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.

In the Pandemic of COVID-19, the Whole world is severely affected in many areas, including the health sector. Ayurveda being a holistic science also explains similar condition thousand years back with their aetiology, sign and symptoms and effective management. Such communicable diseases are described under headings such as Janapadodhwansa, Aupasargicvyadhi etc. with their effective management such as Rejuvenation (Rasayana) therapy, Panchakarma procedures, following codes of right conducts (SadvritaaPalan, AacharRasayana). Till date, there is no established protocol for the management of COVID- 19 like disorders, the only option left with us is a preventive aspect, and that is the first aim of Ayurveda. To make body and mind healthy and capable of fighting against any disease, is possible by following principles of Ayurveda. AacharaRasayana is advised for the same purpose, which is a code of conduct aimed in providing excellent mental, physical, social and spiritual health without having any medicine. Due to the change in lifestyle and not following the codes of conduct, we are becoming more prone to various diseases. Therefore, it must be implemented in the community to obtain the full span of life without disease. This article explains the Ayurvedic view ofAacharRasayana as a Preventive aspect in COVID- 19 like diseases.

Aims and Objective: The present study was carried out with an objective to compare 4% succinylated gelatin with 6% hydroxyethyl starch 130/0.4 for preloading prior to cardiopulmonary bypass in coronary artery bypass grafting patients with respect to haemodynamics status, blood loss, transfusion requirement, ICU stay and complication. Methods: The study enrolling 60 patients of either sex, aged between 30-70 years undergoing elective coronary artery bypass grafting. These patients were randomly divided into two groups of 30 each. Group 1 received 500 ml 6% hydroxyethyl starch (HES) and group 2 received 500 ml 4% succinylated gelatins, on pump over a period of 25 minutes. Data were monitored included haemodynamic changes, postoperative blood loss, transfusion of PRBC and blood products, ICU stay and complications related to colloid usage. Results: We found statistically significant difference in pulse rate 5 minutes after starting colloid. Also found statistically significant difference in mean arterial pressure immediately after shifting patient to ICU but no significant difference found subsequently. There was gradual increase in CVP in both the groups but majority of patients in group 2 showed higher CVP values as compared to group 1 patients. Measured chest tube drain and output higher in starch group as compared to gelatin group, there was no need of reexploration or greater need for blood and blood products in starch group. There was no significant difference in postoperative renal parameter between two groups. Conclusions: Results of our study revealed that both the colloids i.e. 4% succinylated gelatin and 6% hydroxyethyl starch were comparable with respect to haemodynamics parameters, blood loss, transfusion requirement and complication.

Rasayana is one of the unique branches of Ayurveda & it is suggested to increase ojas. Modern scientific observation’s on Rasayana shows that rejuvenating drugs can protect the body against detrimental effects of the atmosphere in which we survive, by augmenting the individual’s capability to fight against disease-carrying organism through stimulating the immune system. The Rasayana therapy improves the merits of rasa, build up to it with nutrients so one can attain prolonged existence, memories, intellect, freedom from diseases, quality in lustre, complexion and voice, optimal improvement of physique and all sense organs. Rasayana is very useful to increase the immunity of the person to keep him away from disease. Rasayana herbs have antioxidant properties which prevent the damage caused by free radicals. According to Ayurveda, Rasayana brings about proper nourishment, growth &enhanced function of all sevens dhatus (tissues). Rejuvenation therapy affects body &mind at the same time it checks the effect of early ageing on both, and enhance the body’s resistance to disease. Considering the grave situation of COVID -19 where effective medicine is yet to be invented, one should develop a healthy immune system for survival. Rasayana drugs provide nutritional supplementation along with enhancing immunity to fight against viral infections such as COVID -19.