Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

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 ). 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.

IntrOductIOnThe distal articulating surface of the ulna and radius should be at the same level for optimal function of the radio-carpal, intercarpal and carpo-metacarpal joint complex [1].Minor modifications in the inferior radio-ulno-carpal complex leads to significant load changes which may result in various pain syndromes [1]. The length of ulna as compared to that of the radius is not constant among individuals during a lifetime [1]. This variation of level of distal articulating surface of ulna with respect to distal articulating surface of radius is known as ulnar variance (UV). It is determined by age, genetics, loading, wrist and elbow pathology [2].UV affects the forces' distribution across the wrist, and for this reason it can be an important feature of wrist disorders or wrist pathology, since the percentage of load transmitted through the distal epiphysis of the radius increases with a shorter ulna. The load sharing between radius and ulna in a person with neutral UV is in the ratio of 80:20, which would change significantly with the increase or decrease in values of UV [3]. A negative UV or a short ulna has been shown to have a causative influence in the occurrence of avascular necrosis of the scaphoid, lunate and scapho-lunate dissociations [4][5][6].A positive UV, on the other hand, predisposes the wrist to triangular fibrocartilaginous cartilage complex (TFCC) injury [7] and cartilaginous wear of the carpal bones (ulnar impaction syndrome) [8] as well as early degenerative arthritis of the wrist [9].Measurement of UV requires standardized technique of radiography and a reliable and reproducible method of measurement. Many measurement techniques have been described including method of perpendiculars, concentric circles method and project a line technique [10]. On reviewing the literature it was observed that there is paucity of data on UV and its implications on wrist pathologies in Indian subjects. AIM OF tHE StudYThe current study has been initiated as a pilot project for evaluation of UV in a regional subset of Indian population. This study has also tried to compare two techniques of measurement of UV viz. method of perpendiculars and modification of the concentric circles method. MAtErIALS And MEtHOdSEthical approval was sought from Institutional Ethics Committee. The period of the current study was from 1 st May 2014 to 30 th September 2014. Thirty patients attending the Orthopaedic outpatient clinics, seeking consultation for Orthopaedic ailments related to the elbow, forearm, wrist and hand were included in the study. Informed consent was taken from all subjects.Adult subjects of either gender aged 18 and above attending the Orthopaedic outpatient clinics with complaints related to the elbow, forearm, wrist and hand and apparently normal wrists were included in the study. Subjects less than 18 years of age, with history of any pathology in the wrist for which he/she was actively taking treatment or had undergone medical or surgical treatment in the past 6 months and those with metabolic bo...

Segmentation is often performed on medical images for identifying diseases in clinical evaluation. Hence it has become one of the major research areas. Conventional image segmentation techniques are unable to provide satisfactory segmentation results for medical images as they contain irregularities. They need to be pre-processed before segmentation. In order to obtain the most suitable method for medical image segmentation, we propose MIST (Medical Image Segmentation Tool), a two stage algorithm. The first stage automatically generates a binary marker image of the region of interest using mathematical morphology. This marker serves as the mask image for the second stage which uses GrabCut to yield an efficient segmented result. The obtained result can be further refined by user interaction, which can be done using the proposed Graphical User Interface (GUI). Experimental results show that the proposed method is accurate and provides satisfactory segmentation results with minimum user interaction on medical as well as natural images.