with a finite heat capacity, is considered. The governing system of partial differential equations is transformed into ordinary differential equations, which are then solved numerically via the Keller-box method. The effects of the governing parameters on the flow and heat transfer characteristics are analyzed and discussed. It is found that as the Prandtl number Pr and the radiation parameter increase, the temperature profile decreases, while as the magnetic and convective parameters decrease, the temperature profile also decreases

Effect Of Radiation And Magnetohydrodynamic Free Convection Boundary Layer Flow On A Solid Sphere With Newtonian Heating In A Micropolar Fluid

In this paper, the effect of radiation on magnetohydrodynamic free convection boundary layer flow on a solid sphere with Newtonian heating in a micropolar fluid, in which the heat transfer from the surface is proportional to the local surface temperature, is considered. The transformed boundary layer equations in the form of nonlinear partial differential equations are solved numerically using an implicit finite difference scheme known as the Keller-box method. Numerical solutions are obtained for the local wall temperature and the local skin friction coefficient, as well as the velocity, angular velocity and temperature profiles. The features of the flow and heat transfer characteristics for various values of the Prandtl number Pr, micropolar parameter K, magnetic parameter M, radiation parameter N R , the conjugate parameter γ and the coordinate running along the surface of the sphere, x are analyzed and discussed

A rare case of recurrent breast malignant phyllodes tumor with lung, axillary and mediastinal lymph nodes metastasis

Background: Phyllodes tumour (PT) is very rare fibroepithelial tumor of the breast and divided based on the World Health Organization into benign, borderline, and malignant subtypes. The most common type of phyllodes tumor is benign, however malignant phyllodes tumors have important clinical implications, as they are more likely to recur locally and potentially metastasize. The most common sites of distant metastasis include the lung, bone, and liver. Case Presentation: A 34-year-old female presented with right nipple blood discharge with palpable right breast lump. Tru-cut biopsy showed atypical cell and subsequently she underwent right wide local excision and histopathological examination showed malignant phyllodes tumor. She then presented again with recurrent ulcerated right breast lump. Repeated tru-cut biopsy showed atypical cell for which she underwent simple mastectomy with final diagnosis of malignant phyllodes tumor. Two weeks after surgery, she presented with right axillary mass with anterior right chest wall mass. Further evaluation demonstrated that masses over right axillary, right anterior mediastinal and bilateral lungs suggestive of metastasis. Conclusion: We presented a rare case of aggressive malignant phyllodes tumor with recurrent and distant metastasis to bilateral lungs, axillary and mediastinal lymph nodes

Diaphragmatic flap reinforcement in delayed repair of iatrogenic oesophageal perforation

Iatrogenic oesophageal perforation is a life-threatening condition with a high mortality rate especially if diagnosis is delayed. The common causes include medical instrumentation such as endoscopy, and surgical procedures. We presented a case of oesophageal perforation secondary rigid endoscopy in a 40-year-old female. The patient developed left sided pneumothorax one day after the procedure. Perforation at distal oesophagus was subsequently confi rmed after a series of investigations. She underwent surgery through the left thoracoabdominal incision and the perforation was primary sutured in two layers with diaphragmatic fl ap reinforcement

Analysis of diagnosis and treatment interval of breast cancer patients attending Sultan Ahmad Shah Medical Centre @IIUM

Introduction: Breast cancer is an ongoing issue that is plaguing many women worldwide. Early detection of breast cancer improve survival. In Malaysia, there is scanty data available to evaluate the acceptable time interval of diagnosis and treatment. This study aimed to analyze the diagnosis and treatment time interval of breast cancer patients attending SASMEC@IIUM. Materials and Methodss: A total of 87 participants were recruited in this retrospective cross-sectional study, conducted at SASMEC@IIUM, from January 2017 to December 2021. Those with recurrent breast cancer or known to have other cancers were excluded. Patients’ data were collected from clinical records and telephone interviews. Waiting times for presentation, referral, assessment, and initial treatment were documented. Results: From 87 participants, 99 % were female with a mean age of 57 years old (SD+11 years old). Majority were at the later stage of disease with 27% of patient were in stage III cancer and 30% had metastatic disease. The diagnostic interval was 13 days for stage IV, 14 days for stage III, 24.5 days for stage II and 70.5 days for stage I. In contrast, the treatment interval was 32 days for stage IV, 28 days for stage III, 23 days for stage II and 19 days for stage I. Statistically both diagnosis and treatment interval according to cancer staging was p = 0.082 and p = 0.273 which were statistically not significant. Conclusion: Adherent to standard international level treatment interval will provide the best oncological outcome. Our diagnosis and treatment interval were within the acceptable international standard of 28 days interval for diagnosis and treatment of breast cancer patients

Multiple Endoscopic Biopsy Sites increase detection of Helicobacter Pylori infection: a multi-centre study

Background: Helicobacter pylori infection affects almost half of the population and remains clinically significant in chronic gastritis and gastric malignancy. However, its prevalence is found to be low in Pahang, Malaysia population where the practice of single antral biopsy during endoscopy has been advocated. Our aim for this research is to determine the role of multiple gastric biopsy sites during endoscopy (OGDS) to increase the detection of Helicobacter pylori infection. The recommended 5 biopsy sites in the Updated Sydney System in which includes antrum, incisura angularis and body of stomach. Methodology: This is a cross sectional study of 141 patients with clinical diagnosis of gastritis or dyspepsia who underwent OGDS in 2 tertiary hospital in Pahang, Malaysia from January 2016 to December 2016. Five biopsy sites have been obtained and tested with CLO test and send for histology. The positive result for Helicobacter pylori infection by CLO test and/ or histology together with sociodemographic data, endoscopic diagnosis and histology characteristics were recorded and analyzed using IBM SPSS Statistic version 23. Results: Total of 17 patients were diagnosed with Helicobacter pylori infection, making the prevalence of the infection to 12%. No significant difference seen in most of the parameters identified. However, we found out that single antral biopsy can missed the infection rate up to 35%. Conclusion: Multiple biopsy sites during endoscopy can increase detection of Helicobacter pylori infection