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

A Comparative Pharmacognostic Evaluation of Different Extracts of Shorea robusta Gaertn. f. Resin

Shorea robusta (Shal) is an important traditional Indian medicinal plant used in various ailments and rituals. The use of different parts of this plant like leaves and resin as a medicament for treatment of various conditions is well documented in literature. However, the studies on phytochemical constituents and medicinal properties in the resin of this plant are scanty. All three samples carried out microscopic characters, ash values, extractive values, T.L.C., and chemical tests. The extractability of methanol, ethanol and chloroform extracts of Shorea robusta were found to be 44.85%, 48.57% and 4.48% respectively. Phytochemical analysis of the extracts of Shorea robusta revealed the presence of alkaloids, flavonoids, triterpenoids and amino acids. The presence of alkaloids and triterpenoids were confirmed by qualitative tests followed by TLC.Key Words: Shorea robusta, phytochemical analysis, triterpenoids, flavonoids.</jats:p

In-vitro Antioxidant and Antibacterial Activity of Methanolic Extract of Shorea robusta Gaertn. F. Resin

The methanolic extract of the resin of Shorea robusta was subjected to investigate its antioxidant and antibacterial properties its utility in free radical mediated diseases including diabetic, cardiovascular, cancer etc. The methanol extract of the resin was tested for antioxidant activity using scavenging activity of DPPH (1,1-diphenyl-2-picrylhydrazil) radical method, reducing power by FeCl3 and antibacterial activity against gram positive and gram negative bacteria using disc diffusion method. The phytochemical screening considered the presence of triterpenoids, tannins and flavoniods. Overall, the plant extract is a source of natural antioxidants which might be helpful in preventing the progress of various oxidative stress mediated diseases including aging. The half inhibition concentration (IC50) of resin extract of Shorea robusta and ascorbic acid were 35.60 µg/ml and 31.91 µg/ml respectively. The resin extract exhibit a significant dose dependent inhibition of DPPH activity. Antibacterial activity was observed against gram positive and gram negative bacteria in dose dependent manner.Key Words: Shorea robusta, antioxidant, antibacterial, Disc-diffusion, DPPH.</jats:p

The missing eyeball-CT evaluation (a case report)

A case of blow out fracture of the medial wall and floor of the orbit with herniation of the eyeball into the ethmoid sinus diagnosed on CT scan is reported. To the best of our knowledge there is no previous report of prolapse of eyeball into the ethmoid sinus

GC-MS Analysis of Phytocomponents in the Various Extracts of Shorea robusta Gaertn F.

The current investigation was carried out to determine the possible phytocomponents present in the different extracts of Shorea robusta using gas chromatography-mass spectrometry (GC-MS). The dried powdered resin of Shorea robusta was extracted exhaustively by Soxhlet apparatus with different solvents such as methanol, ethanol and chloroform. The prepared extracts were analyzed by GC-MS to identify and characterize the phytocomponents present in the crude extracts. Qualitative determination of different phytocomponents from crude extracts of Shorea robusta using GC-MS revealed different types of high and low molecular weight phytoconstituents with varying quantities present in each of the extracts. The GC-MS analysis provided a variety of peaks determining the presence of different compounds in various extracts of Shorea robusta namely Caryophyllene (1.50%), Caryophylline oxide (6.65%), Ledene oxide (11.17%), Calarene epoxide (5.15%), Alloaromadendrene oxide-(1) (8.72%), Beta-amyrin (7.99%), Alpha-amyrin (1.40%), Cycloisolongifolene (2.54%), Isolongifolene (4.73%), Silane (2.64%). The three extracts possess major phytoconstituents that were identified and characterized spectroscopically. The abundance of phytoconstituents was found to decrease in the order: methanol extract&gt;ethanol extract&gt;chloroform extract.</jats:p

Imaging spectrum of pediatric orbital pathology: A pictorial review

A wide spectrum of pediatric orbital disorders can occur in the pediatric age group. Cross-sectional imaging plays an important role in the diagnosis and management of these patients. We reviewed our imaging record and collected representative cases of pediatric orbital pathology. The purpose of this pictorial essay is to illustrate the imaging features of various orbital lesions encountered in children.<b> </b