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.
Background. Soccer players need a very high level of fitness to play and avoid injuries; it reveals that soccer is an extremely challenging game and players has to perform a variety of skills during the play and needs speed, strength, agility, quickness. Objectives. The purpose of this study was to find out the impact of plyometric and resistance training on selected fitness variables among university soccer-playing adults. Methods. A group of (N = 60) soccerplaying adults were selected randomly to participate in this study. The age of the participants was in the range of 18 -24 years, plyometric and resistance-training program was employed for 12 weeks, two days in a week, 40 minutes of training per session. These participants were segregated into two groups namely Group-A (N = 30, plyometric training group), Group -B (N = 30 resistance training group). The pre and post-test considered as follows; Leg strength (leg press), muscular strength endurance (sit-ups test) muscular power (standing long jump), speed (30 M sprint) and agility (Illinois agility test). Results. The improved performances among the participants with regard to the selected fitness variables presented by "p" values and percentages. Plyometric training group: Leg press (p < 0.001), Sit-ups test (p < 0.001), standing long jump (p < 0.001), 30 M Sprinting performance (p < 0.001), and agility (p < 0.001). Resistance training group: Leg press (p < 0.001), Sit-ups test (p < 0.001), standing long jump (p = 0.02), 30 M Sprinting performance (p < 0.001), and agility (p < 0.001). Plyometric and resistance training had shown significant performance from pre to post-test. Conclusion. It was also concluded that the plyometric training group had shown better performance with regard to muscular power and speed. Resistance training group had shown improved performance in leg strength, muscular strength endurance, and agility.
Introduction. Necrosis of the rectum is an uncommon finding due to abundant collateral vasculature. Its management remains challenging, without clear consensus in the literature. Case Report. We describe a case of a 53-year-old woman with multiple medical comorbidities that presented in septic shock and hematochezia. Colonoscopy revealed ischemic colitis. Conservative management was instituted. At two weeks, she presented evidence of peritonitis. Exploratory laparotomy revealed extensive necrosis of the left colon and rectum. Due to dense inflammation, resection was deemed unsafe. Therefore, a transverse ostomy with mucosal fistula was preformed. Multiple drains were left in place. The patient healed uneventfully. Conclusion. This case illustrates that, if extensive dissection of the distal colon and rectum is unsafe due to the patient's critical condition or technical feasibility, then a diverting ostomy of the proximal viable bowel along with a mucus fistula and good drainage of the abdomen represents an acceptable alternative.
Weight training has motivated and attracted the youth to develop their strength and build their muscles. Apart from developing a wholesome personality it also helps in to keep a person fit and healthy. The purpose of the study was to find out the effect of weight training (WT) on sprinting performance, flexibility and strength of the 20 students. A 45 min WT schedule twice a week for 12 weeks was administered. The test considered were strength (1 RM for all the WT components), 50 m run and sit and reach. Speed is one of the variables which is associated with the fitness of the subjects. The analysis of the data reveals a significant (p<0.05) improvement sprinting performance with the mean±SD reading in the pre-test 0.43±0.07 s and in the post-test of 0.41±0.06 s. Flexibility improved (p<0.05) from pre to post test (26.7±9.3) and (31.8±8.4). Squat exercise increased (p<0.05) from pre to post test (75.5±15.1 kg) and (99.5±14.7 kg). The bench press exercise increased (p<0.05) from pre to post test (48.8±24.1) and (65.5±24.3 kg). Barbell front press exercise increased (p<0.05) from pre to post test (24.5±12.7 kg) and (34.4±12.4 kg). High pull downs improved the strength of the lats and back muscles, and the analysis points towards it with from pre to post test (39.5±11.1 kg) and (59.0±10.3 kg; p<0.05). Barbell curls exercise increased (p<0.05) the strength of the biceps muscles from pre to post test (17.3±7.3 kg) and (27.0±7.9 kg). The study has revealed that WT improved strength and also showed some improvement in speed and flexibility.
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