Surgical Implications of COVID-19

At present, the world is in the midst of a COVID-19 pandemic. However, the incidence of surgically treated disorders remains the same. In many countries resources, which were otherwise available to surgical patients, have been allocated to COVID-19 patients. Therefore, surgical resources need to be prioritized for the most-needy surgical patients. Surgical and obstetric emergencies need to be attended to without delay. Urgent operations also need to be performed to save life or limb. Semi-elective operations including oncological surgeries need to be performed within 4 weeks, whilst many elective surgeries can be safely delayed. Regional anaesthesia is preferable to general anaesthesia during the epidemic as it carries a lower risk of disease transmission. Strict infection control measures should be adopted in the operating theatre. Although there were initial concerns about the safety of minimal access surgery, recent evidence indicates that it is safe during this epidemic. Lung transplantation has been preformed successfully in a few patients with severe COVID-19 pneumonia but there is insufficient evidence to justify its more widespread use. Most pregnant COVID-19 women who delivered, did so successfully by caesarian section under spinal anaesthesia. Surgical care during this epidemic has to be customized to suit the individual setting

A Large Dengue Epidemic Affects Sri Lanka In 2017

Sri Lanka experienced its largest dengue epidemic in 2017 with 110,372 reported cases and 301 deaths during the first seven months. Several factors including a change in the dengue virus serotype, unusually heavy monsoon rains and failure to control mosquito breeding sites may have contributed to the magnitude of this epidemic. We describe aspects relating to this large dengue epidemic and the control measures taken to combat it

Crohn’s Disease in South Asia

Crohn’s disease (CD) is a highly complex disease of unknown aetiology. We analysed the epidemiology, clinical characteristics, diagnosis, treatment and pathogenesis of Crohn’s disease in South Asia compared to the rest of the world.The PubMed database and Google scholar were searched till March 2016 for articles on CD. Articles dealing with CD in South Asians were reviewed by the authors, critically analyzed and then summarized.There is a lower incidence of CD in South Asia compared to the West and disease characteristics differ. Although novel genetic factors associated with CD have been identified, significant gaps exist in relation to disease pathogenesis, molecular genetic mechanisms and the use of evidence based treatment modalities.Our review provides a comprehensive overview of existing knowledge on CD in South Asia and identifies gaps in knowledge for future research 

Epidemiology, Pathogenesis and Treatment of Ulcerative Colitis in South Asia

Ulcerative colitis (UC) is a chronic inflammatory disorder of the colon and rectum. Its prevalence is on the rise in many non-Western countries and several factors such as changes in lifestyle and improvements in hygiene may account for this. The cultural and ethnic background of South Asia is different from Western countries and other parts of Asia. We have reviewed the scientific literature on UC in South Asia and describe its epidemiology, clinical characteristics, molecular mechanisms, diagnosis and treatment.

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)